Ulnar neuropathy at the elbow: Reappraisal of the wrist-upper arm latency difference between ulnar and median nerves |
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| Affiliation: | 1. Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland;2. Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France;3. Hôpital Neurologique Pierre Wertheimer, Lyon, France;4. Service de Neurologie-Électrophysiologie clinique, University Hospital (CHRU), Besançon, France;5. Unité de Neuroimmunologie et des maladies Neuromusculaires, Hôpitaux Universitaires de Genève (HUG), Switzerland;6. Neurophysiology Department, CHU Sart Tilman, Liège, Belgium;7. Département Formation, Recherche et Innovation, Centre universitaire de médecine générale et santé publique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland;1. Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan;2. Emeritus of Gifu University, Japan;3. Hermitage of Magnetoencephalography, Japan;1. Department of Neurorehabilitation, Neurological Area, IRCCS San Raffaele Hospital, Milan, Italy;2. Experimental Neurophysiology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy;3. University Vita-Salute San Raffaele, Milan, Italy;1. Division of Developmental Medicine, Boston Children’s Hospital, 02215, United States;2. Harvard Medical School, 02215, United States;3. The Banyan, 600037, India;4. College of Medicine, University of Illinois at Chicago, 60612, United States;5. College of Medicine, University of Florida, 32610, United States;6. Department of Psychology, Temple University, 19122, United States;1. Department of Clinical and Experimental Medicine, Policlinico “G.Martino”, University of Messina, Via Consolare Valeria n1, 98124 Messina, Italy;2. Unit of High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;3. Department of Neuromotor Rehabilitation, IRCCS “San Raffaele Pisana”, Via della Pisana 235, Rome 00163, Italy;4. Department of Geriatrics, Neurosciences & Orthopaedics, Università Cattolica, Largo Agostino Gemelli n8, 00168 Rome, Italy;1. Yale School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven, CT 06519, USA;2. Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Ave, Boston, MA 02215, USA |
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| Abstract: | ObjectivesTo evaluate the sensitivity and specificity of the latency difference (DLat) between ulnar and median nerves of the arm after stimulation at the wrist; one of the easiest techniques proposed for recognizing ulnar neuropathy at the elbow (UNE). As latency difference is not a standardized technique, we set up a multicenter study to recruit large numbers of normal subjects and patients with UNE or generalized neuropathy.MethodsSix centers participated in the study with data obtained from three groups of participants, controls (CTRLs), patients with UNE and patients with generalized neuropathy (GNP).We first verified the anatomical superposition of the ulnar and median nerves in cadaver examination. The optimal recording site for these two nerves was found to be 10 cm above the medial epicondyle. We then standardized the position of the arm with full extension of the elbow and stimulated first the median and then the ulnar nerves at the wrist. CTRLs were examined on both arms at two consecutive visits.ResultsWe recorded 32 idiopathic UNE cases, 44 GNP patients and 62 controls.We demonstrated that a DLat cut-off value of 0.69 ms brings a sensitivity of 0.86 and specificity of 0.89 to discriminate CTRLs from UNE. We also validated that intra-examiner reproducibility was good.ConclusionWe report a lower normal value for DLat than reported in several non-standardized studies and CTRL and UNE groups have clearly separated DLat values.SignificanceDue to its high sensitivity, our standardized technique could be used as a first-line diagnostic tool when UNE is suspected. |
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| Keywords: | Ulnar neuropathy Nerve conduction study Neurophysiology |
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