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Variations in Dorsomedial Hand Innervation Electrodiagnostic Implications

Variations in Dorsomedial Hand Innervation Electrodiagnostic Implications Abstract • Sensory potentials recorded from the dorsal cutaneous branch of the ulnar nerve (DCUN) help localize ulnar nerve lesions. This conduction technique was first described by Jabre in 1980. Abnormalities detected with this technique in control populations are commonly attributed to local trauma. Anatomic variations of cutaneous innervation to the dorsum of the hand, however, have been described. We recorded DCUN responses using both the normal DCUN stimulation point and a secondary site of stimulation at the radial aspect of the forearm in 44 patients. Eleven patients demonstrated a low-amplitude DCUN response. Four of the 11 patients demonstrated sensory potentials obtained from the routine recording site of the DCUN with radial stimulation. We conclude that an abnormal DCUN response may represent anomalous innervation. To avoid some errors in localization, radial forearm stimulation should be performed whenever the DCUN response is abnormal. References 1. Wilbourn AJ. Course D—focal peripheral neuropathies: selected topics. Presented at the annual meeting of the American Association of Electrodiagnostic Medicine; September 26, 1991; Vancouver, British Columbia, Canada. 2. Kim DJ, Kalantri A, Guha S, Wainapel SF. Dorsal cutaneous ulnar nerve conduction: diagnostic aid in ulnar neuropathy . Arch Neurol . 1981;38:321-322.Crossref 3. Stewart JD. The variable clinical manifestations of ulnar neuropathies at the elbow . J Neurol Neurosurg Psychiatry . 1987;50:252-258.Crossref 4. Learmonth JR. A variation in the distribution of the radial branch of the musculo-spiral nerve . J Anat . 1918;53:371-372. 5. Spinner M. The ulnar nerve . In: Injuries to the Major Branches of Peripheral Nerves of the Forearm . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1978:244-246. 6. Hoffman MD, Mitz M, Luisi M, Melville BR. Paired study of the dorsal cutaneous ulnar and superficial radial sensory nerves . Arch Phys Med Rehabil . 1988;69:591-594. 7. Jabre JF. Ulnar nerve lesions at the wrist: new technique for recording from the sensory dorsal branch of the ulnar nerve . Neurology . 1980;30:873-876.Crossref 8. Spindler HA, Felsenthal C. Radial sensory conduction in the hand . Arch Phys Med Rehabil . 1986;67:821-823. 9. Hollinshead WH. Anatomy for Surgeons . New York, NY: Harper & Row Publishers Inc; 1969;3:540-541. 10. Electrodiagnosis of ulnar neuropathies . Lancet . 1987;1:25-26. Letters. 11. Payan J. Electrophysiological localization of ulnar nerve lesions . J Neurol Neurosurg Psychiatry . 1969;32:208-220.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Variations in Dorsomedial Hand Innervation Electrodiagnostic Implications

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1992.00530320102018
Publisher site
See Article on Publisher Site

Abstract

Abstract • Sensory potentials recorded from the dorsal cutaneous branch of the ulnar nerve (DCUN) help localize ulnar nerve lesions. This conduction technique was first described by Jabre in 1980. Abnormalities detected with this technique in control populations are commonly attributed to local trauma. Anatomic variations of cutaneous innervation to the dorsum of the hand, however, have been described. We recorded DCUN responses using both the normal DCUN stimulation point and a secondary site of stimulation at the radial aspect of the forearm in 44 patients. Eleven patients demonstrated a low-amplitude DCUN response. Four of the 11 patients demonstrated sensory potentials obtained from the routine recording site of the DCUN with radial stimulation. We conclude that an abnormal DCUN response may represent anomalous innervation. To avoid some errors in localization, radial forearm stimulation should be performed whenever the DCUN response is abnormal. References 1. Wilbourn AJ. Course D—focal peripheral neuropathies: selected topics. Presented at the annual meeting of the American Association of Electrodiagnostic Medicine; September 26, 1991; Vancouver, British Columbia, Canada. 2. Kim DJ, Kalantri A, Guha S, Wainapel SF. Dorsal cutaneous ulnar nerve conduction: diagnostic aid in ulnar neuropathy . Arch Neurol . 1981;38:321-322.Crossref 3. Stewart JD. The variable clinical manifestations of ulnar neuropathies at the elbow . J Neurol Neurosurg Psychiatry . 1987;50:252-258.Crossref 4. Learmonth JR. A variation in the distribution of the radial branch of the musculo-spiral nerve . J Anat . 1918;53:371-372. 5. Spinner M. The ulnar nerve . In: Injuries to the Major Branches of Peripheral Nerves of the Forearm . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1978:244-246. 6. Hoffman MD, Mitz M, Luisi M, Melville BR. Paired study of the dorsal cutaneous ulnar and superficial radial sensory nerves . Arch Phys Med Rehabil . 1988;69:591-594. 7. Jabre JF. Ulnar nerve lesions at the wrist: new technique for recording from the sensory dorsal branch of the ulnar nerve . Neurology . 1980;30:873-876.Crossref 8. Spindler HA, Felsenthal C. Radial sensory conduction in the hand . Arch Phys Med Rehabil . 1986;67:821-823. 9. Hollinshead WH. Anatomy for Surgeons . New York, NY: Harper & Row Publishers Inc; 1969;3:540-541. 10. Electrodiagnosis of ulnar neuropathies . Lancet . 1987;1:25-26. Letters. 11. Payan J. Electrophysiological localization of ulnar nerve lesions . J Neurol Neurosurg Psychiatry . 1969;32:208-220.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Aug 1, 1992

References