Lurnbrical sparing in carpal tunnel syndrome

Logigian, Eric L.; Busis, Neil A.; Berger, A.; Bruyninckx, Frans; Khalil, Nathalie T.; Shahani, Bhagwan T.; Young, Ryan

doi:10.1212/wnl.37.9.1499

Cited by 63 publications

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“…On the other hand, a sparing of second lumbrical nerve fibers in CTS has been reported [5], indicating a certain degree of resistance against the effects of severe nerve compression. Evidence of such a lumbrical sparing was found in 31 of 36 hands with severe CTS in which it was impossible to record a CMAP from APB, but a response could be obtained from the second lumbrical, reduced in amplitude, and the latency substantially prolonged.…”

Section: Discussionmentioning

confidence: 99%

Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands

Löscher¹,

Auer‐Grumbach²,

Trinka³

et al. 2000

Journal of Neurology

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The second lumbrical-interosseus distal motor latency (2LI-DML) was compared prospectively in 450 hands. Median nerve function was assessed by standard motor and sensory electrophysiological tests. In a control group of 100 hands the upper limit of normal for the 2LI-DML was 0.5 ms. In all hands studied the correlation coefficients of 2LI-DML were higher with sensory nerve tests than with motor studies. Carpal tunnel syndrome (CTS) was diagnosed clinically in 276 hands, and 174 showed no clinical signs of CTS. The 2LI-DML was prolonged in 269 of the 276 hands, with clinical signs of CTS and normal in 170 of 174 non-CTS hands. Thus the 2LI-DML resulted in a sensitivity of 97.5%. On the other hand, combining the standard tests yielded a sensitivity of 98.5 %. In 31 of 36 additional hands a lumbrical response was recorded, although motor and sensory responses form standard median nerve conduction studies were absent, and the 2LI-DML was substantially prolonged. The 2LI-DML therefore represents a highly sensitive, fast, easy-to-perform, and cost-efficient method to study median nerve function across the wrist and may help to localize the lesion in cases in which standard electrophysiological methods fail.

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Section: Discussionmentioning

confidence: 99%

Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands

Löscher¹,

Auer‐Grumbach²,

Trinka³

et al. 2000

Journal of Neurology

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“…In addition, the CMAPs of the interosseous muscles (INT) were elicited by stimulating the ulnar nerve so as to compare the nerve conduction velocity with that after median nerve stimulation [6,9].…”

Section: Methodsmentioning

confidence: 99%

Endoscopic carpal tunnel release and nerve conduction studies

Ueno

Taguchi

Fuchigami

et al. 2001

International Orthopaedics

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We investigated the outcome of endoscopic carpal tunnel release (ECTR) for patients with carpal tunnel syndrome (CTS) in comparison with the results of preoperative nerve conduction studies. The compound muscle action potential (CMAP) of the abductor pollicis brevis muscle (APB) and the second lumbrical muscle (L2) was recorded following median nerve stimulation at the wrist. A total of 38 hands in 35 patients were classified into four categories. Hands with a similarly prolonged distal motor latency for the APB and L2 were classified as type 1 (n=25), while those with a more prolonged distal motor latency for the APB than for the L2 (>0.7 ms) were classified as type 2 (n=10). Hands with a CMAP for the APB, but not L2, were classified as type 3 (n=1), and hands with no CMAP for either the APB or L2 were classified as type 4 (n=2). After ECTR, all of the type 1 and 2 hands were improved. Patients with type 3 and type 4 hands did not show satisfactory improvement, which may have been due to anatomical variation of the recurrent motor branch of the median nerve.Résumé Nous avons examiné la réaction à des opéra-tions de libération du canal carpien endoscopique (LCCE) chez des patients souffrant d'un syndrome du canal carpien (SCC), en utilisant les résultats d'une etude de conduction des nerfs (ECN) préopératoire. La ré-action des potentiels de l'action des muscles composés (PAMC) de l'abducteur pollicis brevis (APB) et du second muscle lombrical (L2) fut enregistrée suivant une stimulation du nerf médian au poignet. Un total de 38 mains de 35 patients fut divisé en quatre catégories. Les mains avec SCC présentant une latence motrice distale prolongée similaire dans APB et L2, furent classées en tant que type 1 (25 mains). Celles avec SCC présentant une latence motrice distale plus prolongée dans APB que dans le L2 (>0.7 ms), furent classées en tant que type 2 (10 mains), celles avec SCC dont les PAMC de APB seuls furent mis en lumiére, furent classées en tant type que 3 (1 main), et celles avec SCC dont les PAMC à la fois de APB et L2 ne furent pas mis en lumière, furent classées en tant que type 4 (2 mains). Après la LCCE, toutes les mains des types 1 et 2 furent bien améliorées. Patients de types SCC 3 et 4 n'ont pas pré-senté une amélioration satisfaisante, par suite probablement d'une variation anatomique d'une branche motrice récurrente. IntroductionIt has been reported that endoscopic carpal tunnel release (ECTR) gives mostly satisfactory results in the treatment of carpal tunnel syndrome (CTS). There are some unsatisfactory results, however. We classified CTS according to the degree of involvement of the recurrent motor branch of the median nerve, based on nerve conduction velocity (NCV) studies, and report the results and the indications for ECTR in patients with CTS. Patients and methodsWe studied 38 hands in 35 patients, with symptoms of carpal tunnel syndrome by ECTR. There were five men and 30 women with a mean age of 66 years (31-83 years). The mean follow-up period was 8 months (3-32 months).W...

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“…Earliest symptoms are usually sensory and include pain and paresthesia worsening, particularly at night over the first three digits. [1][2][3] Hand numbness aggravates during repetitive wrist flexion. Thumb abduction and opposition weakness may be present, and atrophy can be seen as a result of involvement of motor branches.…”

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confidence: 99%

“…Since lumbrical responses remain intact in cases with severe CTS refractory to classical median motor and sensory stimulation, measurements of lumbrical-interosseous (L-I) latency difference may be helpful for establishing the diagnosis. [1] Additionally, this technique is relatively rapid and may decrease the number of nerve conduction tests for the diagnosis of CTS. [8] In the literature, L-I motor nerve conduction studies (NCS) performed with median-ulnar nerve stimulation were often compared with median sensory or median motor studies.…”

mentioning

confidence: 99%

Lumbrical-interosseous recording technique versus routine electrodiagnostic methods in the diagnosis of carpal tunnel syndrome

Yılmaz

Gündüz

Akyüz

2017

Turk J Phys Med Rehab

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Objectives:We aimed to evaluate the sensitivity of second lumbrical-interosseous (L-I) technique and to compare the results with other electrophysiological methods in patients with carpal tunnel syndrome (CTS). Patients and methods:This cross-sectional study was conducted in an electrophysiology laboratory of a university hospital between January 2003 and January 2004. A total of 102 patients with CTS (174 hands) and 40 healthy controls (80 hands) were included. Median motor nerve conduction studies were obtained with recordings from the abductor pollicis brevis (APB), median sensory nerve conduction studies from digits I-III and at palm-wrist segment (P-W), median-ulnar sensory comparison at digit IV (M-U), and median-radial sensory comparison at digit I (M-R) were along with L-I technique. Results:The highest sensitivities were found in the median sensory conduction velocity across the palm-wrist (88%), and digit I-wrist segments (80%), median motor distal latency over the APB (77%), and L-I study (76%). The specificities of conventional tests were higher than the sensitivity of L-I method (63%).Conclusion: L-I method has a good diagnostic sensitivity in CTS; however, P-W, median sensory nerve conduction velocity at digit I and median distal motor latency are more sensitive than L-I method. Therefore, L-I method can be applied as a supportive technique in the evaluation of patients with CTS.

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Lurnbrical sparing in carpal tunnel syndrome

Cited by 63 publications

References 0 publications

Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands

Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands

Endoscopic carpal tunnel release and nerve conduction studies

Lumbrical-interosseous recording technique versus routine electrodiagnostic methods in the diagnosis of carpal tunnel syndrome

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