Disclosures: Kira S. Kopacz: No financial relationships or conflicts of interest

Case Diagnosis: A young adult female with congenital left wrist amputation presenting with a 4-month history of left upper extremity paresthesias.

Case Description or Program Description: The patient presented with a left wrist amputation and a 4-month history of left upper extremity paresthesias following heavy lifting. Paresthesias tracked up and down the left upper extremity. She denied numbness or weakness. She presented for electrodiagnostic evaluation. Due to the left wrist amputation, many anatomical locations could not be used for the nerve conduction studies (NCS). The differential diagnosis included Cubital Tunnel Syndrome. Median motor conduction was tested from the elbow to the Flexor Carpi Radialis. Ulnar motor conduction above and below the elbow to both the Flexor Carpi Ulnaris and Flexor Digitorum Longus. Median and Ulnar sensory active electrodes were placed superficial to the nerves 3 cm proximal to the wrist, reference at the wrist, and stimulation 12 cm proximal. Radial and Musculocutaneous motor studies were performed in the standard manner.

Setting: Outpatient electrodiagnostic laboratory.

Assessment/Results: Due to the limb deficiency, many traditional anatomic locations could not be used for NCS and needle electromyography (EMG). The conduction velocities for the left motor and sensory nerves were all within normal limits. EMG evaluations demonstrated no abnormalities. It was concluded that the patient did not have a left upper extremity neuropathy and her pain was most likely due to elbow extensor tendonitis.

Discussion (relevance): This is the first reported case, to our knowledge, of methods for nerve conduction studies in upper extremity limb deficiencies. Likewise, the sensory techniques are not reported in the literature. These methods may be useful in diagnosing focal and diffuse peripheral neuropathies in the general population.

Conclusions: A successful method for nerve conduction in an upper extremity amputation requires shorter conduction distances and a thorough anatomical knowledge.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/upper-extremity-electrodiagnostic-methods-in-a-left-wrist-amputee-a-case-report/