Ultrasonography of ulnar neuropathy at the elbow: Axonal involvement leads to greater nerve swelling than demyelinating nerve lesion

Abstract Objective To evaluate nerve size parameters measured by ultrasound in patients with ulnar neuropathy at the elbow (UNE) and to correlate them with the type of nerve lesion. Methods The largest cross sectional area (CSA max ) of the ulnar nerve around the elbow and the cubital-to-humeral nerve area ratio (CHR) were measured in 50 elbows with UNE and in 87 elbows of 50 healthy subjects. CSA max and CHR were compared between controls and patients with predominantly demyelinative and axonal nerve involvement. Subgroups of patients with pure sensory and mixed sensorimotor axonal lesion were also compared. Results In patients with axonal nerve involvement, a significantly larger CSA max and CHR were found when compared to those with predominantly demyelinating nerve lesion; both groups differed significantly from healthy controls. CSA max values in patients with sensorimotor axonal lesion were significantly higher than in those with pure sensory axonal involvement. Conclusion CSA max and CHR highly correlate with the type of nerve pathology in UNE, with a significantly larger nerve swelling seen in axonal lesions, as compared to demyelinating lesions. Significance In addition to helping in the localization of nerve lesion, ultrasonography may also reflect the type and degree of nerve lesion as assessed by electrophysiological means.