Publication: Ulnar sinirin dirsek altı ve dirsek üstü arası segmentinde konvansiyonel yöntemle saptanamayan tuzaklanmasının kısa segment santimleme yöntemiyle araştırılması
Abstract
Amaç:Bu çalışmada, dirsek seviyesinde ulnar sinir tuzaklanması açısından semptomatik olan, ancak rutin elektrofizyolojik tetkikler ile anormalliğin saptanamadığı hastalarda, kısa segment santimleme yöntemi kullanılarak, elektrofizyolojik patolojinin araştırılması amaçlandı. Gereç ve Yöntem:Çalışmamız, Nöroloji ABD polikliniğine başvuran, dirsek seviyesinde ulnar sinir tuzaklanmasını düşündürür hastalarda yapılan elektrodiagnostik testler sonrasında, konvansiyonel elektrofizyolojik yönteme göre dirsek altı ve dirsek üstü arasında iletim hızı ve/ veya amplütüde göre anormalliği olmayan 16 hasta ve 18 sağlıklı gönüllü üzerinde yapıldı. Çalışma, grupdaki 7 hastada bilateral tutulum olması nedeni ile 23 kol olarak değerlendirildi. Bütün olgularda median ve ulnar sinir motor, duyu çalışmaları ile dirsekte kısa segment motor iletim çalışması yapıldı. F cevapları çalışıldı. Ulnar motor sinir ileti çalışmaları dirsek 130 derece fleksiyondayken abdüktor digiti minimi kasında yapıldı. Dirsek segmentinde santimleme yöntemi ile ölçülen latans farkı, iletim hızları ve amplitüdleri standart yöntem ile kontrol grubundan elde edilen verilerle karşılaştırıldı. Bulgular: Bu çalışmada, konvansiyonel yöntemde dirsek üstü latanslar (7,2±0,54) uzun, dirsek segmentinde ileti hızları (53,02±2,96) ön kol segmentine göre %19,14 düşük bulundu. Kısa segment santimleme yönteminde dirsek altı 2-dirsek ve dirsek-dirsek üstü 2 cm segmentinde latans farkı (0,42 msn) uzun ve bu aralıklarda iletim hızı yavaş bulundu (sırasıyla 47,5±11,13 , 45,78±12,94). Sonuç:Ulnar sinirin dirsek seviyesindeki tuzak nöropatisinin araştırılmasında kullanılmakta olan konvansiyonel elektrofizyolojik yöntem ile, dirsek seviyesindeki tuzaklanma saptanamayabilir. Kısa segment sinir ileti çalışmaları konvansiyonel motor ve duysal çalışmalardan daha duyarlıdır ve lokalizasyonla ilgili önemli bilgi sağlayabilir. Özellikle rutin çalışmalarda, dirsekte şüpheli bulguları olan hastalarda, ulnar nöropati saptanmasında yararlı bir araçtır. Sonuç olarak, ulnar sinirin dirsek seviyesinde tuzak nöropati tanısında kısa segment çalışmasının rutin olarak yapılmasını önermekteyiz. Ulnar tuzak nöropati, kısa segment iletim, santimleme
Investigation of The Ulnar Nerve Entrapment by Short Segment Nerve Conduction Velocity Study Between the Below and Above Elbow Segment Not Detected by Conventional Technique. Objective: The aim of this study was to investigate the electrodiagnostic pathology by using short segment nerve conduction study in patients wıth symptomatic ulnar nerve compression at the elbow segment with normal routine electrophysiological studies. Method and materials: We studied l6 patients wıth symptomatic ulnar nerve entraptment and 18 healthy volunteers admitted to neurology department wıth normal nerve conduction velocity and/ or amplitude changes across elbow and above elbow segment by using routine electrophysiological tests. İn the study group 23 arms were evaluated because 7 patients had bilateral involvement. In addition to median and unlar nevre motor and nerve studies, short segment nevre conduction studies were performed in all the patients. F-answers were studied also. The ulnar motor nerve conduction studies were performed at an elbow flexion 130 wıth abductor digiti minimi recording. The data of the latance change, conduction velocity and amplitudes between the groups of standart technique and inching technique were compared wıth the control group also. Results: In this study with routine tests latencies were prolonged (7.2+0.54) at above elbow segment, and nerve conduction velocıtes (53.02±2.96) was lowerthan below elbow segment at the rate of 19.14 %. In short segment nerve conduction velocity technique, latance change (0.42 mm) was prolonged at 2 cm distal elbow, across elbow and 2 cm proximal elbow segment, and conduction velocities were slowed at these segments (47.5±11.03, 45.78±12.94 respectivly). . . Conclusion: Conventıonal ulnar nerve conduction studies localize the lesion to elbow region and usually no attempts made to exactly localıze the lesion. SgNCS signifıcantly improves detection of ulnar mononeuropathy at the elbow and should be considered when routine studies are negative and clinical suspicians remains high. As a result short segment NCS should be considered routinely in the diagnosis of ulnar neuropathy at the elbow segment. Key words: ulnar nerve entrapment, short segment conduction, inching
Investigation of The Ulnar Nerve Entrapment by Short Segment Nerve Conduction Velocity Study Between the Below and Above Elbow Segment Not Detected by Conventional Technique. Objective: The aim of this study was to investigate the electrodiagnostic pathology by using short segment nerve conduction study in patients wıth symptomatic ulnar nerve compression at the elbow segment with normal routine electrophysiological studies. Method and materials: We studied l6 patients wıth symptomatic ulnar nerve entraptment and 18 healthy volunteers admitted to neurology department wıth normal nerve conduction velocity and/ or amplitude changes across elbow and above elbow segment by using routine electrophysiological tests. İn the study group 23 arms were evaluated because 7 patients had bilateral involvement. In addition to median and unlar nevre motor and nerve studies, short segment nevre conduction studies were performed in all the patients. F-answers were studied also. The ulnar motor nerve conduction studies were performed at an elbow flexion 130 wıth abductor digiti minimi recording. The data of the latance change, conduction velocity and amplitudes between the groups of standart technique and inching technique were compared wıth the control group also. Results: In this study with routine tests latencies were prolonged (7.2+0.54) at above elbow segment, and nerve conduction velocıtes (53.02±2.96) was lowerthan below elbow segment at the rate of 19.14 %. In short segment nerve conduction velocity technique, latance change (0.42 mm) was prolonged at 2 cm distal elbow, across elbow and 2 cm proximal elbow segment, and conduction velocities were slowed at these segments (47.5±11.03, 45.78±12.94 respectivly). . . Conclusion: Conventıonal ulnar nerve conduction studies localize the lesion to elbow region and usually no attempts made to exactly localıze the lesion. SgNCS signifıcantly improves detection of ulnar mononeuropathy at the elbow and should be considered when routine studies are negative and clinical suspicians remains high. As a result short segment NCS should be considered routinely in the diagnosis of ulnar neuropathy at the elbow segment. Key words: ulnar nerve entrapment, short segment conduction, inching