Exclusive electrophysiological motor involvement in carpal tunnel syndrome

Repaci, Maria; Torrieri, Filomena; Blasio, Francesco Di; Uncini, Antonino

doi:10.1016/s1388-2457(99)00071-1

Cited by 22 publications

(11 citation statements)

References 12 publications

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“…This series included two hands with exclusively motor involvement, i.e. 1.0% of the electrophysiologically detected CTS hands, which agreed well with the earlier percentage of 1.2% (25). It is logical that the test device failed to detect these cases, because it measures merely SNC.…”

Section: Discussionsupporting

confidence: 88%

A handheld nerve conduction measuring device in carpal tunnel syndrome

et al. 2007

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Section: Discussionsupporting

confidence: 88%

A handheld nerve conduction measuring device in carpal tunnel syndrome

et al. 2007

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“…Brown et al (1993) had only one recurrence in 104 endoscopic CTR. However, in contrast to these figures, other authors have reported recurrent symptoms of CTS in up to 19% of patients following CTR, with up to 12% requiring re-exploration (Concanoon et al, 1997;Huang and Zager, 2004;Langloh and Linscheid, 1972;MacDonald et al, 1978;Repaci et al, 1999). We performed 200 secondary operations after primary carpal tunnel decompression during a period of only 2 years.…”

Section: Discussionmentioning

confidence: 73%

Revision Surgery after Carpal Tunnel Release –Analysis of the Pathology in 200 Cases during a 2 Year Period

Stutz

Gohritz

Schoonhoven

et al. 2006

Journal of Hand Surgery

134

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Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.

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“…This study confirms that W-Pmot CV is equivalent to W-Psen CT in the early diagnosis of CTS, suggesting that motor segmental conduction is more commonly affected than originally thought. The frequency of exclusive motor branch involvement in previous studies has varied from 1.2% to 30% (Cosgrove et al, 2002;Repaci et al, 1999). The marked variation in diagnostic rates between different studies may be due to selection bias and the use of different techniques for the confirmation of selective motor involvement.…”

Section: Discussionmentioning

confidence: 95%

“…This is a time-saving technique that is easily performed with an additional stimulating site on the palm, so reducing patient discomfort (Stevens, 1997). If sensory conduction is within the normal range, assessment of transcarpal motor conduction (W-Pmot CV) is likely to increase diagnostic sensitivity, particularly in view of the minority of patients with CTS with selective motor involvement (Chang et al, 2002;Cosgrove et al, 2002;Repaci et al, 1999). However, supramaximal stimulation at the palm is difficult to achieve using the transcarpal motor conduction technique; this can require prior experience of the method (Chang et al, 2002(Chang et al, , 2006Park et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

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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Exclusive electrophysiological motor involvement in carpal tunnel syndrome

Cited by 22 publications

References 12 publications

A handheld nerve conduction measuring device in carpal tunnel syndrome

A handheld nerve conduction measuring device in carpal tunnel syndrome

Revision Surgery after Carpal Tunnel Release –Analysis of the Pathology in 200 Cases during a 2 Year Period

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

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