Cornelson Stacey M, Sclocco Roberta, Kettner Norman W
Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA.
Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Ultrasound. 2019 Sep;22(3):337-344. doi: 10.1007/s40477-019-00370-9. Epub 2019 Mar 12.
Ulnar nerve instability (UNI) in the cubital tunnel is defined as ulnar nerve subluxation or dislocation. It is a common disorder that may be noted in patients with neuropathy or in the asymptomatic. Our prospective, single-site study utilized high-resolution ultrasonography (US) to evaluate the ulnar nerve for cross-sectional area (CSA) and measures of shear-wave elastography (SWE). Mechanical algometry was obtained from the ulnar nerve in the cubital tunnel to assess pressure pain threshold (PPT).
Forty-two asymptomatic subjects (n = 84 elbows) (25 males, 17 females) aged 22-40 were evaluated. Two chiropractic radiologists, both with 4 years of ultrasound experience performed the evaluation. Ulnar nerves in the cubital tunnel were sampled bilaterally in three different elbow positions utilizing US, SWE, and algometry. Descriptive statistics, two-way ANOVA, and rater reliability were utilized for data analysis with p ≤ 0.05.
Fifty-six percent of our subjects demonstrated UNI. There was a significant increase in CSA in subjects with UNI (subluxation: 0.066 mm ± 0.024, p = 0.027; dislocation: 0.067 mm ± 0.024, p = 0.003) compared to controls (0.057 mm ± 0.017) in all three elbow positions. There were no significant group differences in SWE or algometry. Inter- and intra-observer agreements for CSA of the ulnar nerves within the cubital tunnel were assessed using intraclass correlation coefficient (ICC) and demonstrated moderate (ICC 0.54) and excellent (ICC 0.94) reliability.
Most of the asymptomatic volunteers demonstrated UNI. There was a significant increase in CSA associated with UNI implicating it as a risk factor for ulnar neuropathy in the cubital tunnel. There were no significant changes in ulnar nerve SWE and PPT. Intra-rater agreement was excellent for the CSA assessment of the ulnar nerve in the cubital tunnel. High-resolution US could be utilized to assess UNI and monitor for progression to ulnar neuropathy.
肘管内尺神经不稳定（UNI）定义为尺神经半脱位或脱位。它是一种常见疾病，在神经病变患者或无症状者中均可出现。我们的前瞻性单中心研究采用高分辨率超声（US）评估尺神经的横截面积（CSA）和剪切波弹性成像（SWE）测量值。通过对肘管内尺神经进行机械性痛觉测量来评估压力痛阈（PPT）。
对42名年龄在22至40岁之间的无症状受试者（n = 84只肘部）（25名男性，17名女性）进行评估。两名拥有4年超声经验的脊椎按摩师放射科医生进行评估。利用超声、SWE和痛觉测量法在三个不同的肘部位置对双侧肘管内的尺神经进行采样。采用描述性统计、双向方差分析和评估者信度进行数据分析，p≤0.05。
56%的受试者表现出UNI。与对照组（0.057 mm±0.017）相比，在所有三个肘部位置，UNI受试者（半脱位：0.066 mm±0.024，p = 0.027；脱位：0.067 mm±0.024，p = 0.003）的CSA显著增加。SWE或痛觉测量方面无显著组间差异。使用组内相关系数（ICC）评估肘管内尺神经CSA的观察者间和观察者内一致性，结果显示为中等（ICC 0.54）和优秀（ICC 0.94）信度。
大多数无症状志愿者表现出UNI。与UNI相关的CSA显著增加，表明其为肘管内尺神经病变的一个危险因素。尺神经SWE和PPT无显著变化。对于肘管内尺神经CSA评估，观察者内一致性良好。高分辨率超声可用于评估UNI并监测其进展为尺神经病变的情况。
