Normative Values of Nerve Conduction Studies of the Ulnar and Median Nerves Measured in a Standardized Way

Česká verzia

Authors: P. Ridzoň ^1,2; E. Ehler ³; P. Urban ^2,4; B. Procházka ⁴; R. Mazanec ⁵; J. Latta ³; H. Matulová ⁶; P. Otruba ⁷
Authors place of work: Neurologické oddělení, Thomayerova nemocnice, Praha ¹; Klinika pracovního lékařství 1. LF UK a VFN v Praze ²; Neurologická klinika FZS UPa a Pardubické krajská nemocnice, a. s. ³; Státní zdravotní ústav, Praha ⁴; Neurologická klinika 2. LF UK a FN v Motole, Praha ⁵; Neurologická klinika LF UK a FN Hradec Králové ⁶; Neurologická klinika LF UP a FN Olomouc ⁷
Published in the journal: Cesk Slov Neurol N 2014; 77/110(2): 210-215
Category: Short Communication

Práce byla podpořena grantem IGA č. NS/ 10324- 3.

Summary

Objective:
The objective of the study was to set normative values of conduction parameters of the median (NM) and ulnar nerves (NU) on a sufficiently large group of healthy volunteers using standardized methodology. The examination of NU focused on conduction across the elbow region. The differences in conduction parameters between males and females, dominant and non-dominant hands, right and left hands, and their dependence on age were also evaluated.

Subjects and methods:
A total of 227 healthy volunteers, mean age 39.4 years, were examined in five EMG laboratories in the Czech Republic.

Results:
NU: The amplitude of the compound motor action potential (CMAP) registered by a surface electrode from the abductor digiti minimi muscle (ADM) stimulated at the wrist, was 9.6 ± 2.3 mV; motor conduction velocity (MNCV) at the forearm was 60.4 ± 5.2 mV; MNCV across the elbow 57.1 ± 5.9 m/s. When registering from the first dorsal interosseus muscle (IDI) the amplitude of CMAP was 12.0 ± 4.0 mV; MNCV was 59.7 ± 4.7 m/s at the forearm, and 56.5 ± 5.7 m/s across the elbow. Mean difference between MNCV at the forearm and across the elbow was 3.3 ± 6.6 m/s when registering from ADM and 3.2 ± 6.4 m/s when registering from IDI, sensory nerve conduction velocity (SNCV) was 55.8 ± 4.8 m/s. MN: The mean amplitude of CMAP was 10.0 ± 3.0 mV; MNCV at the forearm was 57.1 ± 4.6 m/s; the mean amplitude of the sensory nerve action potential for digit II was 25.7 ± 12.5 µV; SNCV was 55.8 ± 4.7 m/s.

Conclusion:
Owing to the standardized methodology and the large size of the examined group, the data from our study can be used as normative data for conduction studies of UN at the Guyon canal, the forearm, and across the elbow, as well as for the conduction studies of MN distally and at the forearm. Neither the differences in the measured parameters between males and females, dominant and non-dominant hands, and right and left hands, nor the decrease of MNCV with age were clinically significant.

Key words:
nerve conduction studies – reference values – ulnar nerve – median nerve – sex differences – side differencies

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Kimura J. Electrodiagnosis in diseases of nerve and muscle. Priciple and practise. 3rd ed. New York: Oxford University Press 2001: 131– 148.

2. Oh SJ. Clinical electromyography. Nerve conduction studies. 2nd ed. Baltimore: Williams Wilkins 1993: 39– 69, 84– 97.

3. Buschbacher RM. Manual of nerve conduction studies. New York: Demos 2000: 10– 17, 74– 81, 104– 111, 130– 136.

4. Kadaňka Z, Dufek J, Hromada J. Standard elektrofyziologického vyšetření syndromu karpálního tunelu pro potřeby hlášení choroby z povolání. Reviz Posud Lék 2005; 8(2): 41– 45.

5. Kadaňka Z, Bednařík J, Voháňka S. Praktická elektromyografie. Brno: IDVPZ 1994: 66– 74.

6. Metodické opatření ke stanovení nejméně středního stupně závažnosti izolovaného syndromu karpálního tunelu. Věstník MZd ČR 2003; 10: 3– 4.

7. Ehler E, Ridzoň P, Nakládalová M, Urban P, Mazanec R, Fenclová Z. Neurofyziologická diagnostika poškození loketního nervu v oblasti lokte. Cesk Slov Neurol N 2012; 75/ 108(3): 320– 325.

8. Ehler E, Ridzoň P, Urban P, Mazanec R, Nakládalová M, Procházka B et al. Ulnar nerve at the elbow – normative nerve conduction study. J Brachial Plex Peripher Nerve Inj 2013; 8(1): 2.

9. Metodické opatření ke stanovení středního stupně závažnosti poškození loketního nervu v oblasti lokte za pomoci elektrofyziologických kritérií. Věstník MZd ČR 2011; 11: 46– 50.

10. Kadaňka Z., Dufek J, Hromada J. Standard elektrofyziologického vyšetření syndromu karpálního tunelu pro potřeby hlášení choroby z povolání. Dostupné z URL: http:/ / www.czech‑ neuro.cz/ clanek/ 4- Sy‑ karpalniho‑ tunelu/ index.html.

11. AANEM: Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve 1999; 22(3): 408– 411.

12. Benatar M, Wuu J, Peng L. Reference data for commonly used sensory and motor nerve conduction studies. Muscle Nerve 2009; 40: 772– 794.

13. Buschbacher RM. Ulnar nerve motor conduction to the abductor digiti minimi. Am J Phys Med Rehabil 1999; 78 (Suppl 6): S38– S42.

14. Kothari MJ, Heistand M, Rutkove SB. Three ulnar nerve conduction studies in patients with ulnar neuropathy at the elbow. Arch Phys Med Rehabil 1998; 79(1): 87– 89.

15. Kitzinger HB, Aszmann OC, Moser VL, Frey M. Significance of electroneurographic parameters in the diagnosis of chronic neuropathy of the ulnar nerve at the elbow. Handchir Mikrochir Plast Chir 2005; 37(4): 276– 281.

16. Fujimaki Y, Kuwabara S, Sato Y, Isose S, Shibuya K,Sekiguchi Y et al. The effects of age, gender, and body mass index on amplitude of sensory nerve action potentials: multivariate analyses. Clin Neurophysiol 2009; 120(9): 1683– 1686.

17. Garg R, Bansal N, Kaur H, Arora KS. Nerve conduction studies in the upper limb in the malwa region‑ normative data. J Clin Diagn Res 2013; 7(2): 201– 204.

18. Bolton CF, Carter KM. Human sensory nerve compound action potential amplitude: variation with sex and finger circumference. J Neurol Neurosurg Psychiatry 1980; 43(10): 925– 928.

19. Stetson DS, Albers JW, Silverstein BA, Wolfe RA.Effects of age, sex, and anthropometric factors on nerve conduction measures. Muscle Nerve 1992; 15(10): 1095– 1104.

20. Kimura J. Handbook of clinical neurophysiology. Volume 7. Peripheral Nerve diseases. Ediburgh: Elsevier 2006: 467– 525.