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Asymmetric ulnar SNAP
I was recently asked the following question by an AANEM member:
"Another scenario I have encountered is a relative amplitude drop from side to side of Ulnar sensory at the wrist in the presence of normal ulnar motor studies."
For this scenario (especially when needle EMG and MAC are unremarkable), i have a templated bit of text that i have been using and thought i'd run it by you folks:
In the absence of any motor conduction or needle electromyographic abnormalities, the isolated finding of relatively decreased ulnar sensory response is of unclear significance and could be attributed to:
- Ulnar sensory only neuropathy
- Old axonal injury with motor recovery (via collateral sprouting) along the course of its pathway (C8 ramus, lower trunk, medial cord, or ulnar nerve).
- Technical issue (although the test was repeated and all electrodes repositioned during testing today).
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