Ann Rehabil Med.  2014 Dec;38(6):836-842. 10.5535/arm.2014.38.6.836.

Determination of an Ideal Stimulation Site of the Medial Antebrachial Cutaneous Nerve Using Ultrasound and Investigation of the Efficiency

• Oh CH
• Park NS
• Kim JM
• Kim MW

• KMID: 2267095
• DOI: http://doi.org/10.5535/arm.2014.38.6.836

Abstract

OBJECTIVE
To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study.
METHODS
Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site).
RESULTS
The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site.
CONCLUSION
The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN.

Keyword

Medial antebrachial cutaneous nerve; Ultrasonography; Neural conduction

MeSH Terms

Arm
Elbow
Median Nerve
Neural Conduction
Skin
Ultrasonography*

Figure

• 

  Fig. 1 Ultrasound illustration of the MACN and the adjacent anatomy at 6 cm proximal to the medial epicondyle in a 33-year-old man. Left side of the image is radial (lateral) side of the arm. MACN, medial antebrachial cutaneous nerve; MN, median nerve; BA, brachial artery; BV, basilic vein; BF, brachial fascia.

• 

  Fig. 2 Ultrasound image illustrated the MACN at 0, 4, and 8 cm proximal to the medial epicondyle in a 28-year-old healthy woman. Cross sectional view at the elbow crease line (A), 4 cm (B), and 8 cm (C) proximal site from the medial epicondyle. The distance between to the median nerve (+-+) and to the skin (x-x) from the MACN were measured. To avoid pressure to the skin, we applied the ultrasound probe lightly over the skin with enough transducer gel. MACN, medial antebrachial cutaneous nerve.

• 

  Fig. 3 Ultrasound measurement at the elbow crease level showed the shortest distance to the skin and the longest distance to the median nerve (MN) from the medial antebrachial cutaneous nerve (MACN). MN-MACN, distance between the MACN and the MN; Skin-MACN, distance between the MACN and the skin. Statistical differences of each segment in the data of ultrasound were analyzed using the repeated measures ANOVA (p<0.001).

• 

  Fig. 4 Electrophysiologic results of two stimulation sites. (A) SNAP amplitude of the conventional stimulation site showed larger than that of the elbow crease stimulation site (p<0.001). There were no significant differences in (B) maximal stimulation current (p=0.087) and (C) SNAP peak latency (p=0.190). Elbow crease, data on the elbow crease stimulation; 4 cm proximal, data on the conventional stimulation (4 cm proximal to the medial epicondyle); SNAP, sensory nerve action potential. p-values were calculated using the paired-samples t-test for continuous variables.

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