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001 Ulnar neuropathy with abnormal non-localising electrophysiology: clinical, electrophysiological and ultrasound findings
  1. Luciana Pelosi1,
  2. Dominic Ming Yin Tse1,
  3. Eoin Mulroy1,
  4. Andrew M Chancellor2,
  5. Michael R Boland2
  1. 1Neurology, Auckland City Hospital, Auckland, New Zealand
  2. 2Tauranga Hospital, Tauranga, New Zealand
  3. 3Hand Institute, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

Abstract

Introduction Ulnar neuropathy with abnormal non-localising electrophysiology (NL-UN) is often associated with significant disability that is difficult to manage due to the absence of anatomically defining studies. We studied demographic, clinical and electrophysiological characteristics of NL-UN and used ultrasound in order to assist with classification and to examine the utility of ultrasound over and above the conventional electro-diagnostic approach.

Method NL-UNs were identified from 113 consecutive referrals to a single neurophysiologist with suspected ulnar neuropathy. All received systematic electro-diagnostic tests and ulnar nerve ultrasound. NL-UN severity was graded using clinical and electrophysiological scales.

Results In 64 of 113 referrals, an ulnar mononeuropathy was confirmed by electrophysiology. Sixteen of these 64 (25%) had NL-UN, predominantly males (14 out of 16 patients) with severe or moderately severe clinical and electrophysiological ratings in 81%. Ultrasound showed focal ulnar neuropathy at the elbow (UNE) in 13 out of 16, and diffuse ulnar nerve abnormality in three, and identified a likely or possible causative mechanism in 11 UNEs.

Conclusion A quarter of ulnar neuropathies, as demonstrated by abnormal electrophysiology, were NL-UN, of heterogeneous aetiology; the majority were males with significant disability and axonal loss. Ultrasound had a significant role in localization and classification of NL-UN that facilitated management.

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