Conduction block and segmental velocities in carpal tunnel syndrome

Guglielmo, Giovanni; Torrieri, Filomena; Repaci, Maria; Uncini, Antonino

doi:10.1016/s0924-980x(97)00029-5

Cited by 32 publications

(23 citation statements)

References 16 publications

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“…Although segmental W-Pmot CV was first used as a diagnostic method 23 years ago (Kimura, 1978), this technique has not been widely accepted for routine examination because palmar stimulation of the recurrent motor thenar branch can generate variable results. It is also difficult to avoid costimulation of the deep branch of the ulnar nerve and of the thenar muscle (Chang et al, 2002(Chang et al, , 2006Di Guglielmo et al, 1997;Park et al, 2001). However, these difficulties are overcome by improvements in stimulation techniques, notably where the location of the anode is modified (Chang et al, 2002(Chang et al, , 2006.…”

Section: Discussionmentioning

confidence: 97%

“…Indeed, the lack of diagnostic sensitivity of this technique may be because motor fibers are relatively spared in CTS even when sensory fiber conduction is impaired in CTS (Chang et al, 2002(Chang et al, , 2006Di Guglielmo et al, 1997;Kimura, 1978;Lesser et al, 1995;Park et al, 2001;Pease et al, 1988;Walters et al, 2001). Although segmental W-Pmot CV was first used as a diagnostic method 23 years ago (Kimura, 1978), this technique has not been widely accepted for routine examination because palmar stimulation of the recurrent motor thenar branch can generate variable results.…”

Section: Discussionmentioning

confidence: 98%

“…Although this recommendation is widely accepted for CTS electrodiagnosis, the sensitivity of each method has not been assessed in a head-to-head comparison. In addition to the standard techniques described and recommended by the AAN and AANEM, assessment of the short conduction distance through the wrist to the palm motor nerve provides a further sensitive technique for electrodiagnosis (Chang et al, 2002(Chang et al, , 2006Di Guglielmo et al, 1997;Lesser et al, 1995;Pease et al, 1988;Ross and Kimura, 1995;Walters and Murray, 2001) and has been recommended as an additional diagnostic option (AAEM et al, 1999a, b;AAN et al, 1993;Jablecki et al, 1993Jablecki et al, , 2002a. Wrist-palm motor CV (W-Pmot CV) was therefore included in this study.…”

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confidence: 98%

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Electrodiagnosis of Carpal Tunnel Syndrome: Which Transcarpal Conduction Technique Is Best?

Chang

Liao

Lee

et al. 2009

Journal of Clinical Neurophysiology

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Transcarpal conduction techniques are commonly used to be supplementary techniques to distal sensory and motor latencies (DSL and DML) in the electrodiagnosis of carpal tunnel syndrome (CTS). However, which transcarpal conduction techniques, or combination of techniques, are the most sensitive for the electrodiagnosis of CTS is unknown. To determine which transcarpal conduction technique is the most sensitive for the electrodiagnosis of CTS, we prospectively conduct this study. Study subjects were 100 patients with CTS and 50 controls. In addition to DSL and DML determinations, all subjects were evaluated using four transcarpal conduction techniques. These were (1) median wrist-palm sensory conduction time (W-Psen CT); (2) median wrist-palm mixed nerve conduction time (W-Pmix CT); (3) the difference of conduction time across wrist between median and ulnar nerves (W-Pmix M-U CT); and (4) median wrist-palm motor conduction velocity (W-Pmot CV). The sensitivities and specificities of these tests were compared. Ninety patients had one or more electrophysiologic abnormalities. The DSL and DML diagnostic sensitivities were 74% and 72%, respectively. Better sensitivities were obtained with W-Psen CT (82%), W-Pmot CV (81%), W-Pmix CT (78%), and W-Pmix M-U CT (79%). Compared between four transcarpal conduction techniques, there was no significant difference in sensitivity. Of 26 patients with CTS with normal DSL, additional electrophysiologic abnormalities were revealed with W-Psen CT (30.7%), W-Pmot CV (53.8%), W-Pmix CT (30.7%), or W-Pmix M-U CT (38.5%). When W-Pmot CV was compared with W-Psen CT and W-Pmot CV versus W-Pmix CT, calculated probabilities (P = 0.07) showed a clear trend toward statistical significance. Furthermore, of 20 patients with normal DSL and DML, five patients had abnormality for W-Psen CT, eight for W-Pmot CV, four for W-Pmix CT, and six for W-Pmix M-U CT. On the basis of the results, we concluded that the most simple and reliable transcarpal conduction for electrodiagnosis of CTS was W-Psen CT. The most sensitive technique was W-Pmot CV in subjects with normal DSL or with normal DSL and DML. Evaluation of transcarpal motor conduction affords a useful supplementary technique to W-Psen CT.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 98%

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Electrodiagnosis of Carpal Tunnel Syndrome: Which Transcarpal Conduction Technique Is Best?

Chang

Liao

Lee

et al. 2009

Journal of Clinical Neurophysiology

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“…Despite the great controversial of this theme, it is well stated that demyelinating lesions have better prognosis than axonal ones. Di Guglielmo et al 8 , Lesser et al 2 and Pease et al 9 have published distinct works where they used palmar stimulation in CTS, in order to study the conduction block beneath the carpal tunnel segment, but they have given little importance to axonal degeneration. Warfel et al 10 have been the first who used the median palmar SNAP amplitude in order to predict the surgical outcome in CTS, and found that it is a good index, while latencies are not.…”

Section: Discussionmentioning

confidence: 99%

Axonal degeneration in association with carpal tunnel syndrome

Caetano¹

2003

Arq. Neuro-Psiquiatr.

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-Median nerve entrapment in the palm to wrist segment is known as carpal tunnel syndrome (CTS). Electromyography is the best evaluation test to confirm the disease, as it shows a median reduced conduction velocity and/or conduction block; however, the usual CTS electrodiagnostic tests do not separate segmental demyelination alone from segmental demyelination plus secondary axonal degeneration. We studied 100 hands from CTS patients (classified as mild, moderate, and severe), and 50 hands from normal subjects. The median palmar sensory nerve action potential (SNAP) amplitude was measured and compared between the two groups. It would be expected that SNAP was normal if no axonal degeneration had occurred. The results showed that in mild CTS group and part of moderate CTS group SNAP amplitude was normal, whereas in severe CTS group, and part of moderate group SNAP amplitude was reduced, proving that axonal degeneration was involved. As it is well stated that axonal lesions have worse prognosis than segmental demyelinating ones, this simple test may help to preditic the CTS outcome and treatment.KEY WORDS: carpal, tunnel, syndrome, axonal, degeneration.Degeneração axonal na síndrome do túnel do carpo Degeneração axonal na síndrome do túnel do carpo Degeneração axonal na síndrome do túnel do carpo Degeneração axonal na síndrome do túnel do carpo Degeneração axonal na síndrome do túnel do carpo RESUMO -A compressão do nervo mediano no segmento punho-palma produz uma entidade clínica conhecida como síndrome do túnel do carpo (STC). A eletroneuromiografia é o exame de escolha para o diagnóstico da STC, através da identificação de diminuição de velocidade e/ou bloqueio de condução quando estudamos a neurocondução do nervo mediano, no trecho do punho. Entretanto, as técnicas comumente usadas não conseguem separar a lesão em mielínica focal com ou sem degeneração axonal secundária. Avaliamos 100 mãos de pacientes com STC e comparamos com 50 mãos de um grupo controle. Medimos a amplitude do potencial de ação do nervo sensitivo do mediano, com estímulo na palma e captação no dedo, e comparamos entre os grupos controle e de pacientes (o grupo de STC foi subdividido em leve, moderado e grave). Era esperado que a amplitude do potencial estivesse normal enquanto não houvesse degeneração axonal secundária. Os resultados mostraram que, no grupo de STC leve e parte do grupo de STC moderado, a amplitude do potencial está normal, enquanto que, no grupo de STC grave e em parte do grupo de STC moderado, a amplitude está diminuída, ou o potencial está abolido, demonstrando que existe degeneração axonal secundária nos casos de STC mais graves. Como em geral as lesões mielínicas focais têm melhor prognóstico do que as axonais, concluímos que a avaliação proposta pode ser útil no prognóstico e na orientação terapêutica. PALAVRAS-CHAVE: síndrome, túnel, carpo, degeneração axonal.Serviço de Neurofisiologia do Labs -Rio de Janeiro RJ, Brasil:1 Médico especialista em eletroneuromiografia pela Sociedade Brasileira de Neurofisiologia Cl...

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“…It is generally accepted that median sensory conduction is more sensitive than motor conduction in the EDX of CTS. However, the low sensitivity of standard median motor EDX techniques in detecting motor axon abnormality also needs to be considered [13]. CMAP results from the sum of all the synchronously activated muscle fiber action potentials generated through all the axon destined to the APB muscle.…”

Section: Introductionmentioning

confidence: 99%

Evaluation Of The Compound Muscle Action Potential In Diagnosis Of The Mild Carpal Tunnel Syndrome

Alcan

Zinnuroğlu

Karataş

et al. 2016

International Journal of Applied Mathematics, Electronics and Computers

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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. In most patients, the diagnosis can be proposed based on patient history and clinical symptoms, with electrophysical findings. The mild CTS may not produce any nerve conduction abnormalities and this can make standard conventional tests not enough in diagnosis the mild CTS. The aim of this study was to evaluate Compound Muscle Action Potential (CMAP) morphology as more sensitive and specific parameters without any additional testing for diagnosis the mild CTS. A total of seventy seven clinically diagnosed patients with CTS were prospectively enrolled. Data was evaluated from seventy normal hands and forty six hands with the diagnosis of the mild CTS with standard electrodiagnostic (EDX) tests and clinical findings. The specificity and sensitivity rate were calculated to evaluate the utility of CMAP negative peak (NP) morphology parameters evaluated duration (CMAP NP Half-Duration and CMAP NP Full-Duration ) and area (CMAP NP Half-Area and CMAP NP Full-Area ) by comparing the standard EDX test (Median Distal Motor Latency (DML) and peak to peak amplitude of CMAP (CMAP NP Amplitude ) recorded from the abductor policies brevis (APB) muscle. Although CMAP NP Half-Duration and CMAP NP Full-Duration had no statistically significantly difference between the mild CTS and normal group (p>0.05), DML, CMAP NP Amplitude , CMAP NP Half-Area and CMAP NP Full-Area in the mild CTS group were statistically significantly different (p<0.05). The present study shown CMAP NP Full-Area had the highest sensitivity and moderate specificity rate (90.0% and 42.2%, respectively). Furthermore, it was confirmed again that DML was a valuable motor nerve conduction technique for the diagnosis of the mild CTS with high sensitivity and moderate specificity (84.8% and 47.6%, respectively), and it had more sensitive than CMAP NP Half-Area high sensitivity and moderate specificity (80.0% and 38.7%, respectively).This study provided the evidence of CMAP NP Full-Area and CMAP NP Half-Area that could be predictors of the mild CTS

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Conduction block and segmental velocities in carpal tunnel syndrome

Cited by 32 publications

References 16 publications

Electrodiagnosis of Carpal Tunnel Syndrome: Which Transcarpal Conduction Technique Is Best?

Electrodiagnosis of Carpal Tunnel Syndrome: Which Transcarpal Conduction Technique Is Best?

Axonal degeneration in association with carpal tunnel syndrome

Evaluation Of The Compound Muscle Action Potential In Diagnosis Of The Mild Carpal Tunnel Syndrome

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