Retrograde denervation occurs in severe entrapment neuropathy. This study aimed to investigate changes in motor nerve conduction velocity (MNCV) at the upper arm, specifically proximal to the elbow, in cubital tunnel syndrome (CuTS) and to correlate these changes with preoperative severity and postoperative outcomes.
Methods
We retrospectively reviewed 95 elbows with 81 patients with CuTS for preoperative severity, and then 67 elbows with 60 of these patients who underwent anterior subcutaneous transposition surgery for postoperative outcome, classified into favorable and unfavorable groups according to Messina grade.
Results
The reduction of upper arm MNCV was correlated with aging, decreased compound muscle action potentials of abductor digiti minimi muscle, loss of sensory nerve action potentials, and modified McGowan grade. Postoperative assessment revealed lower MNCV values in the “unfavorable” group compared to the “favorable” group at 1 month, 6 months, and the last follow up. At each time point, the optimal cut-off value of upper arm MNCV for predicting postoperative outcomes was 54.1 m/s.
Discussion
Upper arm MNCV might be a useful predictor of poor surgical outcome. Ulnar nerve MNCV at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery.
SoltaniAMBestMJFrancisCS, et al.Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am2013; 38: 1551–1556. DOI: 10.1016/j.jhsa.2013.04.044.
Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve1999; 22: 408–411. DOI: 10.1002/(sici)1097-4598(199903)22:3<408::Aid-mus16>3.0.Co;2-7.
4.
DyCJ. Does an objective and reliable measure of disease severity for cubital tunnel syndrome exist? Commentary on an article by Hollie A. Power, MD, et al.: “compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome”. J Bone Joint Surg Am2019; 101: e34. DOI: 10.2106/JBJS.19.00058.
5.
LiuZJiaZRWangTT, et al.Preliminary study on the lesion location and prognosis of cubital tunnel syndrome by motor nerve conduction studies. Chin Med J2015; 128: 1165–1170. DOI: 10.4103/0366-6999.156100.
6.
TongJDongZXuB, et al.Predictors of surgical outcomes for severe cubital tunnel syndrome : a review of 146 patients. Acta Neurochir2018; 160: 645–650.
7.
FlorczynskiMMKongLBurnsPB, et al.Electrodiagnostic predictors of outcomes after in situ decompression of the ulnar nerve. J Hand Surg Am2023; 48: 28–36. 20221110. DOI: 10.1016/j.jhsa.2022.10.008.
8.
MeilingJBSchappellJBTwoheyEE, et al.Preoperative electrodiagnostic studies and postoperative outcomes for ulnar mononeuropathy at the elbow: a systematic review. PM R2023; 15: 1326–1334. 20230224. DOI: 10.1002/pmrj.12952.
9.
BeekmanRWokkeJHJSchoemakerMC, et al.Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology2004; 63: 1675–1680. DOI: 10.1212/01.wnl.0000142535.24626.90.
10.
GilchristJMSachsGM. Electrodiagnostic studies in the management and prognosis of neuromuscular disorders. Muscle Nerve2004; 29: 165–190. DOI: 10.1002/mus.10489.
11.
AlemdarM. Diagnostic values of conventional conduction parameters in ulnar neuropathy at elbow. Ideggyogy Sz2021; 74: 397–407. DOI: 10.18071/isz.74.0397.
12.
KimuraJ. Electrodiagnosis in diseases of nerve and muscle: principles and practice. Fourth ed.New York: Oxford University Press, 2013: 114–114.
FriedmanRJCochranTP. A clinical and electrophysiological investigation of anterior transposition for ulnar neuropathy at the elbow. Arch Orthop Trauma Surg1987; 106: 375–380. DOI: 10.1007/BF00456873.
15.
ThomasPK. Motor nerve conduction in the carpal tunnel syndrome. Neurology1960; 10: 1045–1045. DOI: 10.1212/wnl.10.12.1045.
16.
ThomasPKFullertonPM. Nerve fibre size in the carpal tunnel syndrome. J Neurol Neurosurg Psychiat1963; 26: 520–527. DOI: 10.1136/jnnp.26.6.520.
17.
StoehrMPetruchFScheglmannK, et al.Retrograde changes of nerve fibers with the carpal tunnel syndrome. An electroneurographic investigation. J Neurol1978; 218: 287–292. DOI: 10.1007/BF00312884.
18.
HawleyJCapobiancoJ. Localizing ulnar nerve lesions by motor nerve conduction study. Electromyogr Clin Neurophysiol1987; 27: 385–392.
19.
OchiaiNHonmoJTsujinoA, et al.Electrodiagnosis in entrapment neuropathy by the arcade of Struthers. Clin Orthop Relat Res2000; 378: 129–135. DOI: 10.1097/00003086-200009000-00021.
20.
JoyntRL. Correlation studies of velocity, amplitude, and duration in median nerves. Arch Phys Med Rehabil1989; 70: 477–481. DOI: 10.1016/0003-9993(89)90011-7.
21.
ChangMHLiuLHLeeYC, et al.Alteration of proximal conduction velocity at distal nerve injury in carpal tunnel syndrome: demyelinating versus axonal change. J Clin Neurophysiol2008; 25: 161–166. DOI: 10.1097/WNP.0b013e3181775981.
22.
KimuraIAyyarDRLippmannSM. Early electrodiagnosis of the ulnar entrapment neuropathy at the elbow. Tohoku J Exp Med1984; 142: 165–172. DOI: 10.1620/tjem.142.165.
23.
ChangMHWeiSJChiangHL, et al.The cause of slowed forearm median conduction velocity in carpal tunnel syndrome: a Palmar stimulation study. Clin Neurophysiol2002; 113: 1072–1076. DOI: 10.1016/S1388-2457(02)00117-7.
24.
McGowanAJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br1950; 32-B: 293–301. DOI: 10.1302/0301-620X.32B3.293.
25.
GoldbergBJLightTRBlairSJ. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am1989; 14: 182–188. DOI: 10.1016/0363-5023(89)90003-8.
26.
MessinaAMessinaJC. Transposition of the ulnar nerve and its vascular bundle for the entrapment syndrome at the elbow. J Hand Surg Br1995; 20: 638–648.
27.
AndersonMHFullertonPMGilliattRW, et al.Changes in the forearm associated with median nerve compression at the wrist in the Guinea-pig. J Neurol Neurosurg Psychiat1970; 33: 70–79. DOI: 10.1136/jnnp.33.1.70.
28.
ChangMHChiangHTGerLP, et al.The cause of slowed forearm median conduction velocity in carpal tunnel syndrome. Clin Neurophysiol2000; 111: 1039–1044. DOI: 10.1016/s1388-2457(00)00288-1.
29.
ChangMHLiaoKKChangSP, et al.Proximal slowing in carpal tunnel syndrome resulting from either conduction block or retrograde degeneration. J Neurol1993; 240: 287–290. DOI: 10.1007/BF00838163.
30.
ChangMHLiuLHWeiSJ, et al.Does retrograde axonal atrophy really occur in carpal tunnel syndrome patients with normal forearm conduction velocity?Clin Neurophysiol2004; 115: 2783–2788. DOI: 10.1016/j.clinph.2004.08.002.
31.
ChangMHLeeYCHsiehPF. The role of forearm mixed nerve conduction study in the evaluation of proximal conduction slowing in carpal tunnel syndrome. Clin Neurophysiol2008; 119: 2800–2803. DOI: 10.1016/j.clinph.2008.09.014.
32.
ChangMHLeeYCHsiehPF. The real role of forearm mixed nerve conduction velocity in the assessment of proximal forearm conduction slowing in carpal tunnel syndrome. J Clin Neurophysiol2008; 25: 373–377. DOI: 10.1097/WNP.0b013e31818e7930.
33.
HavtonLAHotsonJRKellerthJO. Correlation of median forearm conduction velocity with carpal tunnel syndrome severity. Clin Neurophysiol2007; 118: 781–785. 20070216. DOI: 10.1016/j.clinph.2006.12.011.
34.
PowerHASharmaKEl-HajM, et al.Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome. J Bone Joint Surg2019; 101: 730–738. DOI: 10.2106/JBJS.18.00554.
35.
MatsuzakiHYoshizuTMakiY, et al.Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg Am2004; 29: 373–378. DOI: 10.1016/j.jhsa.2004.01.010.
36.
TahaAGalarzaMZuccarelloM, et al.Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction. Neurosurgery2004; 54: 891–896. discussion 895-896. DOI: 10.1227/01.neu.0000115152.78918.61.
37.
KonishiH. Motor nerve conduction studies in the median and ulanar nerves in old adults over 80 years of age. J Japn Orthop Ass1982; 56: 305–320.
38.
TrojaborgW. Motor nerve conduction velocities in normal subjects with particular reference to the conduction in proximal and distal segments of median and ulnar nerve. Electroencephalogr Clin Neurophysiol1964; 17: 314–321. DOI: 10.1016/0013-4694(64)90132-4.
39.
KincaidJCPhillipsLH2ndDaubeJR. The evaluation of suspected ulnar neuropathy at the elbow. Normal conduction study values. Arch Neurol1986; 43: 44–47. DOI: 10.1001/archneur.1986.00520010040019.
40.
BhalaRP. Electrodiagnosis of ulnar nerve lesions at the elbow. Arch Phys Med Rehabil1976; 57: 206–212.
41.
LangHAPuusaAHynninenP, et al.Evolution of nerve conduction velocity in later childhood and adolescence. Muscle Nerve1985; 8: 38–43. DOI: 10.1002/mus.880080108.
42.
ShellySRamon-GonenRPaulP, et al.Nerve conduction differences in a large clinical population: the role of age and sex. J Neuromuscul Dis2023; 10: 925–935. DOI: 10.3233/JND-230052.
43.
Al-QattanMMMurrayKA. The arcade of Struthers: an anatomical study. J Hand Surg Br1991; 16: 311–314. DOI: 10.1016/0266-7681(91)90059-w.
