RESEARCH ARTICLE
Effect of sensory nerve conduction studies of median and ulnar
nerve: Height and body mass index
Chetankumar B Desai
1, Pradyna A Gokhale
2, Pritesh H Gandhi
3, Hemant B Mehta
4, Chinmay J Shah
4 1Department of Physiology, GMERS Medical College, Junagadh, Gujarat, India, 2Department of Physiology, Government Medical College,Baroda, Gujarat, India, 3Medical Officer, GMERS Medical College, Gandhinagar, Gujarat, India, 4Department of Physiology, Government
Medical College, Bhavnagar, Gujarat, India
Correspondence to: Chetankumar B Desai, E-mail: desaichetankumar07@gmail.com Received: January 02, 2021; Accepted: January 26, 2021
ABSTRACT
Background: Nerve conduction studies (NCSs) have been contributed to a better understanding of normal peripheral nerve structure and function and understanding of various peripheral neuropathies. Height and body mass index (BMI) are influencing activity on nerve conduction velocities (NCVs). Median and ulnar nerves in upper limb were tested commonly for sensory NCSs (SNCSs). Multiple variables such as age; gender; BMI; and height influence NCS parameters. Therefore, this present study was assessing effect of height and BMI on SNCS of median and ulnar nerves among healthy subjects. Aim and Objective: This study aims to study and correlate SNCS of median and ulnar nerve with height and BMI. Materials and Methods: After taking permission from Human Ethics Committee, Government Medical College, Bhavnagar, 91 normal healthy subjects of both genders, age 15–65 years, were participated for SNCS of median and ulnar nerve of both hands using RMS Aleron electromyography/NCV EPII Mark 401, 4-Channels instrument. SNCSs of different parameters were taken out and analyzed for statistical significance. Results: P value is not statistically significant in all groups divided on the basis of height except I versus III and II versus III height group in the left ulnar nerve. P value is not statistically significant in all groups divided on the basis of BMI group. Positive correlation is seen in height with latency and negative correlation is seen in height with sensory NCV (SNCV) and amplitude which was similar to other study 3, 6, 13 and no uniform correlation in height with duration. A positive correlation is seen in BMI with SNCV and negative correlation is seen in BMI with duration. There is no uniform correlation in BMI with latency and amplitude. Conclusion: SNCV is slowing as height and BMI increases.
KEY WORDS: Sensory Nerve Conduction Studies; Height; Body Mass Index
INTRODUCTION
Nerve conduction studies (NCSs) have been contributed to a better understanding of normal peripheral nerve structure and function and understanding of various peripheral
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DOI: 10.5455/njppp.2021.11.01027202126012021
National Journal of Physiology, Pharmacy and Pharmacology Online 2021. © 2021 Chetankumar B Desai, et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creative commons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
neuropathies.[1] Height and body mass index (BMI) are
influencing activity on nerve conduction velocities (NCVs).[2-4]
Median and ulnar nerves in upper limb were tested commonly for sensory NCSs (SNCSs). Multiple variables such as age; gender; BMI; and height influence NCS parameters.[5] Height
is an important factor of SNCSs.[6,7] Therefore, this present
study was assessing effect of height and BMI on SNCS of median and ulnar nerves among healthy subjects.
Aims and Objectives
This study aims to study and correlate height and BMI with SNCS of median and ulnar nerve.
MATERIALS AND METHODS
After taking permission from Human Ethics Committee, Government Medical College, Bhavnagar, 91 normal healthy subjects of both genders, age between 15 and 65 years, were included for SNCS of median and ulnar nerve of both hands using RMS Aleron electromyography/NCV EPII Mark 401, 4-Channels instrument. SNCS parameters such as latency, duration, amplitude, and sensory NCV (SNCV) were taken out. Participants were kept in supine position for their relaxation. Participants skin surface was cleaned with spirit swab and allowed dry to avoid any error before placing electrodes on upper limbs. Electrodes were placed with good contact with surface as per standard method. Supramaximal stimulation (up to 50 mA) was used to stimulate nerves for sensory recording antidromic direction till good quality graph was obtained. SNCS Filter Setting High-frequency filter 3 KHz. Low-frequency filter 20 Hz. Sweep speed 2 ms/division. Sweep gain 3 μV/division. Average 20. Display
Analog to digital converter.
Stimulus Duration: (100 μs) 50–1000 μs. Intensity current 0–50 mA. Rate of stimulation 1 Hz.
Procedure of SNCS in Median Nerve[8-10]
Ring electrodes such as active (black color) and reference electrode (red color) were placed 4 cm apart around proximal and distal interphalangeal joints on index finger for median nerve. Ground (green color) electrode was placed on thenar eminence between stimulating and recording electrodes. The sensory branch of median nerve was stimulated to lateral to flexor carpi ulnaris tendon just 3 cm to wrist crease proximally in which cathode was placed 3 cm to wrist crease proximally and anode was placed at distally.
Procedure of SNCS in Ulnar Nerve[8,9,11]
Active and reference electrodes were placed 4 cm apart around proximal and distal interphalangeal joints on little finger for ulnar nerve. Ground electrode was placed in between stimulating and recording electrodes on thenar eminence. Ulnar nerve was stimulated 5–8 cm to ulnar styloid process between flexor carpi ulnaris and ulna proximally in which cathode was placed 3 cm to wrist crease proximally and anode was placed at distally.
Statistical Analysis
Results were Mean ± SD and analyzed by ANOVA test (P < 0.05 considered significant) Pearson correlation coefficient (r: + positive correlation, r: − was negative correlation) in GraphPad trial version software.
RESULTS
This study comprises SNCS on 91 subjects in age 15–65 years in period from October 2011 to May 2013. The study population was divided into four groups on the basis of height of subject. The findings of the present studies are summarized in Tables 1-8.
The physical parameters of subjects included in the study and divided on basis of BMI of subject into four groups in Asian population.[12]
Table 1: Physical parameters in each group according to height (Mean±SD)
Group Age (years) Height (cm) Weight (kg) BMI (Kg/m2)
Group I (>160 cm) n=26 40.3±14.5 154.15±4.71 60.19±10.33 25.32±4.23
Group II (160–169 cm) n=36 40.1±13.8 163.69±2.54 63.97±8.35 23.86±2.99
Group III (170–179 cm) n=25 35±12 173.04±2.56 68.08±8.22 22.74±2.69
Group IV (>180 cm) n=5 45±15.2 181.8±2.45 86.2±4.76 26.09±1.72
Table 2: SNCS parameters in each height group (Mean±SD)
Nerve Group Latency Duration Amplitude SNCV
Right median nerve I 2.26±0.26 3.06±0.84 77.69±24.68 53.86±6.05
II 2.28±0.28 2.80±0.86 62.54±29.66 57.37±6.84
III 2.30±0.24 2.69±0.59 60.99±27.18 55.97±6.10
IV 2.36±0.29 2.66±1.06 56.48±30.01 58.80±4.14
Left median nerve I 2.19±0.23 2.66±0.51 85.78±24.22 57.84±5.1
II 2.24±0.29 2.81±0.61 88.95±17.87 59.46±7.3
III 2.24±0.28 2.63±0.55 82.11±17.06 58.79±6.5
IV 2.31±0.39 3.05±0.48 84.45±19.88 62.66±7.1
Right ulnar nerve I 2.18±0.22 2.84±0.88 61.56±21.12 50.48±5.05
II 2.17±0.23 2.72±1.48 60.15±19.23 51.41±5.24
III 2.18±0.21 2.32±1.04 45.41±15.06 52.59±4.73
IV 2.25±0.07 2.33±0.34 38.58±13.40 52.51±5.10
Left ulnar nerve I 2.18±0.22 2.84±0.88 61.56±21.12 50.48±5.05
II 2.05±0.23 2.50±0.83 71.23±24.65 55.46±5.69
III 2.22±0.38 2.51±0.64 66.27±20.55 54.02±8.02
IV 2.34±0.13 2.32±0.53 62.02±26.38 55.54±6.93
SNCV: Sensory nerve conduction velocity; SNCS: Sensory nerve conduction study
Table 3: Comparison of SNCS parameters inter each height group
Nerve Groups Latency Duration Amplitude SNCV
Right median nerve I versus II P>0.05 P>0.05 P>0.05 P>0.05
I versus III P>0.05 P>0.05 P>0.05 P>0.05
I versus IV P>0.05 P>0.05 P>0.05 P>0.05
II versus III P>0.05 P>0.05 P>0.05 P>0.05
II versus IV P>0.05 P>0.05 P>0.05 P>0.05
III versus IV P>0.05 P>0.05 P>0.05 P>0.05
Left median nerve I versus II P>0.05 P>0.05 P>0.05 P>0.05
I versus III P>0.05 P>0.05 P>0.05 P>0.05
I versus IV P>0.05 P>0.05 P>0.05 P>0.05
II versus III P>0.05 P>0.05 P>0.05 P>0.05
II versus IV P>0.05 P>0.05 P>0.05 P>0.05
III versus IV P>0.05 P>0.05 P>0.05 P>0.05
Right ulnar nerve I versus II P>0.05 P>0.05 P>0.05 P>0.05
I versus III P>0.05 P>0.05 P>0.05 P>0.05
I versus IV P>0.05 P>0.05 P>0.05 P>0.05
II versus III P>0.05 P>0.05 P>0.05 P>0.05
II versus IV P>0.05 P>0.05 P>0.05 P>0.05
III versus IV P>0.05 P>0.05 P>0.05 P>0.05
Left ulnar nerve I versus II P>0.05 P>0.05 P>0.05 P>0.05
I versus III P>0.05 P>0.05 P>0.05 P>0.05
I versus IV P>0.05 P>0.05 P>0.05 P>0.05
II versus III P>0.05 P>0.05 P>0.05 P>0.05
II versus IV P>0.05 P>0.05 P>0.05 P>0.05
III versus IV P>0.05 P>0.05 P>0.05 P>0.05
Table 6: SNCS parameters in each BMI group (Mean±SD)
Nerve Group Latency Duration Amplitude SNCV
Right median nerve <18.5 2.33±0.32 3.51±0.78 64.13±12.23 53.91±7.87
18.5–22.9 2.26±0.42 2.68±0.90 72.17±28.39 56.09±10.41
23–24.9 2.26±0.40 2.88±0.79 64.78±28.80 55.77±9.97
>25 2.32±0.41 2.85±0.85 61.94±28.35 56.67±10.18
Left median nerve <18.5 2.14±0.09 2.49±0.21 69.90±44.39 58.99±3.01
18.5–22.9 2.22±0.44 2.76±0.59 88.97±21.60 58.66±11.71
23–24.9 2.26±0.41 2.73±0.65 83.19±19.64 57.61±10.64
>25 2.22±0.42 2.73±0.67 88.05±21.54 60.68±10.78
Right ulnar nerve <18.5 2.23±0.18 2.77±0.31 52.95±14.87 49.55±4.37
18.5–22.9 2.14±0.42 2.73±1.21 59.80±20.66 52.36±9.65
23–24.9 2.20±0.39 2.62±1.35 53.93±20.72 50.98±9.03
>25 2.19±0.38 2.50±1.18 54.21±20.59 51.57±9.01
Left ulnar nerve <18.5 2.15±0.20 2.97±0.45 64.33±25.28 55.40±3.52
18.5–22.9 2.13±0.42 2.51±0.76 71.50±26.06 54.81±10.76
23–24.9 2.12±0.46 2.61±0.81 76.46±28.40 53.57±10.13
>25 2.06±0.44 2.39±0.76 72.34±26.73 56.12±10.13
BMI: Body mass index; SNCV: Sensory nerve conduction velocity; SNCS: Sensory nerve conduction study
Table 5: Physical parameters in each group according to BMI (Mean±SD)
Group Age (years) Height (cm) Weight (Kg) BMI (Kg/m2)
(Group a) BMI <18.5 (underweight) (n=4) 18±0.5 165±9.22 47±7.35 17.23±1.43
(Group b) BMI (18.5–22.9) (normal) (n=28) 36±15 164±27.6 57±10.29 21.15±3.77
(Group c) BMI 23–24.9 (at risk) (n=30) 40±14 166±26.8 66.6±12.46 24.12±4.06
(Group d) BMI >25 (obese) (n=30) 43±14 163±26.2 73.93±14.09 27.78±4.96
BMI: Body mass index
Table 4: Correlation of SNCS parameters with height
Height parameters Right median nerve Left median nerve Right ulnar nerve Left ulnar nerve
Latency 0.07 0.12 0.06 0.32
Duration –0.08 0.08 –0.15 –0.07
Amplitude –0.22 –0.04 –0.42 –0.27
SNCV –0.18 –0.13 –0.42 –0.03
SNCV: Sensory nerve conduction velocity; SNCS: Sensory nerve conduction study; “−” indicates negative correlation; “+” indicates positive correlation
DISCUSSION
In the present study, an analysis of all SNCS parameters has been attempted and discussion about their variation in relation to height, BMI, is carried out.
P value is not statistically significant in all groups divided on the basis of height except I versus III and II versus III height group in the left ulnar nerve.
Positive correlation is seen in height with latency and negative correlation is seen in height with SNCV and amplitude which
was similar to other study[3,6,13] and no uniform correlation in
height with duration which is similar to other study.[14]
P value is not statistically significant in all groups divided on the basis of BMI group.
A positive correlation is seen in BMI with SNCV and negative correlation is seen in BMI with duration. There is no uniform correlation in BMI with latency and amplitude.
Some studies show negative correlation of conduction velocity of ulnar nerve with height.[15,16] Many studies have shown
Table 7: Comparison of SNCS parameters inter each BMI group
Nerve BMI groups Latency Duration Amplitude SNCV
Right median nerve a versus b P>0.05 P>0.05 P>0.05 P>0.05
a versus c P>0.05 P>0.05 P>0.05 P>0.05
a versus d P>0.05 P>0.05 P>0.05 P>0.05
b versus c P>0.05 P>0.05 P>0.05 P>0.05
b versus d P>0.05 P>0.05 P>0.05 P>0.05
c versus d P>0.05 P>0.05 P>0.05 P>0.05
Left median nerve a versus b P>0.05 P>0.05 P>0.05 P>0.05
a versus c P>0.05 P>0.05 P>0.05 P>0.05
a versus d P>0.05 P>0.05 P>0.05 P>0.05
b versus c P>0.05 P>0.05 P>0.05 P>0.05
b versus d P>0.05 P>0.05 P>0.05 P>0.05
c versus d P>0.05 P>0.05 P>0.05 P>0.05
Right ulnar nerve a versus b P>0.05 P>0.05 P>0.05 P>0.05
a versus c P>0.05 P>0.05 P>0.05 P>0.05
a versus d P>0.05 P>0.05 P>0.05 P>0.05
b versus c P>0.05 P>0.05 P>0.05 P>0.05
b versus d P>0.05 P>0.05 P>0.05 P>0.05
c versus d P>0.05 P>0.05 P>0.05 P>0.05
Left ulnar nerve a versus b P>0.05 P>0.05 P>0.05 P>0.05
a versus c P>0.05 P>0.05 P>0.05 P>0.05
a versus d P>0.05 P>0.05 P>0.05 P>0.05
b versus c P>0.05 P>0.05 P>0.05 P>0.05
b versus d P>0.05 P>0.05 P>0.05 P>0.05
c versus d P>0.05 P>0.05 P>0.05 P>0.05
P<0.05 significant; P>0.05 not significant; BMI: Body mass index; SNCV: Sensory nerve conduction velocity; SNCS: Sensory nerve conduction study Table 8: Correlation of SNCS parameters with BMI
BMI Parameters Right median nerve Left median nerve Right ulnar nerve Left ulnar nerve
Latency 0.10 –0.04 –0.03 –0.12
Duration –0.05 –0.06 –0.10 –0.15
Amplitude –0.07 0.05 –0.09 0.07
SNCV 0.01 0.14 0.01 0.10
BMI: Body mass index; SNCV: Sensory nerve conduction velocity; SNCS: Sensory nerve conduction study; “−” indicates negative correlation; “+” indicates positive correlation
that SNCVs are relatively slower in taller subjects.[3,6] While
Soudmand et al.[17] showed that there is no significant relationship
between height and median sensory conduction velocity. Awang et al.[18] study showed that no any obvious trend of
SNCVs of median and ulnar nerves among different height groups.
Bennal study et al.[19] suggested that negative correlation
between distal fiber diameter and height as well as distal axonal tapering may decrease conduction velocity.
This study concluded that there was no uniform correlation between SNCS and BMI with nerves which was similar to
that other study[18,20] due to may be thick subcutaneous tissue
and adipose tissue in epineurium in higher BMI, [21] so reduce
NCV.
Chadha et al.[22] findings suggest that negative correlation
between distal fiber diameter and height may explain decreased conduction velocity.
SNCS could be attributed to various causes as distance between stimulating and recording electrodes, age of subjects, and diversity of methods and techniques and equipment.[23] These factors influencing SNCS parameters
and contemplates in diagnosis and prognosis of peripheral nerve disease.
CONCLUSION
This present study concludes that positive correlation is seen in height with latency and negative correlation is seen in height with SNCV and amplitude and no uniform correlation in height with duration. A positive correlation is seen in BMI with SNCV and negative correlation is seen in BMI with duration and no uniform correlation in BMI with latency and amplitude. SNCV is slowing as height and BMI increases. ACKNOWLEDGMENTS
We are very thankful to our entire physiology department for their kind support. We are also very thankful to participants for taking part in our study.
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How to cite this article: Desai CB, Gokhale PA, Gandhi PH,
Mehta HB, Shah CJ. Effect of sensory nerve conduction studies of median and ulnar nerve: Height and body mass index. Natl J Physiol Pharm Pharmacol 2021;11(03):331-336.
