Citations
Citations
To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients.
One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion.
The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove.
Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.
Citations
Objective: We tried to make real time observation of the ulnar nerve with elbows in an extended and flexed state at 100 degrees.
Method: We examined 58 elbows of 29 healthy volunteers. The participants were symptomless and showed normal conduction across the elbow. The transducer was applied between the line connecting medial epicondyle and olecranon. We measured the distances between the center of nerve, medial epicondyle, olecranon, skin, and investigated the flattening ratio with elbows extended. Afterwards, we repeated the measurement with the elbows flexed at 100 degrees. We classified the position of the nerves into three groups according to the flexed position. We used the Okamoto classification.
Results: The distance between nerve and skin, between nerve and medial epicondyle was 0.57⁑0.11 cm, 0.83⁑0.15 cm, with the elbow extended. But with the elbow flexed, the distance decreased to a value of 0.45⁑0.11 cm, 0.64⁑0.25 cm, respectively. The flattening ratio was 0.52⁑0.13 at extension, and 0.31⁑0.11 at flexion. Subluxation and dislocation of the ulnar nerve were seen in 20.7% and 5.2% respectively. With the elbow flexed, the ulnar nerve moved anteromedially and superficially in the dislocated group.
Conclusion: With the elbow flexed, the ulnar nerve moves superficially and medially, and the flattening ratio is greater when the elbow is extended. (J Korean Acad Rehab Med 2002; 26: 61-66)
Objective: This study was designed to investigate the effect of elbow flexion on the maximal strengths of supination, pronation, and grip which are important component of hand function.
Method: The maximal isometric strength of supination and pronation using BTE work simulator and grip strength using hand-held dynamometer were measured in thirty normal adult subjects. Maximal voluntary contraction for 5 sec was performed at the 0, 45, and 90 degrees of elbow flexion randomly.
Results: 1) The maximal isometric strengths of supination and pronation were significantly higher at the 0 degree, and lower at 90 degrees of elbow flexion (p＜0.05). 2) The maximal grip strength at the 0 degree of elbow flexion was significantly higher than that of 45 and 90 degrees of elbow flexion (p＜0.05).
Conclusion: The strengths of supination, pronation, and grip were affected by the elbow flexion, which were higher in the extended position of elbow. Therefore the elbow angle should be considered and individualized treatment program should be designed in hand rehabilitation to improve strength and to minimize the incidence of overuse disorder.
Objective: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study.
Methods: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45o, 90o, 135o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature.
Results: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45o, 90o, 135o flexion, respectively. The difference between actual length and estimated lengths were least in 45o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion.
Conclusion: This study suggest that the optimal angle in ulnar nerve conduction study would be 45o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.
Objective: To evaluate the clinical and electrodiagnostic findings of ulnar neuropathy at the elbow.
Method: Sixty-two patients with ulnar neuropathy at the elbow were reviewed retrospectively to establish causes, severity and type of neuropathy, symptom, sign, operation name and operative findings.
Results: 1) Of total 62 cases, 41 were male and 21 were female and the most often were in their forties and fifties. 2) The main cause of the neuropathy is bone deformity caused by previous fracture or dislocation (43.6%). 3) The symptoms observed were motor weakness (66.1%), sensory change (79%) and muscle atrophy (35.5%). 4) Forty-nine cases showed abnormality in nerve conduction study and needle electromyography study, and 9 cases showed abnormality only in the needle electromyography study. 5) On needle electromyography, sparing of flexor carpi ulnaris was shown in 50 cases (80.6%). 6) Operative treatment was performed in 15 cases. Among them, electrodiagnostic and operative diagnosis coincided in only 12 cases (80%).
Conclusion: We conclude that above clinical and electrodiagnostic findings are useful for the diagonosis ulnar neuropathy at the elbow with consideration of etiology, localization and for the selection of operative treatment.
Objective: There is a room for considerable error in the measurement of across-elbow conduction velocity due to the different possible positions of the elbow and the difficulty in measuring distance accurately. We propose a technique for the measurement of conduction velocity through the elbow segment in a fully flexed elbow position with the arm abducted at 90o.
Method: We assumed 'ideal' across-elbow segmental conduction velocity is the mean of the forearm and arm segmental conduction velocities, and established an optimal deflection point at the elbow, which best reflects the ideal conduction velocity in normal healthy subjects. Five deflection points were examined at the elbow. Segmental conduction velocities of across-elbow segments were calculated at each of these points, using the sum of the linear distances from each point to the proximal above-elbow cathode stimulation site and to the distal below-elbow cathode stimulation site.
Results: The optimal deflection point was the midpoint between the epicondyle and the olecranon in an arm abducted 90o and elbow fully flexed position.
Conclusion: Our data suggests that an across-elbow segment velocity lower than 54.2 m/sec, or a difference of more than 11.6 m/sec between the across-elbow and forearm segments is to be considered abnormal. The lower limit values expressed as mean - 2 S.D. for absolute across-elbow segmental conduction velocity and relative velocity difference between the across- elbow segment and forearm segments at other possible deflection points of the elbow were also calculated.
Objectives: The current literature gives confusing advice on the position of the elbow in ulnar nerve conduction study. The purpose of this study was to determine the appropriate position of elbow flexion for a segmental ulnar nerve conduction study and to attain the basic information for an evaluation of ulnar neuropathy.
Methods: Segmental ulnar motor and sensory nerve conduction studies were performed bilaterally on 40 healthy korean adults(20 men and 20 women) with the age range from 19 to 56 years(mean age：29.86). The ulnar nerve was stimulated at 7 cm & 10 cm proximal to the active recording electrode respectively and 5 cm distal, and poximal to the medial epicondyle of the humerus for motor and sensory nerves at each elbow flexion position of 0o, 45o, 90o, and 135o. The segmental distances were measured in each position.
Results: The segmental nerve conduction velocity(NCV) of the elbow segment increased with the degree of elbow flexion, and it was faster than the forearm segment at 90o and 135o of elbow flexion. The NCV showed no statistical difference in each elbow position.
Conclusion: We conclude that the degree of elbow flexion should be maintained 90o or above in an ulnar nerve conduction study.
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