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Rheumatology Advance Access originally published online on June 30, 2009
Rheumatology 2009 48(9):1098-1101; doi:10.1093/rheumatology/kep167
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies

Alessandro Volpe1, Gianluca Rossato2, Mara Bottanelli3, Antonio Marchetta1, Paola Caramaschi4, Lisa Maria Bambara4, Claudio Bianconi2, Guido Arcaro1 and Walter Grassi5

1Department of Internal Medicine, 2Neurology Department, Sacro Cuore Hospital, Verona, 3Neurology Department, Arzignano Hospital, Vicenza, 4Department of Clinical and Experimental Medicine, University of Verona, Verona and 5Department of Rheumatology, University of Ancona, Jesi, Italy.

Correspondence to: Alessandro Volpe, Department of Internal Medicine, Sacro Cuore Hospital, Via Sempreboni 5, 37024 Negrar, Verona, Italy. E-mail: reumatologia{at}sacrocuore.it


  Abstract

Objectives. To evaluate, in patients with ulnar neuropathy at the elbow (UNE), if ultrasonographic differences in ulnar nerve size correlate with severity score determined by electrodiagnostic studies.

Methods. We examined prospectively 38 patients (50 elbows) with UNE. Patients were classified into mild, moderate and severe groups according to electrodiagnostic studies. Cross-sectional areas (CSAs) of the ulnar nerve were measured 4 cm proximal to the medial epicondyle (CSA-prox), 4 cm distal to the epicondyle (CSA-dist) and at the maximum CSA (CSA-max) of the ulnar nerve found between these points. We used a control group of 50 normal elbows.

Results. The CSA-max in the patient group was highly correlated with the severity score obtained by electrodiagnostic studies: mild: 11.1 ± 3.4 mm2, moderate: 15.8 ± 3.8 mm2, severe: 18.3 ± 5.1 mm2 (P < 0.001). Patients with UNE had larger ulnar nerve CSAs than controls at all three levels (P = 0.012 for CSA-prox, P < 0.001 for CSA-max, P = 0.003 for CSA-dist). A cut-off point of >=10 mm2 for CSA-max yields both sensitivity and specificity of 88%.

Conclusions. Ultrasonography can have a role not only in the diagnosis, but also in the severity stratification of patients with UNE.

KEY WORDS: Ultrasound, Entrapment neuropathy, Ulnar neuropathy at the elbow, Ultrasound of peripheral nerves

Submitted 22 March 2009; Accepted 20 May 2009


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