Identifying Effective Tests for Ulnar Neuropathy

People who have ulnar neuropathy, compression of the nerve that passes through the elbow to the lower arm, must be diagnosed as quickly as possible in order to prevent long-term complications from the injury. Currently, there are seven independent tests used by doctors to diagnose ulnar neuropathy. It is known that just using one of these tests isn't enough for an accurate diagnosis, because patient history and other types of testing are also important parts of the puzzle. Wrongly diagnosing the problem as ulnar neuropathy could result in the doctor missing other issues that could be the true problem. The authors of this article wanted to see how these tests compared in determining the problem and the severity of the problem, and how accurate they were.

When ulnar neuropathy first begins, patients may experience hand weakness and some changes in sensation. Testing the changes in sensation may be done by checking light moving touch, vibration thresholds, pressure and pain. However, in the early stages, these changes may not be easily identifiable. As the injury progresses, it is possible that muscle atrophy (wasting away) begins, along with loss of dexterity and muscle strength. Both would affect the strength of pinch and grip.

Researchers studied 26 patients (19 men) who were diagnosed with ulnar neuropathy of the elbow, also called cubital tunnel syndrome. The patients were, on average, 47.6 years old. Testing on the patients was performed by a hand surgeon or an occupational therapist who specialized in this field. The seven tests, in addition to elbow flexion (bending) were:

1- Froment's sign (making a circle with thumb and index finger)
2- Jeanne's sign (similar to Froment's sign)
3- crossed finger test
4- Egawa's sign (bending the middle finger and moving it up and down)
5- finger flexion sign
6- Wartenberg's sign (movement of the little finger)
7- observable signs of fasciculations (muscle twitches)

The researchers found that two of the motor signs (muscle twitches and positive finger flexion) were found more often among the patients than the other tests. They were present in 11 of the patients. The one that was found the least was the Jeanne's sign (not found in any patient) and the Wartenberg's sign (found in four patients).

The authors of this article concluded that the effectiveness of detecting muscle twitches and a positive finger flexion sign could provide useful information for the doctors. They suggest that more testing be done to analyze effectiveness more thoroughly, with a larger group, to ensure the results are repeated.

References: Sarah B. Goldman, PhD, et al. Analysis of Clinical Motor Testing for Adult Patients With Diagnosed Ulnar Neuropathy at the Elbow. In Archives of Physical Medicine and Rehabilitation. November 2009. Vol. 90. Pp. 1846 to 1852.