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EMG/Neuromuscular

Session Name: Learning Center: Ulnar nerve: Electrodiagnostic Challenges in Localizing Problems

Learning Center: Ulnar Nerve: electrodiagnostic Challenges in Localizing Problems

Saturday, October 22, 2022

11:00 AM – 12:00 PM ET

Session Director(s)

Faren H. Williams, MD, MS

Chief Pmr/clinical Prof
University of Massachusetts
Abington, Pennsylvania

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

PDF of Slides

Faculty(s)

William s. Pease, MD

Ernest W. Johnson Professor Emeritus
Ohio State University Hospital PM&R Program
Columbus, Ohio

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

PDF of Slides
Erik Ensrud, MD

Professor
University of Missouri Medical School
Columbia, Missouri

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Chrissa McClellan, MD MPT

Associate Professor PM&R
University of MO-Columbia
Columbia, Missouri

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

PDF of Slides

Lab Marketing

Description: : Electrodiagnostic study of the ulnar nerve can be challenging from a technical standpoint. Measurement around the elbow needs to be done with the elbow flexed, with different techniques described in the literature and varying interpretations of what constitutes a normal versus abnormal study. The session will focus on the importance of recording from the first dorsal interosseus and the abductor digiti minimus, It will stress the importance of contralateral comparison, especially when there is trauma, or an underlying peripheral neuropathy. Data which may look like a peripheral neuropathy could be a medial cord or lower trunk plexopathy. Only a more detailed, comprehensive electrodiagnostic examination can help to differentiate. Demonstration of skills, with emphasis on technical efficiency is important to make appropriate diagnoses and prevent inappropriate surgery. The literature has conflicting information on how to diagnose an ulnar neuropathy with electrodiagnosis. Different techniques are described in the literature with various technical approaches to doing the study. There is an ulnar nerve guideline endorsed by the American Association of Electrodiagnostic and Neuromuscular Medicine which described the variation in the literature, with recommendations for evaluation and interpretation of ulnar nerve studies. This session will provide an opportunity to perform a study using a subject, looking at the different positions for elbow positioning, and describing ways to minimize variations in measurement around the elbow. Goal is to help the participants learn how to approach a patient with possible ulnar nerve pathology.
Each session will be 1 hour in length
Learning Objectives:
Design an electrodiagnostic study for a potential ulnar nerve problem based on the patient's history and physical examination.
Perform a comprehensive nerve conduction study of the ulnar nerve, using different recording sites and muscles for needle EMG.
Understand potential reasons for measurement error about the elbow, and learn how to minimize error to obtain meaningful data.
Differentiate between ulnar nerve problems and other potential problems such as brachial plexopathies or peripheral neuropathies.