Diagnosis Confirmation Rates of Desired Electroneuromyography Results with Pre-Diagnosis of Upper Extremity Entrapment Neuropathy

Abstract

Objective Electroneuromyography (ENMG) is an examination used by clinicians to confirm the diagnosis of patients with suspicion of entrapment neuropathy. The correlation between the ENMG results and requests increases when the clinical examination and anamnesis are well evaluated. This study aims to determine the compatibility of the electroneurophysiological examinations made due to the prediagnosis of entrapment neuropathy at the ENMG Laboratory in the Neurology Clinic and determine whether there is a difference between the clinics that made the requests. Materials and Methods The study complied the examinations made in Canakkale Onsekiz Mart university neurology clinic ENMG laboratory between 01/07/2019 and 21/07/2020, and these examinations were retrospectively scanned. Results: In total, 1464 results were scanned and those who underwent ENMG examination on the entrapment neuropathy protocol (SUT code 703220) were included in the study. Patients for whom requests were made lower extremity entrapment neuropathy and those who were younger than 18 were not included. Information regarding 445 (313 women, 132 men) patients with upper extremity entrapment neuropathy were obtained. The mean age of the patients was 49.5±14.2 (18-89). The study found that among electroneurophysiological examinations made due to the prediagnosis of entrapment neuropathy, 155 (34.8%) were diagnosed with carpal tunnel syndrome, 18 (4.0%) were diagnosed with ulnar nerve entrapment neuropathy, 3 (0.7%) were diagnosed with radial nerve entrapment neuropathy, and 253 (56.9%) had normal results. While there were no significant differences between the rates of normal results in terms of clinics that made the requests. Conclusion: While normal results were obtained on the majority of the electroneurophysiological requests due to the pre-diagnosis of upper extremity entrapment neuropathy, there were no significant differences between the clinics.

Keywords

• Electroneuromyography,
• upper extremity entrapment neuropathy
• clinical compatibility.

References

1. 1. Allieu Y, Mackinnon SE, editors. Nerve compression syndromes of the upper limb. London: Martin Dunitz; 2002.
2. 2. Lundborg G,Dahlin LB. The pathophysiology of nerve compression. Hand Clin 1992;8(2):215–27.
3. 3. Assmus H, Antoniadis G, Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromes. Dtsch Arztebl Int. 2015;112(1-2):14-26.
4. 4. Ay S, Evcik D. Tuzak nöropatiler Romatoloji e. kitap 2018.
5. 5. Alba C. Therapist’s management of radialtunnel syndrome. In: Mackin EJ, Callahan AD, Skirven TM, Schneider LH, Osterman AL, Hunter JM, editors. Rehabilitation of the handan dupper ekstremity, 5th ed. St. Louis: Mosby; 2002 p.696–700.
6. 6. Tunç A, Güngen B. Karpal Tünel Sendromu Hastalarında Elektro diagnostic Evreleme ile Klinik Evre, Semptom Süresi ve Vücut Kitle İndeksi Arasındaki İlişkinin Değerlendirilmesi. Dicle Tıp Dergisi 2017;44: 159. 166.
7. 7. Gupta R, Steward O. Chronic nerve compression induces concurrent apoptosis and proliferation of Schwann cells. J Comp Neurol 2003;461(2):174–86.
8. 8. Ettema AM, Amadio PC, Zhao C, Wold LE, O’Byrne MM, Moran SL, An KN. Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome: a scanning electron microscope study. Plast Reconstr Surg 2006;118(6):1413–22.)

9. 9. Podnar S. Critical reappraisal of referrals to electromyography and nerve conduction studies. Eur J Neurol. 2005;12(2):150-155.
10. 10. Rosenberg NR, Portegies P, de Visser M, Vermeulen M. Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline. J Neurol Neurosurg Psychiatry. 2001;71(2):205-209.
11. 11. Chémali KR, Tsao B. Electrodiagnostic testing of nerves and muscles: when, why, and how to order. Cleve Clin J Med. 2005;72(1):37-48.
12. 12. Karadag YS, Golgeleyen D, Saka M, Bilen S, Oztekin NS, Ak F. Referral Diagnosis Versus Electroneurophysiological Findings-Three Years Experience from a Tertiary Hospital. European Journal of General Medicine. 2014; 11(4):244-7.
13. 13. Nikolic A, Stevic Z, Peric S, Stojanovic VR, Lavrnic D. Evaluation of the adequacy of requests for electrodiagnostic examination in a tertiary referral center. Clin Neurol Neurosurg. 2016;148:130-136..
14. 14. Johnsen B, Fuglsang-Frederiksen A, Vingtoft S, et al. Differences in the handling of the EMG examination at seven European laboratories. Electroencephalogr Clin Neurophysiol. 1994;93(2):155-158
15. 15. Mondelli M, Giacchi M, Federico A. Requests for electromyography from general practitioners and specialists: critical evaluation. Ital J Neurol Sci. 1998;19(4):195-203.
16. 16. Cocito D, Tavella A, Ciaramitaro P, et al. A further critical evaluation of requests for electrodiagnostic examinations. Neurol Sci. 2006;26(6):419-422