Dirsekte Ulnar Nöropati ile İlişkili Faktörlerin ve Elektromiyografi Bulgularının Değerlendirilmesi

Abstract

Amaç: Ulnar sinir seyri boyunca çeşitli noktalarda basıya hassastır ve özellikle dirsek bölgesi travmaya en açık alandır. Bu çalışmada, dirsekte ulnar nöropati ile ilişkili faktörler, lezyonun lateralitesi, elektromiyografi (EMG) ve manyetik rezonans görüntüleme (MRG) bulguları ile bunların üst ekstremite fonksiyonlarına etkileri değerlendirildi. Gereç ve Yöntemler: Ekim 2023-Nisan 2025 arasında ulnar nöropati ön tanısıyla EMG yapılan 18-75 yaş arası 52 hasta retrospektif olarak incelendi. Demografik özellikler, komorbiditeler, dominant el, semptom süresi, yaşam tarzı faktörleri, eşlik eden tuzak nöropatiler ve Kısaltılmış Kol, Omuz ve El Engellilik Anketi (Quick-DASH) skorları kaydedildi. Ulnar sinirin sıkıştığı dirsek MRG ile değerlendirildi. MRG’de sinyal yoğunluğu ve boyut artışı, intranöral/ekstranöral lezyon ve efüzyon varlığı kaydedildi. Bulgular: Katılımcıların 21’i (%40,4) erkek, 31’i (%59,6) kadındı; %88,5’inde sağ el dominanttı. 23 hastada (%44,2) 2 saatten uzun telefon kullanımı, 16’sında (%30,8) dirseği masaya yaslama alışkanlığı vardı. Ulnar nöropati 21 hastada (%40,4) sağ, 12 hastada (%23,1) bilateraldi. Nöropati şiddeti 28 hastada (%53,8) hafif, 7 hastada (%13,5) ağırdı. Ortalama Quick-DASH skoru 31,5±26,9 idi. 23 hastada (%44,2) karpal tünel sendromu eşlik etmekteydi. Orta-ağır ulnar tuzaklanması olan hastalarda MRG bulguları anlamlı derecede daha fazlaydı (p=0,002). Sonuç: Ulnar sinir tuzaklanmasının erken tanısında dikkatli muayene, elektrodiagnostik testler ve görüntüleme yöntemleri birlikte kullanılmalıdır. Yaşam tarzı faktörlerinin modifiye edilmesi semptomların azalmasına ve progresyonun önlenmesine katkı sağlayabilir.

Keywords

• Elektromiyografi
• dirsekte ulnar nöropati
• dizabilite
• manyetik rezonans görüntüleme

Evaluation of Factors Associated with Ulnar Neuropathy at the Elbow and Electromyography Findings

Abstract

Aim: The ulnar nerve is vulnerable to compression along its course, particularly at the elbow. This study aimed to evaluate factors associated with ulnar neuropathy at the elbow, lesion laterality, electromyography (EMG) and magnetic resonance imaging (MRI) findings, and their effects on upper extremity function. Material and Methods: Medical records of 52 patients aged 18–75 who underwent EMG with suspected ulnar neuropathy between October 2023 and April 2025 were retrospectively reviewed. Demographics, comorbidities, hand dominance, symptom duration, lifestyle factors, coexisting entrapment neuropathies, and Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) scores were recorded. MRI findings of the affected elbow included increased nerve signal/size, intraneural or extraneural lesions, and effusion. Results: Of 52 patients, 21 (40.4%) were male and 31 (59.6%) female; 88.5% had right-hand dominance. Prolonged mobile phone use (>2 hours) was reported in 23 patients (44.2%), and leaning on the elbow in 16 (30.8%). Ulnar neuropathy was right-sided in 21 (40.4%) and bilateral in 12 (23.1%). Neuropathy severity was mild in 28 (53.8%) and severe in 7 (13.5%). The mean Quick-DASH score was 31.5±26.9. Coexisting carpal tunnel syndrome was present in 23 patients (44.2%), mostly moderate in severity. MRI findings were significantly more frequent in elbows with moderate to severe entrapment (p=0.002). Conclusion: Careful neurological examination, electrodiagnostic tests, and imaging are essential for early detection of ulnar nerve entrapment. Lifestyle modifications may help reduce symptoms and prevent progression.

Keywords

• Electromyography
• ulnar neuropathy at elbow
• disability
• magnetic resonance imaging

References

1. 1. Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies-a neoteric approach. Insights Imaging. 2019;10(1):37. doi:10.1186/s13244-019-0714-x.
2. 2. Hussein M, Hanumanthu MM, Shirodkar K, Papineni VRK, Rahij H, Velicheti S, et al. Cubital tunnel syndrome: anatomy, pathology, and imaging. Skeletal Radiol. 2025;54(1):1-15. doi:10.1007/s00256-024-04705-4.
3. 3. Oh SJ. Nerve conduction techniques. In: Oh SJ, editor. Clinical electromyography: nerve conduction studies, 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2003:37-53.
4. 4. Nyman E, Lars BD. The unpredictable ulnar nerve-ulnar nerve entrapment from anatomical, pathophysiological, and biopsychosocial aspects. Diagnostics (Basel). 2024;14(5):489. doi:10.3390/diagnostics14050489.
5. 5. Kim S, Chung BM, Kim WT, Lee GY, Hur J, Kim JH, et al. Diagnosing ulnar neuropathy at the elbow on MRI: importance of the longitudinal extent of the hyperintense ulnar nerve. Skeletal Radiol. 2022;51(7):1473-81. doi:10.1007/s00256-022-03990-1.
6. 6. Ukkirapandian K, Vp S, Pawar AS, Udaykumar KP, Rangasmy M. Ulnar nerve entrapment among cell phone users: cell phone elbow (Cubital Tunnel Syndrome). Cureus. 2024;16(3):e55500. doi:10.7759/cureus.55500.
7. 7. American Association of Electrodiagnostic Medicine, Campbell WW. Guidelines in electrodiagnostic medicine. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow. Muscle Nerve Suppl. 1999;8:S171-205.
8. 8. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve. 1999;22(3):408-11. doi:10.1002/(sici)1097-4598(199903)22:3<408::aid-mus16>3.0.co;2-7.

9. 9. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002;25:918-22. doi:10.1002/mus.10185.
10. 10. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30:185-91. doi:10.1007/s10067-010-1470-y.
11. 11. Beaton DE, Wright JG, Katz JN, The upper extremity collaborative group. Development of the Quick DASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038-46. doi:10.2106/JBJS.D.02060.
12. 12. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60. doi:10.3758/BRM.41.4.1149.
13. 13. Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. doi:10.3758/bf03193146.
14. 14. Ashworth NL, Christopher H, Chan KM. Laterality and risk factors for ulnar neuropathy at the elbow. Muscle Nerve. 2020;61(1):101-4. doi:10.1002/mus.26737.
15. 15. Contreras MG, Warner MA, Charboneau WJ, Cahill DR. Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences. Clin Anat 1998;11(6):372-8. doi:10.1002/(SICI)1098-2353(1998)11:6<372::AID-CA2>3.0.CO;2-R.
16. 16. Upton AM, Mccomas A. The double crush in nerve-entrapment syndromes. Lancet 1973;302(7825):359-62. doi:10.1016/s0140-6736(73)93196-6.
17. 17. Wipperman J, Penny ML. Carpal Tunnel Syndrome: rapid evidence review. Am Fam Physician. 2024;110(1):52-57.
18. 18. Omejec G, Žgur T, Podnar S. Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow. Clin Neurophysiol. 2015;126(9):1797-1804. doi:10.1016/j.clinph.2014.12.001.
19. 19. Vij N, Traube B, Bisht R, Singleton I, Cornett EM, Kaye AD, et al. An update on treatment modalities for ulnar nerve entrapment: a literature review. Anesth Pain Med. 2020;10(6):e112070. doi:10.5812/aapm.112070.
20. 20. Preston DC, Shapiro BE. Ulnar neuropathy. In: Preston DC, Shapiro BE, editors. Electromyography and neuromuscular disorders; clinical-electrophysiologic correlations. Boston: Butterworth- Heinemann, 1998. p. 263-290.
21. 21. Depreli O, Angin E. The relationship between smartphone usage position, pain, smartphone addiction, and hand function. J Back Musculoskelet Rehabil. 2024;37(6):1695-1704. doi:10.3233/BMR-240154.
22. 22. Lee JH, Gong HS. Volumetric assessment of ulnar nerves in cubital tunnel syndrome with 3D modeling of the MRI and its relationship with electrodiagnostic findings. J Plast Reconstr Aesthet Surg. 2024;92:244-51. doi:10.1016/j.bjps.2024.03.014.
23. 23. Terayama Y, Uchiyama S, Ueda K, et al. Optimal measurement level and ulnar nerve cross-sectional area cutoff threshold for identifying ulnar neuropathy at the elbow by MRI and Ultrasonography. J Hand Surg Am. 2018;43(6):529-36. doi:10.1016/j.jhsa.2018.02.022.