Diagnostic Accuracy Of Sensory Clinical Findings Of The Hand Dorsum And Of Neurography Of The Dorsal Ulnar Cutaneous Nerve In Ulnar Neuropathy At The Elbow

Publication date: Available online 21 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mauro Mondelli, Federica Ginanneschi, Alessandro Aretini

Abstract

Objective

The main objective is to investigate the diagnostic accuracy and the relation of touch sensation and subjective sensory symptoms in the medial aspect of the hand dorsum, and neurography of the dorsal ulnar cutaneous nerve (DUCN) in ulnar neuropathy at the elbow (UNE). Secondary objective is to report the electrophysiological occurrence of anatomical variant of sensory innervation of the medial aspect of the hand dorsum from superficial radial nerve (SRN).

Design

Prospective, cohort study.

Setting

Electromyography laboratory.

Participants

Consecutive subjects (N=282), those with UNE (N=81) and those without UNE (N=201) were enrolled.

Interventions

Not applicable

Main Outcome Measures

Accuracy and agreement between sensory clinical findings of the medial hand dorsum and neurography of DUCN in UNE diagnosis.

Results

DUCN neurographic and sensory findings had high specificity and relatively low sensitivity. Normal/abnormal sensory nerve action potential (SNAP) of DUCN matched with normal/abnormal touch sensation of the medial aspect of hand dorsum. Abnormal DUCN SNAP was related to the clinical severity of UNE and to the axonal damage of the ulnar nerve. Anatomical variant of the innervation of hand dorsum from SRN was demonstrated in in 31/564 hands (6.2%) belonging to 26/282 subjects (9.2%). If the variant was present, DUCN SNAP of the same side was more frequently absent or of low amplitude.

Conclusions

The utility of DUCN neurography and sensory findings of the medial aspect of the dorsum of the hand is limited in the diagnosis of UNE. However, if DUCN SNAP is absent or low in amplitude, it is advisable to check the presence of the anatomical variant of the innervation of the medial aspect of the hand dorsum from SRN.

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