Nerve conduction velocity and cross-sectional area in ulnar neuropathy at the elbow

IntroductionDistal sensorimotor polyneuropathy (DSPN) is common in people with diabetes but is also found in pre-diabetes. Peripheral nerve myelin damage, which can be assessed by reduced nerve conduction velocity (NCV), is an essential feature of DSPN. Emerging evidence indicates that the development of DSPN may involve the activation of the immune system. However, available studies have mainly investigated circulating immune mediators, whereas the role of immune cells remains unclear. Therefore, we aimed to test whether leukocyte subsets are associated with NCV.Research design and methodsThis cross-sectional study analyzed data from 850 individuals (of whom 252 and 118 had type 2 diabetes and pre-diabetes, respectively) of the Maastricht Study. NCV was measured in the peroneal and tibial motor nerves and the sural sensory nerve and summed to calculate a standardized NCV sum score. Associations between percentages of leukocyte subsets and NCV sum scores were estimated using linear regression models adjusted for demographic, lifestyle, metabolic and clinical covariates.ResultsAfter adjustment for covariates, higher percentages of basophils and CD4+ T cells were associated with lower NCV (p=0.014 and p=0.005, respectively). The percentage of CD8+ T cells was positively associated with NCV (p=0.022). These associations were not modified by glucose metabolism status (all pinteraction >0.05). No associations were found for monocytes, eosinophils, neutrophils, lymphocytes, total T cells, Treg cells and B cells.ConclusionsThe associations of basophils, CD4+ and CD8+ T cells with NCV suggest that cell types from both innate and adaptive immunity may be implicated in the development of DSPN.

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Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy

British Journal of Radiology ◽

10.1259/bjr.20210290 ◽

2021 ◽

pp. 20210290

Author(s):

Ankita Aggarwal ◽

Chandan Jyoti Das ◽

Neena Khanna ◽

Raju Sharma ◽

Deep Narayan Srivastava ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Neuropathy ◽

Ulnar Nerve ◽

Diffusion Tensor ◽

Cross Sectional Area ◽

Ulnar Neuropathy ◽

Control Group ◽

Sectional Area ◽

Cross Sectional

Objective: Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. Methods: This was a case–control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. Results: Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 −3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 −3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 −3 mm2/s respectively. Conclusion: DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. Advances in knowledge: 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol. 2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value. 3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 −3 mm2/s respectively.

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Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at the elbow, and carpal tunnel syndrome

Muscle & Nerve ◽

10.1002/mus.20345 ◽

2005 ◽

Vol 32 (3) ◽

pp. 360-363 ◽

Cited By ~ 41

Author(s):

Mark E. Landau ◽

Kristen C. Barner ◽

William W. Campbell

Keyword(s):

Body Mass Index ◽

Carpal Tunnel Syndrome ◽

Ulnar Nerve ◽

Body Mass ◽

Conduction Velocity ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Ulnar Neuropathy ◽

Tunnel Syndrome

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A prospective study examining the sensitivity of ultrasound determined median nerve cross-sectional area with nerve conduction investigation in the diagnosis of carpal tunnel syndrome

International Musculoskeletal Medicine ◽

10.1179/1753615415y.0000000006 ◽

2015 ◽

Vol 37 (3) ◽

pp. 93-100 ◽

Cited By ~ 1

Author(s):

Tamim Khanbhai ◽

Beena Hameed ◽

Peter Resteghini

Keyword(s):

Carpal Tunnel Syndrome ◽

Prospective Study ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Tunnel Syndrome ◽

A Prospective Study

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Comparing the Diagnostic Accuracy of Simple Tests to Screen for Diabetic Peripheral Neuropathy: Protocol for a Cross-Sectional Study (Preprint)

10.2196/preprints.7438 ◽

2017 ◽

Author(s):

Kate Goddard ◽

Prashanth Vas ◽

Alistair Purves ◽

Viktoria McMillan ◽

Thomas Langford ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Diagnostic Accuracy ◽

Conduction Velocity ◽

Nerve Conduction ◽

Diabetic Peripheral Neuropathy ◽

Velocity Measurement ◽

Sural Nerve ◽

Nerve Conduction Velocity ◽

Cross Sectional Study ◽

Cross Sectional

BACKGROUND Various tests are used to detect diabetic peripheral neuropathy by assessing sense perception in the feet. Tests vary in terms of time and resources required. Simple tests are those that can be conducted quickly and easily in primary care without laboratory equipment. There are some limitations to these simple tests, an example being the variable amplitude of the 128 Hz tuning fork. A new test, VibraTip (McCallan Medical, UK), might be a valuable alternative as it emits a consistent amplitude and may offer improved diagnostic accuracy. OBJECTIVE The aims of this study are to estimate the diagnostic accuracy of the VibraTip device for diabetic peripheral neuropathy against the reference standard of sural nerve conduction velocity measurement, and to assess whether the VibraTip offers superior diagnostic accuracy to other routine tests based on vibration or touch. METHODS The study will prospectively recruit adults with type 2 diabetes who are due to attend a routine follow-up clinic. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be sural nerve conduction velocity measurement. RESULTS Funding is being sought to conduct this research. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against sural nerve conduction velocity measurement, including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic curves will be constructed and compared for each test. CONCLUSIONS This study will be the first within-study comparison of 5 simple tests for screening diabetic peripheral neuropathy and will address uncertainties in the potential benefits of using VibraTip in comparison with the other tests.

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Limb-Specific Features and Asymmetry of Nerve Conduction Velocity and Nerve Trunk Size in Human

Frontiers in Physiology ◽

10.3389/fphys.2020.609006 ◽

2020 ◽

Vol 11 ◽

Author(s):

Ayaka Nobue ◽

Yoko Kunimasa ◽

Hiromu Tsuneishi ◽

Kanae Sano ◽

Hiroyuki Oda ◽

...

Keyword(s):

Conduction Velocity ◽

Nerve Conduction ◽

Action Potentials ◽

Electric Stimulation ◽

Nerve Conduction Velocity ◽

Lower Limbs ◽

Upper Limbs ◽

Cross Sectional ◽

Nerve Ultrasonography ◽

Human Nerve

This study aimed to simultaneously examine the differences of human nerve conduction velocity (NCV) and nerve cross-sectional area (nCSA) between the upper and lower limbs and between different regions of the upper and lower limbs. Thirty healthy subjects volunteered for the study. NCV and nCSA of the ulnar and tibial nerves were measured with the dominant and non-dominant arms and the supporting and reacting legs using supramaximal electric stimulation and peripheral nerve ultrasonography at three regions for ulnar and tibial nerves, respectively. Supramaximal electric stimulation was superficially applied to the ulnar and tibial nerves at each point. These action potentials were recorded from the digiti minimi and soleus muscles for the ulnar and tibial nerves, respectively. Our results clearly showed that the NCV, nCSA, and circumference of the ulnar and tibial nerves were higher and greater in the lower limbs than in the upper limbs. The greater the circumference, the greater the nCSA for both the upper and lower limbs. However, unlike the upper limbs, the supporting leg did not have higher NCV than the reacting leg despite its greater circumference. Therefore, nCSA can be related to the circumference but not necessarily function for NCV developments of the lower limbs. These various aspects between the upper and lower limbs suggest that NCV does not depend on the nCSA sizes or upper and lower limb circumference; the results indicate the existence of limb-specific NCV but not nCSA developments.

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