From the Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy (CV, FS); Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (SC, SM); EMG Service, Local Health Unit Toscana Sud Est, Siena, Italy (AA, MM); and EMG Service, Local Health Unit Toscana Sud Est, "Nottola" Hospital, Montepulciano (Siena), Italy (GG).
Am J Phys Med Rehabil. 2020 Feb;99(2):116-123. doi: 10.1097/PHM.0000000000001286.
The aim of the study was to evaluate the clinical and electrodiagnostic testing in ulnar neuropathy at the elbow and differences according to site (humeroulnar arcade vs. retroepicondylar groove) and injury physiopathology (axonal vs. demyelinating), through prospective multicenter case-control study.
Cases and controls were matched by age and sex. Ulnar neuropathy at the elbow diagnosis was made on symptoms. Statistical analysis was performed using Mann-Whitney, χ, and analysis of variance tests.
One hundred forty-four cases and 144 controls were enrolled. Sensory loss in the fifth finger had the highest sensitivity (70.8%) compared with clinical findings. Motor conduction velocity across elbow reached the highest sensitivity (84.7%) in localizing ulnar neuropathy at the elbow recording from at least one of the two hand muscles (first dorsal interosseous and abductor digiti minimi). Abnormal sensory action potential amplitude from the fifth finger occurred more frequently in axonal than in demyelinating forms. Differences between retroepicondylar groove and humeroulnar arcade regarded conduction block and job type.
Clinical findings have less usefulness than electrodiagnostic testing in ulnar neuropathy at the elbow diagnosis. Motor conduction velocity across elbow recorded from both abductor digiti minimi and first dorsal interosseous increases diagnostic accuracy. Axonal forms have greater clinical and electrodiagnostic testing severity than demyelinating forms, which are more frequent in retroepicondylar groove. Manual workers prevailed in humeroulnar arcade. These findings may be helpful in prognostic and therapeutic approaches.
本研究旨在通过前瞻性多中心病例对照研究，评估肘部尺神经病变的临床和电诊断检查结果，并比较不同部位（肱尺弓与肘后沟）和损伤病理生理学（轴索型与脱髓鞘型）的差异。
病例和对照按年龄和性别匹配。肘部尺神经病变的诊断基于症状。采用 Mann-Whitney、χ2 和方差分析进行统计分析。
共纳入 144 例病例和 144 例对照。与临床发现相比，第五指感觉丧失的敏感性最高（70.8%）。至少在手的两块肌肉（第一背侧骨间肌和小指展肌）中记录到肘部的运动传导速度时，其对定位肘部尺神经病变的敏感性最高（84.7%）。与脱髓鞘型相比，轴索型更容易出现第五指感觉动作电位幅度异常。肘后沟和肱尺弓之间的差异与传导阻滞和职业类型有关。
与电诊断检查相比，临床发现对肘部尺神经病变的诊断价值较低。记录自小指展肌和第一背侧骨间肌的肘部运动传导速度可提高诊断准确性。轴索型比脱髓鞘型的临床和电诊断检查严重程度更大，而后者在肘后沟更为常见。手工劳动者在肱尺弓中更为常见。这些发现可能有助于预后和治疗方法。
