Sonographic Measurements of the Ulnar Nerve at the Elbow With Different Degrees of Elbow Flexion

Patel, Paresh V.; Norbury, John W.; Fang, Xiangming

doi:10.1016/j.pmrj.2013.12.011

Cited by 8 publications

(8 citation statements)

References 23 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CSA and flattening ratio (FR) measurements demonstrated significant differences between nerves with and without UNE especially during elbow flexion with P = 0.005 and P = 0.004 for nerve CSA and FR respectively in which both are less than P < 0.05. Same results were found in a study that proved the mean CSA and the mean flattening ratio of the ulnar nerve were significantly different at 90°of elbow flexion than elbow extension [6].…”

Section: Discussionsupporting

confidence: 79%

“…The cutoff value for the cross-sectional area of the asymptomatic ulnar nerve is suggested by Thoirs and his colleagues [5] to be 9 mm 2 , derived as the upper limit of the 95% confidence interval. Also, Patel and his colleagues [6] recommend the use of the cross-sectional area (CSA) rather than the flattening ratio as it does not change with change of angle at the elbow.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of dynamic sonography in ulnar nerve entrapment at elbow

Al-Azizi

Mosaad

Yahia

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

View full text Add to dashboard Cite

Background: High-resolution ultrasound (HRUS) is a rapidly developing technology that is gaining popularity for the evaluation of the ulnar nerve. Objective: To evaluate the role of dynamic HRUS for the detection of different abnormalities of ulnar nerve entrapment at the elbow. Patients and Methods: Sixty-two elbows divided into 23 elbows with symptomatic and sonographic findings (symptomatic group), 39 elbows as a control group, which were further subdivided into 24 which were clinically and sonographically free (control group), and 15 subjects as a case nonmanifest group who were clinically free, but has sonographic findings (asymptomatic UNE group), were studied. The ulnar nerve cross-sectional area (CSA) was measured at the Guyon canal, mid-forearm, and maximal swelling (MS) point around the elbow. We assessed also the flattening ratio at the elbow by measuring the widest transverse and anteroposterior diameters during elbow extension and flexion. Results: There was a statistically significant difference of the cross-sectional area and flattening ratio of the ulnar nerve at the elbow during extension and flexion between the three groups (symptomatic, case nonmanifest, and healthy control elbows) (P value = 0.05). Conclusion: Dynamic HRUS is a highly accurate, sensitive diagnostic modality for the ulnar nerve entrapment syndrome at the elbow.

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Role of dynamic sonography in ulnar nerve entrapment at elbow

Al-Azizi

Mosaad

Yahia

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

View full text Add to dashboard Cite

show abstract

“…13-15 CSA measurement instead of nerve diameter was found to be a more reliable measure for nerve size. 18,19…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] Previous reports underline the US cross-sectional area (CSA) of the ulnar nerve at the elbow as a valid tool to diagnose CuTS. 18,19 The purpose of this study was to determine the clinical outcome in elbows undergoing endoscopic and open cubital tunnel release for CuTS using US-related changes in the CSA of the ulnar nerve. We hypothesized that US examination is a useful tool to detect reduction of swelling after successful treatment of cubital tunnel release.…”

Section: Introductionmentioning

confidence: 99%

Sonographic Follow-Up of Patients With Cubital Tunnel Syndrome Undergoing in Situ Open Neurolysis or Endoscopic Release: The SPECTRE Study

Lucchina

Fusetti

Guidi

2019

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Background:The measurement of cross-sectional area (CSA) is a diagnostic tool to detect entrapments syndrome. The aim of this study was to compare the clinical outcome in elbows undergoing endoscopic and “in situ” open cubital tunnel release for cubital tunnel syndrome (CuTS) using ultrasound-related changes in the largest CSA of the ulnar nerve. The purpose is to determine the association between clinical outcome and CSA. Methods: From May 2011 to April 2016, 60 patients with CuTS were prospectively followed and not randomly divided in two groups: 30 patients undergoing an endoscopic release (ER) and 30 patients with “in situ” open neurolysis (OR). A sonographic examination was performed by the senior authors at baseline and 3, 6, and 12 months after surgical decompression. Results: CSA values were statistically significantly lower in the ER. Hand grip strength difference with Jamar test was not statistically significant a 12 months (39 kg vs 27 kg). Static-2 point discrimination test difference was only statistically significant lower in the endoscopic group at 3, 6 and 12 months but not clinically relevant (5 mm vs 6 mm). The American Shoulder and Elbow Surgeons—Elbow questionnaire (ASES-e) function score, ASES-e Pain score, and ASES-e Satisfaction score were not statistically significant different between the two groups at 3, 6, and 12 months post operatively. Conclusions: The study confirms that in spite of lower values of CSA in the ER, there is not a statistically significant difference between the two techniques in terms of subjective outcomes. Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve. Type of study/LOE: Prognostic Level III

show abstract

“…The most important measure that ultras onography can provide, owing to its sensitivity, is the nerve cross-sectional area, which is the area inside the hyperechoic rim of the epineurium, calculated using the ellipse method or -if the nerve does not have an elliptical or circular shape -the tracing method 23 . Another measure that is usually assessed is the ratio between the cross-sectional area of nerve tracts that are involved in the pathological damage and those that are spared 24,25 .…”

Section: Ultrasonographymentioning

confidence: 99%

New technologies for the assessment of neuropathies

et al. 2017

View full text Add to dashboard Cite

Peripheral neuropathies are among the most common neurological disorders 1 . In routine clinical practice, diagnosis of peripheral neuropathies is typically based on clinical assessment, nerve conduction studies and needle electromyography, which can determine whether symptoms are caused by primary axonal damage or demyelinating damage. This distinction is often relevant to therapeutic choices and to prognosis, as axonal damage typically reflects an inflammatory (for example, vasculitic) or degenerative (for example, hereditary or idiopathic) process that correlates with disability, whereas demyelinating damage can reflect a hereditary neuro pathy, but more often reflects an acquired immunemediated neuropathy. Besides metabolic, inflammatory or primary degenerative neuropathies, peripheral nerves can also be damaged by compression from adjacent tissue structures, such as tendons, cysts or haematomas. In this case, proper identification of the site, nature and degree of the lesion might be challenging, but is relevant to treatment and prognosis. Moreover, some patients present with symptoms that suggest damage to small nerve fibres, which nerve conduction studies cannot be used to detect.In the past 15 years, several techniques have become available to investigate focal and diffuse peripheral neuropathies, and their reliability has widened the spectrum of diagnostic tools for clinicians and improved assessment of neuropathies. In this Review, we provide an overview of these new and emerging technologies. We first discuss peripheral nerve imaging with MRI and ultrasonography, which can provide information about the precise localization of neuro pathies and the pathological processes involved in large-fibre neuropathies, and can complement clinical and electrophysiological evaluation. We then consider techniques that can provide diagnostic information when the pathological process is restricted to small nerve fibres and is consequently not detectable with nerve conduction studies or neuroimaging. These include skin biopsy, which is established in clinical practice, and the emerging techniques of corneal confocal microscopy, laser-evoked potentials and heat-related and pain-related evoked potentials, and microneurography.Nerve imaging technology Advances in imaging techniques have made it possible to gain great insight into nerve pathology with magnetic resonance and ultrasound. Each approach offers distinct advantages, and can provide different information about damage to large myelinated fibres. Abstract | Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean th...

show abstract

Sonographic Measurements of the Ulnar Nerve at the Elbow With Different Degrees of Elbow Flexion

Abstract: The mean CSA of the ulnar nerve at the elbow at 30° was not significantly different than at 90°. However, the average flattening ratio at 90° was found to be significantly higher than at 30° for the right arm.

Cited by 8 publications

References 23 publications

Role of dynamic sonography in ulnar nerve entrapment at elbow

Role of dynamic sonography in ulnar nerve entrapment at elbow

Sonographic Follow-Up of Patients With Cubital Tunnel Syndrome Undergoing in Situ Open Neurolysis or Endoscopic Release: The SPECTRE Study

New technologies for the assessment of neuropathies

Contact Info

Product

Resources

About