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Ulnar Neuropathy at the Elbow: Evaluation of Discriminatory Performance of Multitiered Electrodiagnostic-Based
Nathan J Savage1, John S McKell2
1Department of Physical Therapy, High Point University, High Point, North Carolina, U.S.A.
Purpose:
Ulnar neuropathy at the elbow (UNE) is a common entrapment neuropathy for which electrodiagnostic (EDX) testing is routinely used to confirm diagnosis. Multitiered EDX-based classifications of UNE severity have been proposed; however, their ability to discriminate between consecutive severity categories has not been rigorously evaluated.
Methods:
This retrospective analysis of prospectively collected cross-sectional data included 299 elbows from 262 patients referred for EDX testing for suspected UNE. Elbows were categorized using two commonly cited multitiered EDX-based classifications (Padua and Zeidman) and compared with consolidated binary categorizations ("Negative" or "UNE"). Linear mixed-effects models were used to evaluate differences in key electrophysiologic variables across consecutive EDX-based severity categories and between consolidated binary categorizations. Additional analyses examined the influence of sex and age category on relevant electrophysiologic findings.
Results:
Multitiered classifications demonstrated limited discriminatory capability between consecutive severity categories. Only 17% of comparisons in the Padua classification and 44% in the Zeidman classification significantly differentiated adjacent categories. In contrast, all consolidated binary categorizations demonstrated consistent and significant differences in electrophysiologic findings, with moderate to large effect sizes. Sex and age category significantly influenced ulnar motor nerve conduction across the elbow, with men and older patients generally exhibiting slower conduction velocities.
Conclusions:
Multitiered EDX-based classifications of UNE severity demonstrate poor discrimination between adjacent categories. Consolidated binary categorizations of UNE provide superior discriminatory capability and may offer greater clinical utility. These findings apply specifically to electrophysiologic assessment and should not be interpreted as measures of clinical symptom severity. Sex and age category should be considered when interpreting EDX results in patients with suspected UNE.
