Clinical and electrophysiological aspects of distal ulnar neuropathy

OBJECTIVES: To evaluate the use of fixed distance side to side comparison of abductor digiti minimi (ADM) and first dorsal interosseous (FDI) compound muscle action potential (CMAP) studies in the diagnosis of distal ulnar neuropathy. MATERIALS AND METHODS: Thirty normal controls underwent ADM and FDI CMAP studies bilaterally at a fixed ADM recording to stimulating point distance of 6 cm. Side to side mean latency differences to both muscles were calculated. Twenty patients with suspected unilateral distal ulnar neuropathy from routine nerve conduction studies had positive results when compared with controls. RESULTS: The upper limit of normal for side to side mean latency difference at 3 SD above the mean was 0.394 and 0.474 ms for ADM and FDI, respectively. All 20 patients had side to side mean CMAP latency difference above 3 SDs in the ADM, FDI or both muscles. Fifty percent of cases had involvement of the superficial sensory branch. CONCLUSIONS: Fixed distance side to side CMAP latency comparison is a useful electrodiagnostic adjunct for distal ulnar neuropathy. Trauma was the most common aetiology in the 20 reported cases. Correlation was found between aetiological factors and sites of lesions as localized with this method.