Ann Arbor, MI, United States
Ann Arbor, MI, United States

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Werner R.A.,Veterans Administration Health System | Werner R.A.,University of Michigan | Chiodo T.,University of Michigan | Spiegelberg T.,University of Michigan | Franzblau A.,University of Michigan
Muscle and Nerve | Year: 2012

Introduction: The objective of this study was to determine whether a hand diagram could be used to predict ulnar mononeuropathy. Methods: This was a prospective study of 117 consecutive patients referred for hand symptoms. Each subject filled out a hand diagram of symptoms and had median and ulnar sensory and motor nerve conduction studies, including ulnar conduction across the elbow. Results: The best model for predicting an ulnar mononeuropathy included hand diagram scores of definite or possible. The model had a sensitivity of 50% and specificity of 93% with an ROC area of 0.90. Conclusions: The ulnar hand diagram scoring system can be useful as a screening tool in the electrodiagnostic laboratory or for epidemiologic studies. © 2012 Wiley Periodicals, Inc.


Werner R.A.,Veterans Administration Health System | Werner R.A.,University of Michigan | Franzblau A.,University of Michigan | Evanoff B.,Washington University in St. Louis | Ulin S.,University of Michigan
PM and R | Year: 2015

Background: Limited studies have estimated the prevalence of ulnar neuropathy (UN) in the workplace. Hand diagrams have been demonstrated to have a good sensitivity and specificity when attempting to identify patients with UN. Objective: To determine the prevalence and associated risk factors for UN among active workers based on results of a hand diagram, and to determine the reliability of hand diagram scoring. Design: Cross-sectional study. Setting: Seven different industrial and clerical work sites. Methods: A total of 501 active workers were screened. Subjects completed a hand diagram and the Job Content Questionnaire, and had ergonomic assessment of their job. Each hand diagram was scored independently by 2 raters. Main Outcome Measures: Rating of the hand diagram for UN. Results: Interrater reliability of scoring the hand diagram for UN was very high. The estimated prevalence of UN was 3.6%. Suspected UN was associated with positioning of the elbow but not by contact stress at the elbow or force at the hand. Smokers had a lower prevalence, but smokers with suspected UN had higher-pack year histories. Workers with suspected UN had a greater sense of job insecurity and lower job satisfaction rating. Conclusions: Hand diagram rating has a high interrater reliability. Suspected UN has a relatively high prevalence among active workers in comparison to prior estimates of the prevalence of UN among the general population and is not strongly associated with ergonomic factors. © 2015 American Academy of Physical Medicine and Rehabilitation.


Werner R.A.,Veterans Administration Health System
PM and R | Year: 2013

Carpal tunnel syndrome (CTS) and ulnar mononeuropathies at the elbow and wrist are the most common nerve entrapments in the upper extremities. Electrodiagnostic studies are a valid and reliable means of confirming the clinical diagnosis. This review addresses various electrodiagnostic techniques to evaluate the median and ulnar nerves at the wrist and elbow. It also discusses the limitations of electrodiagnostic studies with regard to the sensitivity and specificity of such testing. © 2013 by the American Academy of Physical Medicine and Rehabilitation.


PubMed | Veterans Administration Health System
Type: Journal Article | Journal: Muscle & nerve | Year: 2012

The objective of this study was to determine whether a hand diagram could be used to predict ulnar mononeuropathy.This was a prospective study of 117 consecutive patients referred for hand symptoms. Each subject filled out a hand diagram of symptoms and had median and ulnar sensory and motor nerve conduction studies, including ulnar conduction across the elbow.The best model for predicting an ulnar mononeuropathy included hand diagram scores of definite or possible. The model had a sensitivity of 50% and specificity of 93% with an ROC area of 0.90.The ulnar hand diagram scoring system can be useful as a screening tool in the electrodiagnostic laboratory or for epidemiologic studies.

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