Analysis of Clinical Motor Testing for Adult Patients With Diagnosed Ulnar Neuropathy at the Elbow

Abstract Goldman SB, Brininger TL, Schrader JW, Curtis R, Koceja DM. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Objective To compare the dichotomous results for 7 ulnar nerve clinical motor tests (Froment's sign, Wartenberg's sign, finger flexion sign, Jeanne's sign, crossed finger test, Egawa's sign, presence of clinical fasciculations) with motor nerve conduction velocity findings. Design A static group comparison design assessed for differences among dichotomous test outcomes with respect to motor nerve conduction velocity. Setting Five medical facilities throughout the United States provided data for this study. Participants Records from participants (N=26) with diagnosed ulnar neuropathy at the elbow were included for data analysis. Interventions Not applicable. Main Outcome Measures Demographic data included age, sex, handedness, duration of symptoms, and the number of days between the clinical and electrodiagnostic exam. Other dependent variables included motor conduction velocity of the ulnar nerve, compound muscle action potential amplitude, and the dichotomous clinical motor test outcomes. Results Two motor signs, the presence of clinical fasciculations and a positive finger flexion sign, were identified more frequently (each present in 11 patients) than the other motor signs. An analysis of covariance revealed significant differences in motor nerve conduction velocity between positive and negative results for all the clinical motor tests except for the finger flexion sign. Significant chi-square analyses were found for the following comparisons: the presence of clinical fasciculations and Froment's sign, the finger flexion sign and the crossed finger test, Egawa's sign and Froment's sign, Warteberg's sign and Froment's sign, the crossed finger test and Froment's sign, and Egawa's sign and Wartenberg's sign. Conclusions Some clinical motor tests are better than others at identifying early motor involvement, providing the rehabilitation professional some insight regarding the relative decrement of motor nerve conduction velocity when a selected test is positive.