Skip to main content
SpringerLink
Log in

Clinical and Electrodiagnostic Work-up of Peripheral Nerve Lesions

  • Chapter
High-Resolution Sonography of the Peripheral Nervous System

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Diagnostic work-up of patients with peripheral nerve lesions includes a detailed evaluation of the clinical history, a thorough search for predisposing factors and trigger events, palpation at the suspected lesion site, specific provocation maneuvers and assessment of motor deficits (distribution, muscle power and atrophy), sensory disturbances (distribution and quality) and autonomic impairment (sudomotor activity) — all embedded in a careful standard neurological examination. Motor deficits are best evaluated by a combination of manual muscle testing and functional evaluation of all individual muscles (with the hand and arm put into a normal position because wrist drop and other positioning abnormalities might pretend muscle weakness) (Labosky and Waggy 1986). Quantitative assessment of muscle strength, implicit to a proper monitoring of nerve recovery and re-innervation, may make use of a dynamometer or of the modified “Medical Research Council (MRC) grading scale for muscle power” (Medical Research Council of the United Kingdom 1978) (Table 3.1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Bakke JL, Wolff HG (1948) Occupational pressure neuritis of the deep palmar branch of the ulnar nerve. Arch Neurol Psychiatry 60:549

    Google Scholar 

  • Brown WF, Watson BV (1993) Acute retrohumeral radial neuropathies. AAEM case report 27. Muscle Nerve 16:706–711

    Article  PubMed  CAS  Google Scholar 

  • Campbell WW (1998) Entrapment neuropathies. In: Gilchrist J (ed) Prognosis in neurology. Butterworth-Heinemann, Boston, pp 307–312

    Google Scholar 

  • Campbell WW, Sahni KS, Pridgeon RM et al. (1988) Intraoperative electroneurography: management of ulnar neuropathy at the elbow. Muscle Nerve 11:75–81

    Article  PubMed  CAS  Google Scholar 

  • Campbell WW, Pridgeon RM, Riaz, G et al. (1991) Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 14:733–738

    Article  PubMed  CAS  Google Scholar 

  • Campbell WW, Pridgeon RM, Sahni KS (1992) Short segment incremental studies in the evaluation of ulnar neuropathy at the elbow. Muscle Nerve 15:1050–1054

    Article  PubMed  CAS  Google Scholar 

  • Campellone JV (1999) Peroneal neuropathy from antithrombotic stocking. J Clin Neuromusc Dis 1:14–16

    Article  CAS  Google Scholar 

  • DeLisa JA, Saeed MA (1983) The tarsal tunnel syndrome. Muscle Nerve 6:664–670

    Article  PubMed  CAS  Google Scholar 

  • Dellon AL, Hament W, Gittelshon A (1993) Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 43:1673–1677

    PubMed  CAS  Google Scholar 

  • Eisen A, Schomer D, Melmed C (1977) The application of F-wave measurements in the differentiation of proximal and distal upper limb entrapments. Neurology 27:662–668

    PubMed  CAS  Google Scholar 

  • Felsenthal G (1977) Median and ulnar distal motor and sensory latencies in the same normal subject. Arch Phys Med Rehabil 58:297–302

    PubMed  CAS  Google Scholar 

  • Foerster O (1933) The dermatomes in man. Brain 56:1–39

    Article  Google Scholar 

  • Gassel MM (1964) Sources of error in motor nerve conduction studies. Neurology 14:825

    PubMed  CAS  Google Scholar 

  • Gessini L, Jandolo B, Pietrangeli A (1984) The anterior tarsal syndrome. Report of four cases. J Bone Joint Surg Am 66:786–787

    PubMed  CAS  Google Scholar 

  • Goodgold J, Kopell HP, Spielholz NI (1965) The tarsal tunnel syndrome. N Eng J Med 273:742–745

    CAS  Google Scholar 

  • Green DP (1984) Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg 9:850–854

    CAS  Google Scholar 

  • Guidelines in Electrodiagnostic Medicine (1999) American Association of Electrodiagnostic Medicine. J Muscle Nerve, Suppl S5–S12

    Google Scholar 

  • Gutierrez A, England JD (2002) Peripheral nerve injury. In: Katirji B, Kaminski HJ, Preston DC et al. (eds) Neuromuscular disorders in clinical practice. Butterworth-Heinemann, Boston

    Google Scholar 

  • Gutmann E, Young JZ (1944) The re-innervation of muscle after various periods of atrophy. J Anat 78:15–43

    PubMed  CAS  Google Scholar 

  • Honet JC, Jebsen RH, Perrin EB (1968) Variability of nerve conduction velocity determinations in normal persons. Arch Phys Med Rehabil 49:650–654

    PubMed  CAS  Google Scholar 

  • Kaplan PE (1984) Posterior interosseous neuropathies: natural history. Arch Phys Med Rehabil 65:399

    PubMed  CAS  Google Scholar 

  • Keck C (1962) The tarsal tunnel syndrome. J Bone Joint Surg 44A:180–182

    Google Scholar 

  • Kimura J (1979) The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain 102:619–635

    Article  PubMed  CAS  Google Scholar 

  • Kimura J, Murphy MJ, Varda DJ (1976) Electrophysiological study of anomalous innervation of intrinsic hand muscles. Arch Neurol 33:842

    PubMed  CAS  Google Scholar 

  • Koller RL, Blank NK (1980) Strawberry pickers’ palsy. Arch Neurol 39:320–324

    Google Scholar 

  • Kothari MJ, Preston DC, Logigian EL (1996) Lumbrical and interossei recordings localize ulnar neuropathy at the wrist. Muscle Nerve 19:170–174

    Article  PubMed  CAS  Google Scholar 

  • Kumiai D (1987) The facts of Katmandu: squatter’s palsy. JAMA 257:28

    Article  Google Scholar 

  • Kuschner SH, Ebramzadeh E, Johnson D et al. (1992) Tinel’s sign and Phahlen’s test in carpal tunnel syndrome. Orthopedics 15:1297–1302

    PubMed  CAS  Google Scholar 

  • Labosky DA, Waggy CA (1986) Apparent weakness of median and ulnar motors in radial nerve palsy. J Hand Surg 11A:528

    Google Scholar 

  • Levin KH (2002) Cervical radiculopathies. In: Katirji B, Kaminski HJ, Preston DC et al. (eds) Neuromuscular disorders in clinical practice. Butterworth-Heinemann, Boston

    Google Scholar 

  • Liveson JA, Ma DM (1992) Laboratory reference for clinical neurophysiology. Davis Company, Philadelphia

    Google Scholar 

  • Lubinska L (1977) Early course of Wallerian degeneration in myelinated fibers of the rat phrenic nerve. Brain Res 130:47–63

    Article  PubMed  CAS  Google Scholar 

  • Ma MD, Wilbourn AJ, Kraft GH (1984) Unusual sensory conduction studies. American Association of Electromyography and Electrodiagnosis, Rochester

    Google Scholar 

  • Maudsley R (1967) Fibular tunnel syndrome. J Bone Joint Surg 49B:384–389

    Google Scholar 

  • Medical Research Council of the United Kingdom (1978) Aids to the examination of the peripheral nervous system. MRC, Pendragon House, London

    Google Scholar 

  • Miller RG (1991) Ulnar neuropathy at the elbow. AAEM case report 1. Muscle Nerve 14:97–101

    Article  PubMed  CAS  Google Scholar 

  • Miller RG, Camp PE (1979) Postoperative ulnar neuropathy. JAMA 242:1636–1639

    Article  PubMed  CAS  Google Scholar 

  • Miller RG, Hummel EE (1980) The cubital tunnel syndrome: treatment with simple decompression. Ann Neurol 7:567–569

    Article  PubMed  CAS  Google Scholar 

  • Mondelli M, Giannini F, Reale F (1998) Clinical and electrophysiological findings and follow-up in tarsal tunnel syndrome. Electroencephalogr Clin Neurophysiol 109:418–425

    Article  PubMed  CAS  Google Scholar 

  • Morris HH, Peter BH (1976) Pronator teres syndrome: clinical and electrophysiological features in seven cases. J Neurol Neurosurg Psych 39:461–464

    Article  CAS  Google Scholar 

  • Mumenthaler M, Schliack H, Stoehr M (1998) Läsionen peripherer Nerven und radikuläre Läsionen. Thieme Verlag, Stuttgart New York

    Google Scholar 

  • Oh SJ, Kim DE, Kuruoglu HL (1994) What is the best diagnostic index of conduction block and temporal dispersion? Muscle Nerve 17:489–493

    Article  PubMed  CAS  Google Scholar 

  • Oh SJ, Meyer RD (1999) Entrapment neuropathies of the tibial (posterior tibial) nerve. Neurol Clin 17:593–615

    Article  PubMed  CAS  Google Scholar 

  • Oh SJ (2003) Clinical electromyography. Nerve conduction studies. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  • Olney RK, Hanson M (1988) Ulnar neuropathy at or distal to the wrist. AAEE case report 15. Muscle Nerve 11:828–832

    Article  PubMed  CAS  Google Scholar 

  • Phalen GS (1966) The carpal tunnel syndrome: seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg 48A:211–228

    Google Scholar 

  • Rich P (1897) Le nerf cubital et les muscles de le’éminence thenar. Bull Mem Soc Anat Paris 5:251

    Google Scholar 

  • Rosenbaum RB (1999) Disputed radial tunnel syndrome. Muscle Nerve 22:960–967

    Article  PubMed  CAS  Google Scholar 

  • Rosenbaum RB, Ochoa JL (1993) Carpal tunnel syndrome and other disorders of the median nerve. Butterworth-Heinemann, Boston

    Google Scholar 

  • Rowntree T (1949) Anomalous innervation of the hand muscles. J Bone Joint Surg 31B:505

    CAS  Google Scholar 

  • Seddon HJ (1943) Three types of nerve injury. Brain 66:237–239

    Article  Google Scholar 

  • Stevens JC (1987) Electrodiagnosis of carpal tunnel syndrome. AAEE minimonograph 26. Muscle Nerve 10:99–113

    Article  PubMed  CAS  Google Scholar 

  • Stevens JC, Sun S, Beard CM et al. (1988) Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 38:134–138

    PubMed  CAS  Google Scholar 

  • Stevens JC, Beard M, O’Fallon WM et al. (1992) Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 67:541–548

    PubMed  CAS  Google Scholar 

  • Stoehr M, Bluthardt M (1993) Atlas der klinischen Elektromyographie und Neurographie. Kohlhammer, Stuttgart Berlin Köln

    Google Scholar 

  • Sturzenegger M, Rutz M (1991) Die Radialisparesen: Ursachen, Lokalisation und Diagnostik. Nervenarzt 62:722–729

    PubMed  CAS  Google Scholar 

  • Sunderland S (1945) Traumatic injuries of the peripheral nerves — simple compression injuries of the radial nerve. Brain 68:56–72

    Article  Google Scholar 

  • Suranyi L (1983) Median nerve compression by Struthers’ ligament. J Neurol Neurosurg Psych 46:1047–1049

    CAS  Google Scholar 

  • Szabo RM, Chidgey LK (1989) Stress carpal tunnel pressures in patients with carpal tunnel syndrome and normal patients. J Hand Surg 14:624–627

    Article  CAS  Google Scholar 

  • Tinel J (1915) Le signe du „fourmillement“ dans les lésions des nerfs périphériques. Presse Méd 23:385–396

    Google Scholar 

  • Wilbourn AJ (1986) Common peroneal mononeuropathy at the fibular head. Muscle Nerve 9:825–836

    Article  PubMed  CAS  Google Scholar 

  • Wilbourn AJ, Lambert E (1976) The forearm median-toulnar nerve communication: electrodiagnostic aspects. Neurology 26:368

    Google Scholar 

  • Wong L, Dellon AL (1997) Brachial neuritis presenting as anterior interosseous nerve compression. J Hand Surg 22:A536–539

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Section for Electrodiagnosis (EMG/NLG), Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Professor Stefan Kiechl MD

Authors
  1. Professor Stefan Kiechl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Radiology, Section for Diagnostic and Interventional Sonography, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Siegfried Peer MD (Professor) (Professor)

  2. Department of Radiology, St. Bernards Hospital, Europort 1-4, Gibraltar

    Gerd Bodner MD (Professor) (Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Kiechl, S. (2008). Clinical and Electrodiagnostic Work-up of Peripheral Nerve Lesions. In: Peer, S., Bodner, G. (eds) High-Resolution Sonography of the Peripheral Nervous System. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-49084-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-49084-5_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-49083-8

  • Online ISBN: 978-3-540-49084-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation