title: Can neurologic examination predict pathophysiology of ulnar neuropathy at the elbow?
abstract: OBJECTIVE
  To explore the utility of neurologic examination to predict the pathophysiology of ulnar nerve lesions in patients with ulnar neuropathies at the elbow (UNE).
  
  
  METHODS
  We prospectively recruited consecutive patients with suspected UNE. Four blinded investigators took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. In patients with axonal UNE, conduction block and conduction slowing, the pathophysiologies of UNE and neurologic examination findings were compared.
  
  
  RESULTS
  We found significant differences in muscle bulk and strength of the ulnar hand muscles between 96 arms with axonal UNE, 34 with conduction block, and 45 with isolated conduction slowing. Severe muscle atrophy and weakness (0-3/5 on MRC) predicted axonal UNE, and moderate weakness (-4/5 on MRC) with normal muscle bulk predicted UNE with conduction block. Using more restrictive criteria for axonal and conduction block UNE, muscle strength of 4-5/5 on MRC was predictive of isolated conduction slowing.
  
  
  CONCLUSIONS
  Although we found significant differences in patterns of muscle bulk and strength between groups of UNE patients with different UNE pathophysiologies, in the majority of arms, neurologic examination could not reliably predict UNE pathophysiology.
  
  
  CONCLUSIONS
  Results confirm that nerve conduction studies are essential for determination of the pathophysiology of ulnar neuropathy at the elbow.
authors.affiliation: Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia. Electronic address: gregor.omejec@kclj.si.
authors.forename: Gregor
authors.initials: G
authors.lastname: Omejec
authors.affiliation: Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia. Electronic address: tomaz.zgur@kclj.si.
authors.forename: Tomaž
authors.initials: T
authors.lastname: Žgur
authors.affiliation: Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia. Electronic address: simon.podnar@kclj.si.
authors.forename: Simon
authors.initials: S
authors.lastname: Podnar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology; D009431:Neural Conduction; D009460:Neurologic Examination; D020424:Ulnar Neuropathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography
keywords: Axonal neuropathy; Nerve conduction block; Nerve conduction slowing; Nerve conduction studies; Neurologic examination; Pathophysiology of peripheral neuropathy; Ulnar neuropathy at the elbow