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A Scoring System for Predicting Recovery to a Grade of Minimal Physical Assistance after Stroke
Author(s) -
Stineman Margaret G.,
Xie Dawei,
Kwong Pui L.,
Kurichi Jibby,
Ripley Diane Cowper,
Bruce Vogel W.,
Bates Barbara E.
Publication year - 2013
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2013.08.087
Subject(s) - bates , gerontology , library science , medicine , engineering , computer science , aerospace engineering
Disclosures: H. Chen, No Disclosures: I Have Nothing To Disclose. Case Description: We present a case series of three patients with a prior history of anterior ulnar nerve transposition surgery who underwent an ulnar motor nerve conduction study (NCS) utilizing ultrasound assistance. Setting: Outpatient Electrodiagnostic Clinic Results or Clinical Course: The NCS was carried out using a Sonosite M-Turbo ultrasound system (Sonosite, Bothell, WA, USA) equipped with a 13-6 MHz multifrequency, linear transducer and a Cadwell Sierra Wave EMG machine (Cadwell, Kennewick, WA, USA). In all three patients, the ulnar nerve was easily localized anterior to the medial epicondyle. The nerve was subsequently mapped to determine the proper below-elbow and above-elbow stimulation sites. Once the nerve was mapped, the nerve conduction study was carried out in a routine manner. All patients tolerated the procedure well. Discussion: Ulnar nerve entrapment at the elbow (cubital tunnel syndrome) is one of the most common compression neuropathies. Surgical treatment of cubital tunnel syndrome typically involves decompression and anterior transposition of the ulnar nerve. After surgical treatment, patients will often be referred for repeat NCS to assess for changes in conduction velocity. However, in a patient with a transposed ulnar nerve, it is technically difficult to localize the proper NCS stimulation sites and mapping of nerve position is performed through multiple submaximal stimulations. In addition, without knowing the true anatomical location of the nerve, it is difficult to obtain accurate measurements of the nerve length. These factors lead to inaccurate conduction velocity studies and increased patient discomfort. We present a case series of a novel approach to ulnar motor NCS with ultrasound assistance. We believe that our approach eliminates the need for mapping of the nerve position with multiple stimuli, giving improved patient comfort. In addition, by knowing the exact course of the transposed nerve, it may result in more accurate measurements of the ulnar nerve length and improved NCS accuracy and efficiency. Conclusions: With a strong anatomy background and appropriate training in this modality, ultrasound may be successfully applied to NCS of the ulnar nerve in patients with a history of an anterior ulnar nerve transposition.