Effect of shoulder and elbow position on ulnar nerve conduction

Hsu, Kevin; Robinson, Lawrence R.

doi:10.1002/mus.26489

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…5 Keeping the arm under the head during sleep with shoulder abducted and elbow acutely flexed, can decrease nerve conduction velocity and cause paresthesias in the ulnar nerve distribution in the hand. 6 Ulnar nerve subluxation has been reported as a risk factor for nerve entrapment, but without any conclusive evidence. However, some surgeons advocate anterior transposition if nerve instability is noted intra-operatively.…”

Section: Etiologymentioning

confidence: 99%

Nerve entrapment around elbow

Naik

Bawa

Arya

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.

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Section: Etiologymentioning

confidence: 99%

Nerve entrapment around elbow

Naik

Bawa

Arya

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…A study in healthy subjects 26 recorded nerve conduction velocities in postures similar to postures 1, 2, and 3 in this study. A significant difference in conduction velocity was found between postures 1 and 3.…”

Section: Discussionmentioning

confidence: 99%

Cubital tunnel perfusion in different postures—An anatomical investigation

Rossmann

Heber

et al. 2021

Muscle and Nerve

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Introduction/Aims: For cubital tunnel syndrome, the avoidance of predisposing arm positions and the use of elbow splints are common conservative treatment options.The rationale is to prevent excessive stretching and compression of the nerve in the cubital tunnel, as this mechanical stress impedes intraneural perfusion. Data regarding those upper extremity postures to avoid, or whether elbow flexion alone is detrimental, are inconsistent. This study aimed to assess perfusion and size changes of the cubital tunnel during different postures in an experimental cadaver setup.Methods: Axillary arteries in 30 upper extremities of fresh cadavers were injected with ultrasound contrast agent. High-resolution ultrasound of the cubital tunnel was performed during five different arm postures that gradually increased tension on the ulnar nerve and caused cubital tunnel narrowing. Contrast enhancement within the tunnel was measured to quantify perfusion. Cubital tunnel crosssectional area was measured to detect compression.Results: Increasing tension significantly reduced perfusion. When isolated, neither shoulder elevation, elbow flexion, pronation, nor extension of wrist and fingers impaired perfusion. However, combining two or more of these postures led to significant decreases. Significant narrowing of the cubital tunnel was seen in full elbow flexion and shoulder elevation.Discussion: Combinations of some upper extremity joint positions reduce nerve perfusion, but isolated elbow flexion does not have a significant impact. We hypothesize that elbow splints alone may not influence cubital tunnel perfusion but may only prevent direct compression of the ulnar nerve. Advising patients about upper extremity postures that should be avoided may be more effective.

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“…Finally, technical factors must also be considered when evaluating positional changes in nerve conduction studies. For example, both ulnar and fibular nerves can become stretched or slackened with joint movements, producing apparent changes in nerve conduction velocity 14,15 . As we have acquired more experience with ultrasound in patients with neuromuscular disorders, we have gained an increased appreciation for the extent to which nerves move during limb movement.…”

mentioning

confidence: 99%

“…For example, both ulnar and fibular nerves can become stretched or slackened with joint movements, producing apparent changes in nerve conduction velocity. 14,15 As we have acquired more experience with ultrasound in patients with neuromuscular disorders, we have gained an increased appreciation for the extent to which nerves move during limb movement. In this regard, the point of stimulation along the nerve may also change as limbs are moved.…”

mentioning

confidence: 99%

Provocative changes in nerve conductions: Fact or fiction?

Robinson

2023

Muscle and Nerve

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At times electrodiagnostic medical consultants (EMCs) are asked to perform studies in both a neutral position, and then again after the patient is in a provocative position that exacerbates symptoms, to assess for measurable electrophysiologic changes. While this approach might seem initially appealing, particularly when standard studies are not effective at diagnosis, empiric studies in several conditions have been unimpressive. Studies in median neuropathy at the wrist, thoracic outlet syndrome, piriformis syndrome and radial tunnel syndrome have failed to demonstrate reproducible changes in nerve conduction studies in positions that exacerbate symptoms. Furthermore, there is lack of a plausible pathophysiologic mechanism for producing both measurable and rapidly reversible electrophysiologic changes after just a few minutes, or less, of compression. Axon loss and demyelination would not be rapidly reversible, and positional changes of 2 min or less (the durations generally studied) would be insufficient to produce measurable nerve ischemia. Lastly we have gained a greater appreciation for how much nerves move within limbs with changes in joint position; this movement can lead to misleading changes in nerve conduction studies. It is thus appropriate to conclude that testing nerve conduction in provocative or symptomatic positions adds no value to electrodiagnostic testing.

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Effect of shoulder and elbow position on ulnar nerve conduction

Cited by 5 publications

References 5 publications

Nerve entrapment around elbow

Nerve entrapment around elbow

Cubital tunnel perfusion in different postures—An anatomical investigation

Provocative changes in nerve conductions: Fact or fiction?

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