What causes misdiagnosis in ulnar neuropathy?

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Failure to perform a thorough history and examination (see Presentation) is probably the most important cause of mistakes in diagnosis. A thorough history and physical examination can usually tell the clinician the most important fact—that is, whether an ulnar neuropathy is likely to be present at all—even if precise localization of the lesion is not always possible.

Another possible cause of misdiagnosis is failure to search for the Martin-Gruber anastomosis during neurophysiologic testing (see Workup). As a consequence, the physician may inaccurately diagnose conduction block.

Similarly, failure to increase the sensitivity of testing by assessing nerve conduction to the first dorsal interosseous muscle as well as to the abductor digiti minimi may cause the examiner to miss an existing ulnar neuropathy. [109]

Another common error is testing only one nerve in the limb, thereby missing other potential conditions, such as polyneuropathy.

Finally, the clinician may perform the electrodiagnostic tests at suboptimal limb temperatures (< 30°C), leading to falsely prolonged latencies and increased amplitudes. [110]

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