{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T06:53:03Z","timestamp":1781851983765,"version":"3.54.5"},"reference-count":43,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006470","name":"Aristotle University of Thessaloniki","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006470","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","em-consulte.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Neurophysiologie Clinique"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1016\/j.neucli.2025.103134","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:07:29Z","timestamp":1767719249000},"page":"103134","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["The split elbow sign in amyotrophic lateral sclerosis: A systematic review and meta-analysis"],"prefix":"10.1016","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0147-3948","authenticated-orcid":false,"given":"Vasiliki","family":"Poulidou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5651-7082","authenticated-orcid":false,"given":"Vasilis-Spyridon","family":"Tseriotis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bombaci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Vucic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-4391","authenticated-orcid":false,"given":"Nathan","family":"Pavey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6743-6544","authenticated-orcid":false,"given":"Sotirios","family":"Papagiannopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios K","family":"Kimiskidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianthi","family":"Arnaoutoglou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.neucli.2025.103134_bib0004","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1056\/NEJMra1603471","article-title":"Amyotrophic lateral sclerosis","volume":"377","author":"Brown","year":"2017","journal-title":"N Engl J Med"},{"key":"10.1016\/j.neucli.2025.103134_bib0003","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4103\/0972-2327.99700","article-title":"The split hand sign","volume":"15","author":"Benny","year":"2012","journal-title":"Ann Indian Acad Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0007","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1136\/jnnp-2011-301456","article-title":"The split hand syndrome in amyotrophic lateral sclerosis","volume":"83","author":"Eisen","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0017","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/(SICI)1097-4598(199907)22:7<870::AID-MUS9>3.0.CO;2-O","article-title":"Dissociated small hand muscle involvement in amyotrophic lateral sclerosis detected by motor unit number estimates","volume":"22","author":"Kuwabara","year":"1999","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.neucli.2025.103134_bib0023","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.clinph.2012.07.025","article-title":"Split-hand index for the diagnosis of amyotrophic lateral sclerosis","volume":"124","author":"Menon","year":"2013","journal-title":"Clin Neurophysiol"},{"key":"10.1016\/j.neucli.2025.103134_bib0025","article-title":"Dissociated leg muscle atrophy in amyotrophic lateral sclerosis\/motor neuron disease: the 'split-leg","volume":"10","author":"Min","year":"2020","journal-title":"Sign Sci Rep"},{"key":"10.1016\/j.neucli.2025.103134_bib0037","doi-asserted-by":"crossref","first-page":"371","DOI":"10.3389\/fnins.2019.00371","article-title":"Split-hand syndrome in amyotrophic lateral sclerosis: differences in dysfunction of the FDI and ADM spinal motoneurons","volume":"13","author":"Wang","year":"2019","journal-title":"Front Neurosci"},{"key":"10.1016\/j.neucli.2025.103134_bib0039","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1080\/21678421.2019.1646770","article-title":"Split-hand index in amyotrophic lateral sclerosis: an F-wave study","volume":"20","author":"Wang","year":"2019","journal-title":"Amyotroph Lateral Scler Front Degener"},{"key":"10.1016\/j.neucli.2025.103134_bib0021","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.clinph.2022.08.020","article-title":"Split-hand index for amyotrophic lateral sclerosis diagnosis: a frequentist and bayesian meta-analysis","volume":"143","author":"Lu","year":"2022","journal-title":"Clin Neurophysiol"},{"key":"10.1016\/j.neucli.2025.103134_bib0013","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jocn.2021.06.015","article-title":"Split hand in amyotrophic lateral sclerosis: a systematic review and meta-analysis","volume":"90","author":"Hu","year":"2021","journal-title":"J Clin Neurosci"},{"key":"10.1016\/j.neucli.2025.103134_bib0001","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s41983-023-00671-1","article-title":"Split limb phenomenon in amyotrophic lateral sclerosis: electrophysiologic study","volume":"59","author":"Abdul-Wahab","year":"2023","journal-title":"Egypt J Neurol Psychiatry Neurosurg"},{"key":"10.1016\/j.neucli.2025.103134_bib0012","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-54372-y","article-title":"Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis and its differential diagnosis value","volume":"9","author":"Hu","year":"2019","journal-title":"Sci Rep"},{"key":"10.1016\/j.neucli.2025.103134_bib0019","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/01616412.2020.1866354","article-title":"Split phenomenon of antagonistic muscle groups in amyotrophic lateral sclerosis: relative preservation of flexor muscles","volume":"43","author":"Liu","year":"2021","journal-title":"Neurol Res"},{"key":"10.1016\/j.neucli.2025.103134_bib0038","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3389\/fneur.2019.00565","article-title":"Reassessment of split-leg signs in amyotrophic lateral sclerosis: differential involvement of the extensor digitorum brevis and abductor hallucis muscles","volume":"10","author":"Wang","year":"2019","journal-title":"Front Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0033","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1007\/s00415-015-7721-8","article-title":"Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis","volume":"262","author":"Simon","year":"2015","journal-title":"J Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0034","doi-asserted-by":"crossref","first-page":"173","DOI":"10.4103\/aian.AIAN_491_17","article-title":"Clinical mimickers of amyotrophic lateral sclerosis\u2014Conditions we cannot afford to miss","volume":"21","author":"Singh","year":"2018","journal-title":"Ann Indian Acad Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0015","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1136\/jnnp-2018-319894","article-title":"Relative preservation of triceps over biceps strength in upper limb-onset ALS: the 'split elbow","volume":"90","author":"Khalaf","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0022","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1136\/jnnp-2020-323331","article-title":"Pattern of paresis in ALS is consistent with the physiology of the corticomotoneuronal projections to different muscle groups","volume":"91","author":"Ludolph","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0035","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1136\/jnnp-2019-320534","article-title":"Split elbow sign: more evidence for the importance of cortical dysfunction in ALS","volume":"90","author":"Vucic","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0014","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1017\/cjn.2023.62","article-title":"Split phenomenon of fasciculation between antagonistic muscles in amyotrophic lateral sclerosis: an ultrasound study","volume":"51","author":"Hu","year":"2024","journal-title":"Can J Neurol Sci"},{"key":"10.1016\/j.neucli.2025.103134_bib0011","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1499668","article-title":"Quantifying the split-elbow sign: a comprehensive study in amyotrophic lateral sclerosis","volume":"15","author":"He","year":"2024","journal-title":"Front Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0027","first-page":"16","article-title":"The split-elbow index: a biomarker of the split elbow sign in ALS","volume":"7","author":"Pavey","year":"2022","journal-title":"Clin Neurophysiol Pr"},{"key":"10.1016\/j.neucli.2025.103134_bib0026","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.neucli.2025.103134_bib0006","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jclinepi.2020.01.008","article-title":"A full systematic review was completed in 2 weeks using automation tools: a case study","volume":"121","author":"Clark","year":"2020","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.neucli.2025.103134_bib0010","first-page":"e1230","article-title":"PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst Rev"},{"key":"10.1016\/j.neucli.2025.103134_bib0036","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"10.1016\/j.neucli.2025.103134_bib0018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v082.i13","article-title":"lmerTest Package: tests in linear mixed effects models","volume":"82","author":"Kuznetsova","year":"2017","journal-title":"J Stat Softw"},{"key":"10.1016\/j.neucli.2025.103134_bib0029","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1186\/s12874-022-01788-2","article-title":"Meta-DiSc 2.0: a web application for meta-analysis of diagnostic test accuracy data","volume":"22","author":"Plana","year":"2022","journal-title":"BMC Med Res Methodol"},{"key":"10.1016\/j.neucli.2025.103134_bib0031","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2022083","article-title":"Meta-analysis of diagnostic test accuracy studies with multiple thresholds for data integration","volume":"44","author":"Shim","year":"2022","journal-title":"Epidemiol Health"},{"key":"10.1016\/j.neucli.2025.103134_bib0040","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1002\/(SICI)1097-4598(200001)23:1<138::AID-MUS22>3.0.CO;2-7","article-title":"The \"split hand syndrome\"","volume":"23","author":"Wilbourn","year":"2000","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.neucli.2025.103134_bib0032","first-page":"286","article-title":"Exploring the split hand phenomenon with the neurophysiological index","volume":"53","author":"Silva","year":"2023","journal-title":"Neurophysiol Clin"},{"key":"10.1016\/j.neucli.2025.103134_bib0043","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1371953","article-title":"Neurophysiological indices for split phenomena: correlation with age and sex and potential implications in amyotrophic lateral sclerosis","volume":"15","author":"Zoccolella","year":"2024","journal-title":"Front Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0016","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1002\/mus.24958","article-title":"Split-hand phenomenon in amyotrophic lateral sclerosis: a motor unit number index study","volume":"53","author":"Kim","year":"2016","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.neucli.2025.103134_bib0030","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1136\/jnnp-2017-317917","article-title":"Split hand muscle echo intensity index as a reliable imaging marker for differential diagnosis of amyotrophic lateral sclerosis","volume":"89","author":"Seok","year":"2018","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0020","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000493386","article-title":"Amyotrophic lateral sclerosis descriptive epidemiology: the origin of geographic difference","volume":"52","author":"Logroscino","year":"2019","journal-title":"Neuroepidemiology"},{"key":"10.1016\/j.neucli.2025.103134_bib0044","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1136\/jnnp-2016-315018","article-title":"Genetic epidemiology of amyotrophic lateral sclerosis: a systematic review and meta-analysis","volume":"88","author":"Zou","year":"2017","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0042","doi-asserted-by":"crossref","first-page":"3204","DOI":"10.1007\/s00415-023-11660-y","article-title":"Split-elbow sign in the PRO-ACT and Southern Italy ALS cohorts: a potential marker of disease severity and lower motor neuron involvement?","volume":"270","author":"Zoccolella","year":"2023","journal-title":"J Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0008","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1136\/jnnp-2017-315573","article-title":"Cortical influences drive amyotrophic lateral sclerosis","volume":"88","author":"Eisen","year":"2017","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0041","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2022.1100040","article-title":"Split phenomena in amyotrophic lateral sclerosis: current evidences, pathogenetic hypotheses and diagnostic implications","volume":"16","author":"Zoccolella","year":"2023","journal-title":"Front Neurosci"},{"key":"10.1016\/j.neucli.2025.103134_bib0009","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/nrneurol.2016.140","article-title":"Pathophysiological and diagnostic implications of cortical dysfunction in ALS","volume":"12","author":"Geevasinga","year":"2016","journal-title":"Nat Rev Neurol"},{"key":"10.1016\/j.neucli.2025.103134_bib0028","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1136\/jnnp-2021-326266","article-title":"Split-hand and split-limb phenomena in amyotrophic lateral sclerosis: pathophysiology, electrophysiology and clinical manifestations","volume":"92","author":"Philippe","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.1016\/j.neucli.2025.103134_bib0002","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/mus.21107","article-title":"Differences in excitability properties of FDI and ADM motor axons","volume":"39","author":"Bae","year":"2009","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.neucli.2025.103134_bib0005","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/mus.26123","article-title":"Spinal excitability changes do not influence the mechanisms of split-hand syndrome in amyotrophic lateral sclerosis","volume":"58","author":"Cengiz","year":"2018","journal-title":"Muscle Nerve"}],"container-title":["Neurophysiologie Clinique"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0987705325000929?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0987705325000929?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T06:12:20Z","timestamp":1781849540000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0987705325000929"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["S0987705325000929"],"URL":"https:\/\/doi.org\/10.1016\/j.neucli.2025.103134","relation":{},"ISSN":["0987-7053"],"issn-type":[{"value":"0987-7053","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The split elbow sign in amyotrophic lateral sclerosis: A systematic review and meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Neurophysiologie Clinique","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.neucli.2025.103134","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Masson SAS.","name":"copyright","label":"Copyright"}],"article-number":"103134"}}