What is the best way to assess focal slowing of the ulnar nerve?

Objective: The study assessed the influence of the length of the across elb ow (AE) segment of the ulnar nerve on the true and false positive rates of velocity measurements: of the AE segment. Using a short AE length will incr ease effects of the measurement error (ME), and using a long distance will 'dilute' the slowing due to the focal lesion; it is not known which length is optimal to detect focal slowing. Methods: A simulation was performed to assess diagnostic yield for AE lengt hs of 50, 100 and 150 mm, taking into account ME, variation in true velocit y, and severity of the lesion. ME of latencies and distances were first det ermined in a healthy subject. Results: ME proved lower than in a published study. Diagnostic yield was co nsistently better for an AE length of 50 mm than for 100 or 150 mm. The opt imum length is therefore near 50 mm. Yield increased with severity of the l esion, smaller ME, and when interindividual variation in true velocity was small. Judging AE on its own had a slightly better yield than comparing AE velocity to forearm velocity, except for populations with a larger than nor mal spread in true conduction variability. Conclusions: The best balance between effects of ME and 'dilution' to detec t focal nerve slowing is obtained at nerve lengths of about 50 mm. The need to incorporate all possible compression sites necessitates the use of a su boptimal length of about 80 mm. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.