Ann Rehabil Med.  2018 Jun;42(3):483-487. 10.5535/arm.2018.42.3.483.

Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report

• Kim MJ
• Kang JW
• Kim GY
• Lim SG
• Kim KH
• Park BK
• Kim DH

• KMID: 2417842
• DOI: http://doi.org/10.5535/arm.2018.42.3.483

Abstract

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Keyword

Ulnar nerve compression syndromes; Wrist; Electrodiagnosis

MeSH Terms

Diagnosis*
Electrodiagnosis
Neural Conduction*
Ulnar Nerve
Ulnar Nerve Compression Syndromes
Ulnar Neuropathies
Wrist

Figure

• 

  Fig. 1. (A) Orthodromic ulnar sensory inching test with distal forearm recording (E1 and E2) was conducted at three sites: 3 cm, 5 cm, and 7 cm distal to pisiform (P-3, P-5 and P-7, respectively). Light yellow area represents hypoesthesia to touch and pinprick, and arrow indicates a positive Tinel sign. (B) Right orthodromic ulnar sensory inching test revealed abnormal conduction delay (0.6 ms) and definite partial conduction block (81.1%) between 3 cm and 5 cm distal to pisiform compared with the left side (C).

• 

  Fig. 2. (A) Ultrasonographic evaluation showed compression of right superficial ulnar sensory branch 3.5 cm distal to pisiform (long and thick arrows) and swelling of superficial ulnar sensory branch around upper 1/3 hypothenar area (thin arrows on the proximal side). (B) Surgical exploration demonstrated swelling of the superficial sensory branch of the ulnar nerve (white arrow) and fibrotic band-like structure compressing the superficial sensory branch (asterisk). Green arrow indicates the main trunk of ulnar nerve; yellow arrow, deep branch of ulnar nerve; and red arrow, ulnar artery.

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