Ulnar Neuropathy At Elbow (UNE): Clinical And Electrophysiological Study Of 279 Cases
We report a retrospective study on patients referred to EMG services of ASL 7 and Department of Neurosciences in the period 1.1.95 to 31.12.99. In agreement with recently developed AAEM-AAN guidelines (Neurology 1999, 52:688–690), we recognized as affected by UNE all patients with symptoms and/or signs of ulnar nerve impairment associated with corresponding electrophysiological findings. The minimal electrophysiological criteria for diagnosis is the reduction of the ulnar MNCV in the segment above-below elbow (<50 m/s) or the difference greater than 10 m/s between this value and the more distal MNCV (segment below elbow-wrist). This finding may be associated with a reduction of the above/below elbow CMAP greater than 20%. For clinical assessment we utilized severity scale proposed by Antoniadis et al. (Neurosurgery 1997, 41:585–91): stage 1-recent and mild symptoms of intermittent paresthesias and hypesthesias; stage 2-persistent symptoms and varying degrees of weakness and intrinsic muscle atrophy; stage 3-marked intrinsic muscle atrophy, weakness, and deformity. A global neurophysiological severity measurement is proposed, based on 13-steps which takes into account 4 parameters: above/below elbow MNCV and CMAP difference, EMG findings of the first dorsal interosseous muscle and SNAP at wrist by fifth finger stimulation. Then, 279 UNE from 254 subjects (89 females and 165 males, mean age 58.7 and 55.8 years respectively) were diagnosed: 155 (55.5%) idiopathic cases, 45 (16.1%) post-traumatic (18 with elbow fracture), 29 (10.4%) due to repetitive stress of the elbow, 28 (10%) with elbow arthropathy. Highest significant correlations have been founded between clinical severity and global neurophysiological score (p < 0.0001) on the one hand and symptoms duration (p < 0.001) on the other hand. Gender significant differences are lacking for age, symptoms duration and clinical severity, whereas the mean neurophysiological score in males results slightly greater than in females (p < 0.05).
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Document Type: Abstract
Affiliations: Dipartimento di Neuroscienze-Sez
Publication date: March 1, 2001