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Serial electrodiagnostic studies in acute partial conduction block from cyclist's palsy.

Paul E Barkhaus1, Erie Gonzalez Gutierrez1, Sanjeev D Nandedkar1,2

  • 1Departments of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Muscle & Nerve
|August 26, 2023
PubMed
Summary

Partial conduction block (PCB) in cyclist's palsy resolved initially within weeks but full recovery took months. Accurate PCB characterization requires optimizing electrode placement and comparing with the unaffected side.

Keywords:
compound muscle action potentialselectrodiagnosismotor conduction studiespartial conduction blocksurface electrodes

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Area of Science:

  • Neuroscience
  • Clinical Electrophysiology

Background:

  • Compression neuropathies, such as cyclist's palsy, can cause partial conduction block (PCB).
  • Limited literature exists on the resolution of PCB in compression neuropathy.

Purpose of the Study:

  • To investigate the resolution of partial conduction block (PCB) in a case of cyclist's palsy using serial nerve conduction studies.
  • To monitor recovery patterns of PCB over time.

Main Methods:

  • Serial nerve conduction studies (NCS) and needle electromyography (EMG) were performed on a patient with cyclist's palsy.
  • Compound muscle action potential (CMAP) amplitudes were recorded from ulnar-innervated muscles (FDI, PI, ADM) in both limbs.
  • Sensory NCS and EMG assessed denervation and motor unit potential firing patterns.

Main Results:

  • Partial conduction block (PCB) was confirmed in the first dorsal interosseous (FDI) and palmar interosseus (PI) muscles proximal and distal to the compression site.
  • Initial recovery of CMAP amplitudes in FDI and PI occurred between weeks 2-3, with near-complete recovery by 14 weeks.
  • Sensory NCS were normal; EMG showed no active denervation, with motor unit potentials normalizing by 99 days post-onset.

Conclusions:

  • Partial conduction block (PCB) can show rapid initial resolution, but complete recovery may take several months.
  • Standard nerve conduction criteria for PCB may be misleading if only comparing responses above and below the block.
  • Comprehensive PCB assessment necessitates optimizing electrode positioning and comparing findings with the contralateral limb.