Salim Hirani

  • Designation: Neurophysiology Department, Ysbyty Gwynedd Hospital
  • Country: UK
  • Title: Neurophysiological Grading Tool of Ulnar Nerve Entrapment Across Wrist and across Elbow with Case Presentation


Salim Hirani has worked in Neurophysiology for more than 30 years. He completed a Neurophysiology course in the United Kingdom. He has worked in several different countries and can speak four or five languages. 


Ulnar nerve entrapment across the elbow (UNEAE) and across the wrist (UNEAW) is the second most common hand entrapment after carpal tunnel syndrome. Few gradings are available for UNEAE and fewer for UNEAW.
The aim of this research is;
1. To create a clinically appropriate ulnar nerve entrapment grading tool to cover both entrapment areas in one research paper.
2. To see the relation of sensory nerve involvement across the wrist with the entrapment across the elbow and to evaluate its effectiveness in terms of compatibility with previous research without any invasive tests like needle EMG examination. 
3. Identify the lesions below and across the wrist and elbow to support the clinical physiologist (CP) in grading them properly and help the consultant decide whether to treat them conservatively or surgically.
4. Compare the recording from the first dorsal interosseous (FDI) muscles with the abductor digiti minimi (ADM) muscle to see which muscle is more sensitive and shows early changes in ulnar nerve entrapment. 
The proposed revised grading system is based on more nuanced, descriptive categories, ranging from "normal” to "early”, "mild”, "moderate” and "severe”. Some additional clinical grading categories are proposed to create a full grading system for UNEAW and UNEAE.

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