Shubert Daniel J, Prud'homme Joseph, Sraj Shafic
West Virginia University, Morgantown, USA.
Hand (N Y). 2021 Mar;16(2):170-173. doi: 10.1177/1558944719840750. Epub 2019 Apr 4.
Electrodiagnostic studies (EDX) serve a prominent role in the diagnostic workup of cubital tunnel syndrome (CBTS), but their reported sensitivity varies widely. The goals of our study were to determine the sensitivity of EDX in a cohort of patients who responded well to surgical cubital tunnel release (CBTR), and whether the implementation of the Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) criteria improves the sensitivity. We identified 118 elbows with clinical CBTS who had preoperative EDX and underwent CBTR. The EDX diagnoses were CBTS, ulnar neuropathy (UN), and normal ulnar nerves. We divided the 118 elbows into those that received above-elbow stimulation (XE group) and those that did not (non-XE group). We calculated the sensitivities for all groups and reinterpreted the results according to the AANEM guidelines. Cubital tunnel release provided significant relief in 93.6% of the elbows. Based on the EDX reports, 11% patients had clear CBTS, 23% had UN, and 66% showed no UN. The sensitivities were 11.7% for CBTS and 34.2% for any UN. In the XE group, the sensitivity of the EDX reports for CBTS and UN climbed to 33.3% and 58.3%, respectively. When we calculated the across-elbow motor nerve conduction velocity, the sensitivity for CBTS and UN was 87.5% and 100%, respectively. The XE and non-XE groups showed no difference except for sex, bilaterality, concomitant carpal tunnel release, and obesity ( < .05). Implementing AANEM guidelines results in significant improvement in correlation of clinical and electrodiagnostic findings of CBTS.
电诊断研究(EDX)在肘管综合征(CBTS)的诊断检查中发挥着重要作用,但其报道的敏感性差异很大。我们研究的目的是确定在一组对手术肘管松解术(CBTR)反应良好的患者中EDX的敏感性,以及实施神经肌肉与电诊断医学协会(AANEM)标准是否能提高敏感性。我们确定了118例临床诊断为CBTS且术前进行了EDX检查并接受了CBTR的肘部病例。EDX诊断结果为CBTS、尺神经病变(UN)和尺神经正常。我们将这118例肘部病例分为接受肘上刺激的病例(XE组)和未接受肘上刺激的病例(非XE组)。我们计算了所有组的敏感性,并根据AANEM指南重新解释结果。肘管松解术使93.6%的肘部症状得到显著缓解。根据EDX报告,11%的患者有明确的CBTS,23%的患者有UN,66%的患者未显示出UN。CBTS的敏感性为11.7%,任何UN的敏感性为34.2%。在XE组中,EDX报告对CBTS和UN的敏感性分别升至33.3%和58.3%。当我们计算跨肘运动神经传导速度时,CBTS和UN的敏感性分别为87.5%和100%。除了性别、双侧性、同时进行腕管松解术和肥胖外,XE组和非XE组没有差异(<0.05)。实施AANEM指南可显著改善CBTS临床和电诊断结果的相关性。