TITLE

Clinical Assessment of the Ulnar Nerve at the Elbow: Reliability of Instability Testing and the Association of Hypermobility with Clinical Symptoms

AUTHOR(S)
Calfee, Ryan P.; Manske, Paul R.; Gelberman, Richard H.; Van Steyn, Mario O.; Steffen, Jennifer; Goldfarb, Charles A.
PUB. DATE
December 2010
SOURCE
Journal of Bone & Joint Surgery, American Volume;12/1/2010, Vol. 92-A Issue 17, p2801
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Ulnar nerve hypermobility has been reported to be present in 2% to 47% of asymptomatic individuals. To our knowledge, the physical examination technique for diagnosing ulnar nerve hypermobility has not been standardized. This study was designed to quantify the interobserver reliability of the physical examination for ulnar nerve hypermobility and to determine whether ulnar nerve hypermobility is associated with clinical symptoms. Methods: Four hundred elbows in 200 volunteer participants were examined. Each participant was queried regarding symptoms attributable to the ulnar nerve. Three examiners, unaware of reported symptoms, independently performed a standardized examination of both elbows to assess ulnar nerve hypermobility. Ulnar nerves were categorized as stable or as hypermobile, which was further subclassified as perchable, perching, or dislocating. Provocative maneuvers, consisting of the Tinel test and flexion compression testing, were performed, and structural measurements were recorded. Kappa values quantified the examination's interobserver reliability. Unpaired t tests, chi-square tests, Wilcoxon tests, and Fisher exact tests were utilized to compare data between those with hypermobile nerves and those with stable nerves. Results: Ulnar nerve hypermobility was identified in 37% (148) of the 400 elbows. Hypermobility was bilateral in 30% (fifty-nine) of the 200 subjects. For the three examiners, weighted kappa values on the right and left sides were 0.70 and 0.74, respectively. Elbows with nerve hypermobility did not experience a higher prevalence of subjective symptoms (snapping, pain, and tingling) than did elbows with stable nerves. Provocative physical examination testing for ulnar nerve irritability, however, showed consistent trends toward heightened irritability in hypermobile nerves (p = 0.04 to 0.16). Demographic data and anatomic measurements were similar between the subjects with stable nerves and those with hypermobile nerves. Conclusions: Ulnar nerve hypermobility occurs in over one-third of the adult population. Utilizing a standardized physical examination, a diagnosis of ulnar nerve hypermobility can be established with substantial interobserver reliability. In the general population, ulnar nerve hypermobility does not appear to be associated with an increased symptomatology attributable to the ulnar nerve. Clinical Relevance: The results of this study demonstrate the reliability of clinically diagnosing ulnar nerve hypermobility and the lack of association of ulnar nerve hypermobility with symptoms.
ACCESSION #
55819341

 

Related Articles

  • Diagnosis, Causes and Treatments of Instability Following Total Knee Arthroplasty. Moon Jong Chang; Hyungtae Lim; Na Rae Lee; Young-Wan Moon // Knee Surgery & Related Research;Jun2014, Vol. 26 Issue 2, p61 

    Instability following total knee arthroplasty is one of the major causes of revision surgery. In most cases, it can be prevented by using an appropriate prosthesis and a good surgical technique. Particular attention should be given to confirmation of diagnosis for which thorough history taking,...

  • Treatment of Lateral Ankle Instability. MCNERNEY, JOHN // Podiatry Management;Sep2015, Vol. 34 Issue 7, p135 

    The article discusses diagnosis, management, and treatment options for lateral ankle instability. Topics explored include the prevalence of lateral ankle sprains among the youth particularly those involved in sports, the need to check for possible presence of edema, hematoma, and eccymosis...

  • Testing for elbow instability. Roche, Stephen J. L.; Vrettos, Basil C. // CME: Continuing Medical Education;Sep2011, Vol. 29 Issue 9, p381 

    The article offers physical examination techniques to test for elbow instability. According to the article, elbow instability usually presents with pain and patients will complain of medial sided elbow pain when throwing or with similar type actions. The physical examination techniques described...

  • Surgical images: musculoskeletal Elbow mass in a 58-year-old woman. Harvey, Edward J. // Canadian Journal of Surgery;Aug2006, Vol. 49 Issue 4, p281 

    The article cites a case of a 58-year-old woman presented to a trauma clinic after a fall. Her physical examination revealed a large, swollen left forearm, elbow and distal arm. An anterolateral dissection was carried out using a small medial portal to protect the ulnar nerve, in which two...

  • Recognizing Posterior and Posterolateral Knee Instability. Shea, Jennifer D. // Athletic Therapy Today;May97, Vol. 2 Issue 3, p30 

    Provides information on posterior and posterolateral knee instability. Epidemiology of posterior cruciate ligament (PCL) deficiencies; Discussion on the mechanisms in PCL injuries; Assessments used in testing ligamentous laxity.

  • Uncomplicated Elbow Dislocation Rehabilitation. Uhl, Tim L. // Athletic Therapy Today;May2000, Vol. 5 Issue 3, p31 

    Focuses on the rehabilitative management for uncomplicated elbow dislocation. Effects of hyperextension movements to elbow structures; Significance of neurovascular assessment in elbow dislocation evaluations; Stages of elbow joint instability.

  • Posterolateral Dislocation of the Elbow Joint. Eygendaal, D.; Verdegaal, S.H.M.; Obermann, W.R.; Van Vugt, A.B.; Poll, R.G.; Rozing, P.M. // Journal of Bone & Joint Surgery, American Volume;Apr2000, Vol. 82-A Issue 4, p555 

    Background: Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative...

  • CONTRIBUTION OF MONOBLOCK AND BIPOLAR RADIAL HEAD PROSTHESES TO VALGUS STABILITY OF THE ELBOW. Pomianowski, Stanislaw; Morrey, Bernard F.; Neale, Patricia G.; Park, Min J.; O'Driscoll, Shawn W.; Kai Nan An // Journal of Bone & Joint Surgery, American Volume;Dec2001, Vol. 83-A Issue 12, p1829 

    Evaluates the stabilizing effect of radial head placement in cadaver elbows with a deficient medial collateral ligament. Mean valgus laxity change; Effect of forearm rotation on valgus laxity; Valgus elbow laxity during flexion; Calculation of angular deviations of the ulna from the optimum...

  • Varied clinical presentation of os odontoideum: a case report. Chrobak, Karen; Larson, Ryan; Stern, Paula J. // Journal of the Canadian Chiropractic Association;Sep2014, Vol. 58 Issue 3, p268 

    Objective: To present a case of an os odontoideum and to provide insight into the varied clinical presentations. Clinical Features: A 54 year old man presented with chronic neck pain without headache. A clinical examination was performed and the chiropractor viewed his AP and lateral...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics