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Ethan Nadj

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Introduction to Neurophysiology Lab Report 1: Sensory Receptive Fields

Ulnar Nerve Conduction Latency Equal for Motor or Sensory Innervation Measured

Below the Elbow and at the Wrist in Healthy University Students

Nerve cell conduction velocities is a specific area of importance in motor control and

sensory innervation fields. When nerve cell action potential propagation speeds fall below

normal levels, the results can cause dramatic negative consequences in motor and sensory

functions of the human. The ulnar nerve is one such pathway that is at greater risk of injury

due to its exposure at the elbow. Damage in this region ranges from mild sensory anomalies

to severe cases, where compression can cause significant pain, muscle spasms, and loss of

motor and sensory function. Nerve conduction assessments are a primary method of

assessment when investigating suspected nerve dysfunction that allude to the site of

compression and potential cause. As motor conduction and sensory innervation run along the

same pathway, conduction velocity testing is a valuable asset for health professionals to

utilise when assessing the function of the ulnar nerve. This report aims to capture an insight

into the differences that exist in conduction velocity between motor control, and sensory

innervation of the ulnar nerve in one university student. It is expected that conduction will be

similar to results gathered in previous research. If values fall below normative data, it may

indicate signs of potential nerve compression and provide cause to conduct future

investigation to determine aetiology.

Methods
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Motor nerve conduction testing procedure

Ulnar nerve stimulation sites were located on the participant’s elbow, following

procedures outlined in Preston and Shapiro (2013, pp. 99-101). Sites were marked with a felt

tip pen so they could be found easily between stimulations. Grounding electrodes were placed

over the muscle belly of the abductor digiti minimi and fifth metacarpal-phalangeal joint.

Amplifying electrodes were placed on the palm and wrist, see figure 1. Sites were cleaned

prior to attachment of electrodes using alcohol swabs and an abrasion scrub. Stimulating

electrodes were soaked in saline to increase conductivity and voltage was set at a level high

enough to produce a motor response without causing pain. Propagation voltage will vary

between participants, but this study found that ≥5mV when testing motor conduction, and

>10µV when testing sensory conduction. Conduction voltages are in line with previous

experimental set ups (Preston & Shapiro, 2013). Motor conduction results are displayed in

figure 2 and table 2.

Figure 1. Ulnar motor nerve conduction experimental set up

Sensory nerve conduction testing procedure

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Testing sites were cleaned following the same procedures as motor nerve testing.

Coil recording electrodes were placed around the fourth and fifth interphalangeal joints of the

hand. Stimulation electrodes were placed vertically (positive above negative) at the medial

wrist, adjacent to the flexor carpi ulnaris tendon. See figure 2. Pulses were delivered using an

averaging pattern, results presented in table 3.

Figure 2. Ulnar sensory nerve conduction experimental set up

Analysis and Data collection

Lab Chart software was used to perform the experiment and collect data for both

motor and sensory conduction velocities. It is important to note that stimulation signals tend

to be alike noise interference emitted by recording equipment. As such, an averaging

stimulation pattern was used during testing to ensure nerve impulse was accurately recorded.

Following stimulation, a high and low frequency filter was used to isolate the nerve impulse

from equipment noise. See table 1.

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Table 1

Suggested amplifier conduction settings

Frequency Coupling Gain ~

Setting
Low frequency AC 2K
0.1 Hz
filter
High frequency 10 kHz “ ” “ ”
filter

Results

Conduction latency at the elbow was the same for motor and sensory conduction

testing, measuring 7.75 milliseconds (ms) before response, despite distances between

stimulating cathode and recording electrode being 19 cm greater, in sensory conduction

testing. This trend did not carry over to latency measured at the wrist however, with latency

being greater in motor conduction testing, measuring 3.55 ms, compared to 3.4 ms for

sensory conduction. Conduction velocity was above normative thresholds of 54 m/sec for

sensory conduction, measuring 73.56 m/sec. Interestingly Motor conduction velocities were

below normative thresholds of 50 m/sec, measuring only 30.95 m/sec.

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Table 2

Motor Conduction Velocities of the Ulnar Nerve

Latency (ms) Distance (cm) Velocity (m/s)

Stimulator Position
Wrist 3.55 13
30.95
Elbow 7.75 26
Note: ms = milliseconds, cm = centimetres, m/s = metres per sec
* Values are displayed as averaged results to reduce sample noise. Distance refers to the
distance between positive cathode of stimulator and positive electrode of recorder.

Table 3

Sensory Conduction Velocities of the Ulnar Nerve

Latency (ms) Distance (cm) Velocity (m/s)

Stimulator Position
Wrist 3.4 13
73.56
Elbow 7.75 45
Note: ms = milliseconds, cm = centimetres, m/s = metres per sec
*Values are displayed as averaged results to reduce sample noise. Distance refers to the space
between positive cathode of stimulator and positive electrode of recorder.

Table 4

Typical velocities of Ulnar nerve conduction.

Nerve Type Motor Sensory

Measurements M M
Distal Latency < 3.1 ms at 7cm < 3.2 ms at 7 cm
Conduction Velocity > 50 m/sec >54 m/sec
Amplitude 5 mV >10 µV
Note: Distal latency was measured between the positive cathode stimulator, and positive
recording electrode.

Discussion

Latency values were consistent with norms for both motor and sensory stimulations.

However, motor velocity was below normal values of 50 m/s, measuring only 30.95 m/s

when tested below the elbow. This may be attributable to testing only being conducted below
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the elbow and at the wrist. Testing recommendations suggest measuring velocity at three

sites, above the elbow, below the elbow, and at the wrist, to provide the most accurate data

(Preston & Shapiro, 2013). Furthermore, it would be beneficial to perform additional

conduction testing across the forearm, to allow for diagnostic comparison to pathological

values associated with common peripheral neuropathies of the cubital tunnel, carpal tunnel

and Guyon’s canal.

The most common of neuropathy associated with the ulnar nerve is cubital tunnel

syndrome (CBTS). Diagnosis of CBTS is based on a combination of neuromotor function

tests. Conduction velocity testing results below 50 m/s across the width of the arm are

considered indicative of CBTS. Additional evidence to support suspected CBTS can be found

if conduction velocity is diminished by more than 10m/s when signals travel from above the

elbow to below the elbow, in comparison to velocities measured at the wrist (Nakashian et

al., 2020). Unfortunately, no direct comparison can be made using the data collected in this

experiment, as conduction was assessed only down the length of the forearm. It would be

worthwhile re-testing the motor conduction of the participant with the additional test

included, to see if results remain at below norms (Ginanneschi et al., 2018).

Another condition less commonly associated with dysfunction of the ulnar nerve

iscarpal tunnel, this condition has been noted in some cases to impact the ulnar nerve

(Ginanneschi et al., 2018). The main theory suggests that the closeness of the carpal tunnel to

Guyon’s canal results in symptoms being present in both areas, when only one area is

compressed. (Ginanneschi et al., 2018).

One specific limitation of the testing is that it provided only a brief insight into the

compound muscle action potential propagations of the ulnar nerve in healthy university

students, a relatively unexplored population. Interestingly, this study added further evidence
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to support the consistency of delay between stimulation delivery and nervous system

response, regardless of the conduction site in healthy subjects.

In conclusion, the findings of this study provide a useful point of reference for

assessing the motor and sensory functions of the ulnar nerve in university student

populations. Future research should consider expanding testing to include conduction

measurement at sites above the elbow, across the width of the forearm, and at the axilla, on

both arms of the participants to allow for greater comparability to clinical assessments used to

determine pathological dysfunction of the ulnar nerve and increase the similarity between

testing procedures of previous research studies (Preston & Shapiro, 2013). Making these

small changes will provide additional data about the specific functional capacity of the ulnar

nerve conduction within the subject evaluated in this assessment and provide researchers

greater opportunities to compare the findings with other research investigating ulnar nerve

function.
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References

Desai, C. B., Kacha, Y., Gokhale, P. A., Gandhi, P., Mehta, H., & Shah, C. J. (2021).

Handedness affecting sensory nerve conduction study of median and ulnar nerve.

National Journal of Physiology, Pharmacy and Pharmacology, 11(10), 1199-1202.

https://doi.org/https://doi.org/10.5455/njppp.2021.11.08292202109092021

Ginanneschi, F., Mondelli, M., Cioncoloni, D., & Rossi, A. (2018). Impact of carpal tunnel

syndrome on ulnar nerve at wrist: Systematic review. Journal of Electromyography

and Kinesiology, 40, 32-38.

https://doi.org/https://doi.org/10.1016/j.jelekin.2018.03.004

Kang, S., Yang, S. N., Yoon, J. S., Kang, H. J., & Won, S. J. (2016). Effect of Carpal Tunnel

Syndrome on the Ulnar Nerve at the Wrist. Journal of Ultrasound in Medicine, 35(1),

37-42. https://doi.org/https://doi.org/10.7863/ultra.15.02064

Nakashian, M. N., Ireland, D., & Kane, P. M. (2020). Cubital Tunnel Syndrome: Current

Concepts. Current reviews in musculoskeletal medicine, 13(4), 520-524.

https://doi.org/10.1007/s12178-020-09650-y

Preston, D. C., & Shapiro, B. E. (2013). 10 - Routine Upper Extremity, Facial, and Phrenic

Nerve Conduction Techniques. In D. C. Preston & B. E. Shapiro (Eds.),

Electromyography and Neuromuscular Disorders (Third Edition) (pp. 97-114). W.B.

Saunders. https://doi.org/https://doi.org/10.1016/B978-1-4557-2672-1.00010-6