Validation of preoperative nerve conduction studies by intraoperative studies in patients with ulnar neuropathy at the elbow. 2016

Gregor Omejec, and Krešimir Božikov, and Simon Podnar
Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia. Electronic address: gregor.omejec@kclj.si.

OBJECTIVE To validate the findings of preoperative motor short-segment nerve conduction studies (SSNCSs) by intraoperative SSNCSs in patients with cubital tunnel syndrome. METHODS We prospectively recruited patients with ulnar neuropathy at the elbow (UNE) localized distal to the medial epicondyle (ME). Preoperatively, motor SSNCSs and ultrasonography (US) were performed. Immediately after surgical dissection of the humeroulnar aponeurotic arcade (HUA), intraoperative near-nerve motor SSNCSs were performed, and compared to preoperative findings. RESULTS We studied 36 arms with UNE in the cubital tunnel. Preoperative US localized UNE distal to ME in all operated arms, and demonstrated ulnar nerve constriction in 19 of them. Visual inspection confirmed ulnar nerve swelling in all studied nerves, but was unreliable with regard to ulnar nerve constriction. In all 5 (14%) arms with inconclusive localization by SSNCSs, intraoperative SSNCSs confirmed the preoperative US diagnosis of cubital tunnel syndrome. Intraoperative SSNCSs confirmed the preoperative localization in 24 (67%) arms, and were non-contributive in 7 (19%) arms with intraoperatively non-recordable responses. CONCLUSIONS Intraoperative near-nerve SSNCSs did not change the localization in any of 36 arms with UNE distal to ME. Therefore, our data indicate that a combination of preoperative SSNCSs and US reliably localizes UNE in the cubital tunnel. CONCLUSIONS Our present study suggests that in arms with consistent preoperative SSNCSs and US studies, no intraoperative near-nerve SSNCSs are needed to confirm ulnar nerve entrapment under the HUA.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009431 Neural Conduction The propagation of the NERVE IMPULSE along the nerve away from the site of an excitation stimulus. Nerve Conduction,Conduction, Nerve,Conduction, Neural,Conductions, Nerve,Conductions, Neural,Nerve Conductions,Neural Conductions
D011300 Preoperative Care Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed) Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D004551 Elbow Joint A hinge joint connecting the FOREARM to the ARM. Elbow Joints,Joint, Elbow,Joints, Elbow
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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