Diagnostic values of conventional conduction parameters in ulnar neuropathy at elbow

2021 ◽  
Vol 74 (11-12) ◽  
pp. 397-407
Author(s):  
Murat Alemdar
Keyword(s):  
Action Potential ◽  
Diagnostic Accuracy ◽  
Ulnar Nerve ◽  
Diagnostic Yield ◽  
Reduction Rate ◽  
Clinical Signs ◽  
Sensory Nerve ◽  
Nerve Fibers ◽  
Ulnar Neuropathy ◽  
The Absolute

Conventional parameters used in electrodiagnosis of ulnar neuropathy at elbow (UNE) are: (i) absolute across-elbow ulnar nerve motor conduction velocity (MCV), (ii) reduction rate of composed muscle action potential (CMAP) amplitude from above to below elbow stimulation, and (iii) MCV difference between forearm and across-elbow segment. We aimed to search the diagnostic accuracy values of these parameters on UNE, and their correlations with axonal dysfunction of ulnar nerve fibers. Arms with clinical signs of UNE and two-fold healthy controls were included. We detected the best cut off points of the measured parameters and their possible combinations. Their diagnostic accuracy values and correlations with parameters reflecting the axonal functions were analyzed, statistically. Totally, 118 arms with UNE and 236 controls were included. Absolute across-elbow MCV yielded a higher accuracy than MCV difference and reduction rate of CMAP amplitude (p = 0.010 and p˂0.001, respectively). Besides, combining it with other parameters did not increase the diagnostic yield. Correlation analyses revealed that the only parameter having positive linear correlations with sensory nerve action potential amplitudes both in the control and the disease groups is the absolute across-elbow MCV. The absolute across-elbow MCVs have also positive linear correlation with CMAP amplitudes in disease group. The absolute across-elbow MCV is the most valuable conventional parameter for the electrodiagnosis of UNE. It is also the most correlated parameter with the electrodiagnostic parameters reflecting the axonal functions of the ulnar nerve fibers.

scholarly journals Electroneurographic parameters in patients with metabolic syndrome

2014 ◽  
Vol 4 (1) ◽  
pp. 45-49
Author(s):  
Suljo Kunić ◽  
Emir Tupković ◽  
Mediha Nišić ◽  
Semiha Salihović
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Glycemic Control ◽  
Action Potential ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Sensory Nerve ◽  
Group I ◽  
Patients With Diabetes ◽  
Group Ii

Introduction: The aim of this study was to measure electroneurographic (ENG) parameters of the median and ulnar nerve in patients with metabolic syndrome and to determine whether the large imbalance in glycemic control came to neuropathic changes to the template.Methods: The study included 100 patients with metabolic syndrome diagnosed according to the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III). The patients were divided into two groups. Group I – patients with normal glycemic control and Group II - patients with diabetes mellitus for up to five years. We measured sensory conductive velocity (SCV), the amplitude of sensory nerve action potential (SNAP), motor conductive velocity (MCV), terminal motor latency (TML) and compose muscle action potential after distal stimulation (CMAP-I) and after proximal stimulation (CMAP-II) for the ulnar and median nerve.Results: Sensory and motor parameters in Group II were amended to neuropathic pattern compared to Group I. There were significant differences in: SNAP amplitude for all tested nerves, SCV values for both left and right median and ulnar nerve; MCV and TML for left median nerve; MCV, TML and CMAP-I for right median nerve area; MCV and TML for left ulnar nerve; MCV, CMAP-I and CMAP-II for right ulnar nerve area.Conclusion: Patients with metabolic syndrome and diabetes mellitus duration of five years have the significant changes in sensory and motor peripheral nerves. Neuropathic changes are possible in patients with metabolic syndrome and normal glycemic control.

scholarly journals The red flags of ulnar neuropathy in leprosy

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259804
Author(s):  
Márcia Jardim ◽  
Robson T. Vital ◽  
Ximena Illarramendi ◽  
Mariana Hacker ◽  
Beatriz Junqueira ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Ulnar Nerve ◽  
Clinical Signs ◽  
Nerve Biopsy ◽  
Ulnar Neuropathy ◽  
Sensory Impairment ◽  
Nerve Enlargement ◽  
Leprosy Patients ◽  
Demyelinating Lesions ◽  
Temporal Dispersion

The diagnosis of pure neural leprosy is more challenging because patients share characteristics with other common pathologies, such as ulnar compression, which should be taken into consideration for differential diagnosis. In this study, we identify ulnar nerve conduction characteristics to aid in the differential diagnosis of ulnar neuropathy (UN) in leprosy and that of non-leprosy etiology. In addition, we include putative markers to better understand the inflammatory process that may occur in the nerve. Data were extracted from a database of people affected by leprosy (leprosy group) diagnosed with UN at leprosy diagnosis. A non-leprosy group of patients diagnosed with mechanical neuropathy (compressive, traumatic) was also included. Both groups were submitted to clinical, neurological, neurophysiological and immunological studies. Nerve enlargement and sensory impairment were significantly higher in leprosy patients than in patients with compressive UN. Bilateral impairment was significantly higher in the leprosy group than in the non-leprosy group. Leprosy reactions were associated to focal demyelinating lesions at the elbow and to temporal dispersion (TD). Clinical signs such as sensory impairment, nerve enlargement and bilateral ulnar nerve injury associated with eletrodiagnostic criteria such as demyelinating finds, specifically temporal dispersion, could be tools to help us decided on the best conduct in patients with elbow ulnar neuropathy and specifically decide if we should perform a nerve biopsy for diagnosis of pure neural leprosy.

Case 9

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Clinical Practice ◽  
Action Potential ◽  
Ulnar Nerve ◽  
Sensory Nerve ◽  
Accurate Diagnosis ◽  
Sensory Nerve Action Potential ◽  
First Dorsal Interosseous ◽  
Nerve Lesions ◽  
Sensory Nerve Action ◽  
Ulnar Nerve Lesions

Ulnar nerve lesions are the second most common mononeuropathies encountered in clinical practice. Although the majority of the lesions are due to entrapment/compression of the ulnar nerve around the elbow (at the cubital tunnel or ulnar groove), it is important to consider and exclude distal ulnar nerve lesions at the wrist or palm. This case highlights the clinical and electrodiagnostic findings of ulnar neuropathies at the wrist, including Guyon canal and pisohamate hiatus. It also discusses the electrodiagnostic challenges in distinguishing distal from proximal ulnar nerve lesions. Emphasis is placed on the use of additional studies, such as the dorsal ulnar sensory nerve action potential, first dorsal interosseous recording, inching studies, and palm stimulation, in the accurate diagnosis of ulnar nerve lesions at the wrist.

Modeling the Excitability of Mammalian Nerve Fibers: Influence of Afterpotentials on the Recovery Cycle

2002 ◽  
Vol 87 (2) ◽  
pp. 995-1006 ◽  
Author(s):  
Cameron C. McIntyre ◽  
Andrew G. Richardson ◽  
Warren M. Grill
Keyword(s):  
Experimental Data ◽  
Action Potential ◽  
Experimental Studies ◽  
Sensory Nerve ◽  
Nerve Fibers ◽  
Recovery Cycle ◽  
Channel Activation ◽  
Single Action ◽  
Potential Shape ◽  
Wide Range

Human nerve fibers exhibit a distinct pattern of threshold fluctuation following a single action potential known as the recovery cycle. We developed geometrically and electrically accurate models of mammalian motor nerve fibers to gain insight into the biophysical mechanisms that underlie the changes in axonal excitability and regulate the recovery cycle. The models developed in this study incorporated a double cable structure, with explicit representation of the nodes of Ranvier, paranodal, and internodal sections of the axon as well as a finite impedance myelin sheath. These models were able to reproduce a wide range of experimental data on the excitation properties of mammalian myelinated nerve fibers. The combination of an accurate representation of the ion channels at the node (based on experimental studies of human, cat, and rat) and matching the geometry of the paranode, internode, and myelin to measured morphology (necessitating the double cable representation) were needed to match the model behavior to the experimental data. Following an action potential, the models generated both depolarizing (DAP) and hyperpolarizing (AHP) afterpotentials. The model results support the hypothesis that both active (persistent Na+ channel activation) and passive (discharging of the internodal axolemma through the paranodal seal) mechanisms contributed to the DAP, while the AHP was generated solely through active (slow K+ channel activation) mechanisms. The recovery cycle of the fiber was dependent on the DAP and AHP, as well as the time constant of activation and inactivation of the fast Na+ conductance. We propose that experimentally documented differences in the action potential shape, strength-duration relationship, and the recovery cycle of motor and sensory nerve fibers can be attributed to kinetic differences in their nodal Na+ conductances.

Relationships between Clinical Scales on Severity of Symptoms and Electrodiagnostic Measures on Abnormality of Nerve Conduction in Carpal Tunnel Syndrome

1998 ◽  
Vol 42 (12) ◽  
pp. 841-845 ◽  
Author(s):  
Heecheon You
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Biological Significance ◽  
Sensory Nerve ◽  
Nerve Fibers ◽  
Peak Amplitude ◽  
Clinical Scales ◽  
Tunnel Syndrome

This study examined the severity of carpal tunnel syndrome symptoms in relation to nerve conduction measures of the median nerve. The symptom scales include (1) numbness, (2) tingling, (3) nocturnal symptoms, (4) pain, (5) weakness, and (6) clumsiness; the nerve conduction measures are (1) peak amplitude and (2) peak latency of the sensory action potential, (3) conduction velocity of the sensory nerve fibers, (4) peak amplitude and (5) onset latency of the motor action potential. The symptom severity and nerve conduction impairment were evaluated for 34 affected hands of 24 patients (6 males and 18 females) by using a questionnaire developed by Levine et al. and an electromyographic instrument, respectively. Significant relationships identified among the clinical scales resulted in a dichotomous symptom classification scheme with a criterion of the relatedness to nerve damage: primary and secondary symptoms. Correlation analysis on the symptom and electrodiagnostic measures showed both the severity scales for the primary and all the symptoms had higher correlations with the extent of the nerve injury than that for the secondary symptoms. These results demonstrated a biological significance of the clinical scales, which can be used in evaluating the outcome of treatments and developing a model for exposure-severity relationship.

scholarly journals Nerve sheath tumor, benign neurogenic slow-growing solitary neurilemmoma of the left ulnar nerve: A case and review of literature

2016 ◽  
Vol 30 (2) ◽  
pp. 219-229 ◽  
Author(s):  
Andra Elena Martin ◽  
D. Martin ◽  
Aurelia Mihaela Sandu ◽  
Angela Neacsu ◽  
Oana Rata ◽  
...  
Keyword(s):  
Action Potential ◽  
Ulnar Nerve ◽  
Histopathological Examination ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Definitive Treatment ◽  
Nerve Sheath Tumor ◽  
Left Forearm ◽  
Dominant Female ◽  
Slow Growing

AbstractThis paper represent a report of a case with ulnar nerve schwannoma (neurilemmoma), benign neurogenic slow-growing, tumors originating from Schwann cells along the course of a nerve (1) (2) (3). Schwannomas are the most common tumors of the peripheral nerves which occur in the adults (0.8–2%) (5). Usually they progress slowly and so they can remain painless swellings for a few years before other symptoms appear. Most of these lesions could be diagnosed clinically, are mobile in the longitudinal plane along the course of the involved nerve but not in the transverse plane (7). EMG, MRI, and ultrasonography are useful tools in the diagnosis. The definitive treatment of benign peripheral nerve schwannomatosis is complete enucleation of the tumor mass without damaging the intact nerve fascicles followed by confirmatory hystopathological examination (12). We present the case of a 62 years old right hand-dominant female who notice a slow increasing bulge over the inner aspect of her distal volar left forearm superior to the wrist, for a longer period of time not exactly specified; this was tracked and associated by pain, tingling and numbness over inner one and half fingers of her left hand in progress until the presentations. A diagnosis of soft-tissue tumor was presumed clinically. The other investigations were ultrasonography (US), nerve conduction studies (NCSs) such as sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). In this case IRM was suggestive of a benign growth in her left ulnar nerve in the forearm region. Microsurgical techniques were used for ample enucleation of the tumor the distal volar left forearm. Subsequent histopathological examination confirmed the presumed diagnosis of a benign cellular schwannoma. At her last follow-up one month after surgery, the patient was neurological gradually improving sensory and motor function and she is highly satisfied with the results of surgery.

080 Electrodiagnostic and ultrasound correlates of clinical severity in ulnar neuropathy

2018 ◽  
Vol 89 (6) ◽  
pp. A32.3-A33
Author(s):  
Luciana Pelosi ◽  
Eoin Mulroy
Keyword(s):  
Diagnostic Yield ◽  
Clinical Signs ◽  
Clinical Severity ◽  
Ulnar Neuropathy ◽  
Sensory Loss ◽  
Nerve Ultrasound ◽  
Cross Sectional ◽  
Hand Muscles ◽  
Ultrasound Findings ◽  
Marked Atrophy

IntroductionThis is a retrospective review of 135 consecutive patients (M:F=71:64, mean age 52.6 years; 141 arms) referred to our institution with ulnar neuropathy over a two year period. We analysed electrodiagnostic and ultrasound findings in relation to clinical severity.MethodsAll patients underwent electrodiagnostic (AAN) and ultrasound examination of the symptomatic ulnar nerve(s). Clinical severity was graded on a 4 point scale from ‘very mild’ (symptoms only) to ‘severe’ (sensory loss plus marked atrophy of ulnar-innervated hand muscles).ResultsIn ‘very mild’ neuropathies, the number of abnormal electrodiagnostic and ultrasound studies was 2 and 11 respectively, out of 54; in ‘mild’ neuropathies 19 and 25 out of 40; in ‘moderate’, 23 and 24 out of 24; and in ‘severe’, 23 and 23 out of 23. In 25 arms, (18 of which were clinically ‘severe’ or ‘moderate’), electrophysiology was abnormal but non-localising. Ultrasound showed abnormally large cross-sectional area at the elbow in 22 and diffuse nerve enlargement in three. Ultrasound identified nerve subluxation in 24 (17%) neuropathies, 58% of which were ‘very mild’, 25% ‘mild’ and 17% ‘moderate’ or ‘severe’.ConclusionIn patients with symptoms but no clinical signs, electrophysiological evidence of ulnar neuropathy was present in 3.7%, whereas abnormal nerve ultrasound, often associated with subluxation, was demonstrated in 20%. Ultrasound increased the diagnostic yield of electrophysiology in the ‘very mild’ and, to a lesser extent, the ‘mild’ neuropathies by a combined 11%, and localised the lesion in all ulnar neuropathies with abnormal but non-localising electrophysiology. Nerve subluxation was disproportionately represented amongst the clinically ‘very mild’ neuropathies with abnormal ultrasound.

scholarly journals A comparative study of the conduction velocity of motor and sensory fibres of ulnar and median nerves among leprosy patients and normal subjects

2020 ◽  
Vol 8 (6) ◽  
pp. 2088
Author(s):  
Ishita Saha ◽  
Sujoy P. Bhattacharyya ◽  
Debabrata Bandyopadhyay
Keyword(s):  
Action Potential ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Statistical Tests ◽  
Clinical Signs ◽  
Sensory Nerve ◽  
Peripheral Nerve Involvement ◽  
Significant Difference ◽  
Leprosy Patients

Background: Leprosy and the associated scourge have affected humanity for thousands of years. One of the most debilitating consequences of leprosy is peripheral neuropathy. Nerve Conduction Velocity study provides us with a non-invasive modality to assess peripheral nerve involvement in leprosy.Methods: With this in mind, a cross-sectional observational study was conducted including 30 leprosy patients as "Cases" and 30 age-matched healthy subjects, not suffering from any kind of neurological disorders, as "Controls". Using a digital electromyography machine, the Latency, Amplitude and Conduction Velocities of Motor and Sensory fibres of Ulnar and Median nerves were recorded. The results were compared among controls and cases using suitable statistical tests (descriptive statistics and significance testing using unpaired t-test).Results: In this study, with regard to Sensory Nerve conduction Velocity (SNCV), statistically very significant difference was noted in case of right (p 0.0011) and left (p 0.0037) ulnar nerves among controls and cases. The difference in the amplitude of Motor Action potential (MAP) with regard to right median nerve, among cases and controls, was also statistically significant (p 0.0127). Further the amplitude of Sensory Nerve Action Potential (SNAP) values were higher among cases compared to controls.Conclusions: As such, the findings of this study (and which is also corroborated by many previous studies) lead us to the conclusion that NCV studies can detect lepromatous neuropathy much before the emergence of frank clinical signs and this type of neuropathy is predominantly demyelinating in nature with occasional axonal loss.

scholarly journals Effect of pregnancy on median and ulnar nerve conduction

2017 ◽  
Vol 5 (3) ◽  
pp. 978
Author(s):  
Sapana S. Motewar ◽  
Narendra P. Bachewar
Keyword(s):  
Action Potential ◽  
Pregnant Women ◽  
Ulnar Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Sensory Nerve ◽  
Action Potential Amplitude ◽  
Minimum Latency ◽  
Sensory Latency

Background: Pregnancy causes altered function of excitable membranes such as muscle and nerve, due to hormonal changes and edema. We failed to find any studies focusing on the issue of nerve conduction during pregnancy, in India. Thus present study aims to see the difference between nerve conduction parameters viz. motor and sensory conduction, in pregnant and non-pregnant women.Methods: This was a cross-sectional study carried out in randomly selected 30 pregnant women, of any age, in 28-40 weeks of gestation and age matched non-pregnant controls. We studied distal motor latency, compound muscle action potential amplitude, motor nerve conduction velocity, F-minimum latency, sensory latency, sensory nerve action potential amplitude and sensory nerve conduction velocity in bilateral median and ulnar nerves using Aleron-RMS.Results: Present study found no statistically significant difference between motor and sensory conduction of above said nerves in pregnant and nonpregnant women, except F minimum latency of left median nerve in pregnant women and sensory latency of left ulnar nerve in non-pregnant women were prolonged significantly (p<0.05).Conclusions: All motor and sensory parameters of bilateral median and ulnar nerves were normal as compared to non-pregnant controls.

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