Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series

Saad Javeed, Nathan Birenbaum, Yameng Xu, Christopher F. Dibble, Jacob K. Greenberg, Justin K. Zhang, Braeden Benedict, Kiersten Sydnor, Christopher J. Dy, David M. Brogan, Amir H. Faraji, Robert J. Spinner, Wilson Z. Ray

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BACKGROUND:Chronic entrapment neuropathy results in a clinical syndrome ranging from mild pain to debilitating atrophy. There remains a lack of objective metrics that quantify nerve dysfunction and guide surgical decision-making. Mechanomyography (MMG) reflects mechanical motor activity after stimulation of neuromuscular tissue and may indicate underlying nerve dysfunction.OBJECTIVE:To evaluate the role of MMG as a surgical adjunct in treating chronic entrapment neuropathies.METHODS:Patients 18 years or older with cubital tunnel syndrome (n = 8) and common peroneal neuropathy (n = 15) were enrolled. Surgical decompression of entrapped nerves was performed with intraoperative MMG of the hypothenar and tibialis anterior muscles. MMG stimulus thresholds (MMG-st) were correlated with compound muscle action potential (CMAP), motor nerve conduction velocity, baseline functional status, and clinical outcomes.RESULTS:After nerve decompression, MMG-st significantly reduced, the mean reduction of 0.5 mA (95% CI: 0.3-0.7, P <. 001). On bivariate analysis, MMG-st exhibited significant negative correlation with common peroneal nerve CMAP (P <. 05), but no association with ulnar nerve CMAP and motor nerve conduction velocity. On preoperative electrodiagnosis, 60% of nerves had axonal loss and 40% had conduction block. The MMG-st was higher in the nerves with axonal loss as compared with the nerves with conduction block. MMG-st was negatively correlated with preoperative hand strength (grip/pinch) and foot-dorsiflexion/toe-extension strength (P <. 05). At the final visit, MMG-st significantly correlated with pain, PROMIS-10 physical function, and Oswestry Disability Index (P <. 05).CONCLUSION:MMG-st may serve as a surgical adjunct indicating axonal integrity in chronic entrapment neuropathies which may aid in clinical decision-making and prognostication of functional outcomes.

Original languageEnglish
Pages (from-to)242-250
Number of pages9
JournalOperative Neurosurgery
Issue number3
StatePublished - Sep 1 2023


  • Case series
  • Electrodiagnosis
  • Entrapment neuropathy
  • Mechanomyography
  • Peripheral nerve
  • Surgical decompression


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