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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(03): 195-200
DOI: 10.1590/0004-282X-ANP-2020-0193
ARTICLE

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow

Determinação da utilidade das alterações mínimas da latência da onda F no eletrodiagnóstico da neuropatia ulnar do cotovelo
Abdulkadir TUNÇ 
1   Sakarya University, Sakarya Training and Research Hospital, Sakarya, Turkey.
,
Vildan GÜZEL 
2   Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
,
Aysel TEKEŞİN 
3   Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey.
,
Yıldızhan ŞENGÜL 
4   Gaziosmanpaşa Taksim Education and Research Hospital, Department of Neurology, Istanbul, Turkey.
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ABSTRACT

Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

RESUMO

Introdução: A neuropatia ulnar do cotovelo (NUC) é a segunda neuropatia por encarceramento mais comum. Existem poucas informações sobre a aplicação dos estudos da onda F para avaliação da NUC. Objetivo: O objetivo deste estudo foi avaliar o valor diagnóstico das alterações mínimas de latência da onda F (F-min), comparando-as com análises de condução nervosa em pacientes com suspeita de NUC. Métodos: Noventa e quatro pacientes com suspeita de NUC foram admitidos neste estudo. A condução nervosa sensitiva e motora e as análises da onda F nos nervos mediano e ulnar foram realizadas em ambas as extremidades superiores. Resultados: Um total de 188 membros superiores de 94 pacientes foi examinado. A média de idade foi 41,4±12,9 anos e 69 pacientes eram do sexo feminino (73,4%). A velocidade de condução motora média do nervo ulnar através do cotovelo (VCM) nos braços afetados foi significativamente mais lenta do que a velocidade em braços saudáveis. As latências médias F-min do nervo ulnar foram significativamente mais longas nos braços afetados. Cinquenta e um pacientes foram diagnosticados eletrofisiologicamente como apresentando NUC (54,2%). Pacientes com presença de NUC tiveram, de forma significativa, detecção de VCM mais lenta no nervo ulnar ao nível do cotovelo, presença de latência mais longa da onda F-mínima no nervo ulnar, bem como latência de início distal mais longa. Por fim, os pacientes sintomáticos, e com condução nervosa normal, foram avaliados separadamente. Apenas a latência da onda F mínima média do nervo ulnar foi significativamente maior neste grupo, em comparação com os braços saudáveis. Conclusão: Nosso estudo confirmou a utilidade das medidas de latência da onda F-mínima no eletrodiagnóstico da NUC. As diferenças de latência da onda F podem ajudar a fazer um diagnóstico precoce para fornecer melhores opções de tratamento.

Keywords:

Cubital Tunnel Syndrome - Median Nerve - Ulnar Nerve - Electrodiagnosis

Palavras-chave:

Síndrome do Túnel Cubital - Nervo Mediano - Nervo Ulnar - Electrodiagnóstico

Authors’ contribution:

AT: concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review. VG: concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, manuscript preparation, manuscript editing, manuscript review. AT: concept, design, definition of intellectual content, clinical studies, experimental studies, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review. YŞ: concept, design, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review.




Publication History

Received: 10 May 2020

Accepted: 24 July 2020

Article published online:
07 June 2023

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  • REFERENCES

  • 1 Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005 Jul;234(1-2):5-10. https://doi.org/10.1016/j.jns.2005.02.010
  • 2 Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, et al. Cubital tunnel syndrome- a review and management guidelines. Cent Eur Neurosurg 2011. May;72(2):90-8. https://doi.org/10.1055/s-0031-1271800
  • 3 Todnem K, Michler RP, Wader TE, Engstrøm M, Sand T. The impact of extended electrodiagnostic studies in ulnar neuropathy at the elbow. BMC Neurol. 2009 Oct;9:52. https://doi.org/10.1186/1471-2377-9-52
  • 4 Uludağ B, Kisabay A, Ataç C, Karatepe A, Turman B. F wave parameters and F-Jitter. J Neurol Sci. 2006 Jan;23(1):8-13.
  • 5 Sathya GR, Krishnamurthy N, Veliath S, Arulneyam J, Venkatachalam J. F wave index: A diagnostic tool for peripheral neuropathy. Indian J Med Res. 2017 Mar;145(3):353-7. https://doi.org/10.4103/ijmr.IJMR_1087_14
  • 6 Koçer A, Gözke E, Dörtcan N, Us O. A comparison of F waves in peripheral nerve disorders. Electromyogr Clin Neurophysiol. 2005 Dec;45(7-8):417-23.
  • 7 Fraser JL, Olney RK. The relative diagnostic sensitivity of different F-wave parameters in various polyneuropathies. Muscle Nerve. 1992 Aug;15(8):912-8. https://doi.org/10.1002/mus.880150808
  • 8 Alemdar M. Value of F-wave studies on the electrodiagnosis of carpal tunnel syndrome. Neuropsychiatr Dis Treat 2015 Aug; 11:2279-86. htps://doi.org/10.2147/ndt.s45331
  • 9 Cevik MU, Altun Y, Uzar E, Acar A, Yucel Y, Arıkanoglu A, et al. Diagnostic value of F-wave inversion in patients with early carpal tunnel syndrome. Neurosci Lett 2012 Feb;508(2):110-3. https://doi.org/10.1016/j.neulet.2011.12.030
  • 10 Alemdar M. Ulnar to median nerve minimum F-wave latency difference in confirmation of ulnar neuropathy at elbow. J Clin Neurophysiol 2013 Aug;30(4):411-4. https://doi.org/10.1097/wnp.0b013e31829ddb84
  • 11 American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter: electrodiagnostic studies in ulnar neuropathy at the elbow. Neurology. 1999 Mar;52(4):688-90. https://doi.org/10.1212/wnl.52.4.688
  • 12 Kim DH, Kang YK, Hwang M, Jo HS, Kim KH. Localization of ulnar neuropathy at the elbow using new stimulator for the inching test. Clin Neurophysiol. 2004 May;115(5):1021-6. https://doi.org/10.1016/j.clinph.2003.12.017
  • 13 Kern RZ. The electrodiagnosis of ulnar nerve entrapment at the elbow. Can J Neurol Sci. 2003;30(4):314-9. https://doi.org/10.1017/s0317167100003012
  • 14 Azrieli Y, Weimer L, Lovelace R, Gooch C. The utility of segmental nerve conduction studies in ulnar mononeuropathy at the elbow. Muscle Nerve. 2003 Jan;27(1):46-50. https://doi.org/10.1002/mus.10293
  • 15 Beekman R, Plas Van Der JPL, Uitdehaag BMJ, Schellens RLLA, Visser LH. Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve. 2004 Aug;30(2):202-8. https://doi.org/10.1002/mus.20093
  • 16 Sattari S, Emad M. Changes in ulnar nerve conduction velocity across the elbow in different angles of elbow flexion. Electromyogr Clin Neurophysiol. 2007 Nov-Dec;47(7-8):373-6.
  • 17 Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. WITHDRAWN: Second AAEM literature review of the usefulness of nerve conduction studies and needle electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve. 2002 Jun;S977. https://doi.org/10.1002/mus.10215
  • 18 Cevik MU, Altun Y, Uzar E, Acara A, Yucela Y, Arikanoglua A, et al. Diagnostic value of F-wave inversion in patients with early carpal tunnel syndrome. Neurosci Lett. 2012 Feb;508(2):110-3. https://doi.org/10.1016/j.neulet.2011.12.030
  • 19 Menkes DL, Hood DC, Bush AC. Inversion of the F-waves in median neuropathy at the wrist (carpal tunnel syndrome) an adjunctive electrodiagnostic method. J Contemp Neurol. 1997;1:2-9.
  • 20 Weber F. The diagnostic sensitivity of different F-wave parameters. J Neurol Neurosurg Psychiatry. 1998 Oct;65(4):535-40. https://doi.org/10.1136/jnnp.65.4.535
  • 21 Hilburn JW. General principles and use of electrodiagnostics studies in carpal and cubital tunnel syndromes. With special attention to pitfalls and interpretation. Hand Clin. 1996 May;12(2):205-21.
  • 22 Landau ME, Barner KC, Campbell WW. Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at the elbow, and carpal tunnel syndrome. Muscle Nerve. 2005 Sep;32(5):360-3. https://doi.org/10.1002/mus.20345
  • 23 Nouhan R, Kleinert JM. Ulnar nerve decompression by transposing the nerve and z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg Am. 1997 Jan;22(1):127-31. https://doi.org/10.1016/s0363-5023(05)80192-3
  • 24 Erdem HR, Ergun S, Erturk C, Ozel S. Electrophysiological evaluation of the incidence of martin-gruber anastomosis in healthy subjects. Yonsei Med J. 2002 Jun;43(3):291-5. https://doi.org/10.3349/ymj.2002.43.3.291