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Ultrasonographic Measurements of the Ulnar Nerve at the Elbow

Role of Confounders

School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

Address correspondence to Kerry Thoirs, PhD, MMed (Rad), DMU, School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide SA 5000, Australia. E-mail: kerry.thoirs{at}unisa.edu.au

Objective. The purpose of this study was to identify factors confounding high-resolution ultrasonographic measurements of the ulnar nerve to test their influence when discriminating between limbs affected and unaffected by ulnar nerve entrapment (UNE) at the elbow. Methods. High-resolution ultrasonographic measurements of ulnar nerve dimensions at the elbow were compared between 2 groups of subjects: symptomatic and asymptomatic for UNE. Rank analysis of covariance regression tests were performed to determine whether significant differences existed between the 2 groups. The changing coefficient method (using rank analysis of covariance tests) was used to test for potential confounding effects of age, weight, height, body mass index, sex, limb sidedness, limb handedness, and nerve mobility. These tests were repeated for each measurement while controlling for the identified confounders. Exact 2-tailed Wilcoxon signed rank tests were performed to test for significant differences between measurements of the diameter of the ulnar nerve with the elbow in full extension and full flexion. Results. Age, weight, body mass index, sex, and elbow position were shown to have confounding influences on high-resolution ultrasonographic measurements of the ulnar nerve. No confounding effect was apparent for limb sidedness or dominance. Cross-sectional area and long-axis diameter measurements demonstrated significant differences between nerves with and without UNE after controlling for confounders. Conclusions. Two cross-sectional measurements (area and maximum cross-sectional diameter) of the ulnar nerve, made at the level of the medial epicondyle, were found to be robust discriminators between nerves with and without UNE. In the absence of normative reference values of the ulnar nerve, the contralateral limb may be used as the comparative control.

Key Words: confounder • measurements • ulnar nerve • ulnar nerve entrapment • ultrasonography

Abbreviations: ANCOVA, analysis of covariance • BMI, body mass index • CI, confidence interval • HRUS, high-resolution ultrasonography • UNE, ulnar nerve entrapment