경증의 수근관증후군에서 여러 전기진단학적 지표들의 유용성
The Usefulness of Various Electrodiagnostic Parameters in Mild Carpal Tunnel Syndrome
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Objectives: The purpose of this study is to evaluate the sensitivities and specificities of various electrodiagnostic parameters and to investigate the useful methods to increase the sensitivity in the electrodiagnosis of mild carpal tunnel syndrome (CTS). Methods: The 178 hands of 142 patients with mild CTS based on the Steven's electrodiagnostic criteria were studied. We performed seven electrodiagnostic tests: distoproximal ratio in the second or third finger (M2DP, M3DP); median-radial latency difference to the thumb (MRLD); median-ulnar latency difference to the ring finger (MULD); second lumbrical-interosseous motor latency difference (LILD); median sensory-ulnar motor latency difference to the second or third finger (M2SUM, M3SUM). The sensitivity and specificity of each test were calculated. Results: The sensitivities of electrodiagnostic parameters were noted in the M2DP(98.9%), M3DP(98.9%), MRLD(87.6%), MULD(86.5%), M3SUM(74.2%), M2SUM(55.6%), LILD(54.5%). Among electrodiagnostic parameters, M2DP(49.0%) and M3DP(68.0%) revealed relatively low specificities than others. Percentage of mild CTS hands which was abnormal at two differently combined electrodiagnostic test: in M2DP and M3DP(98.3%), M3DP and MULD(86.0%), M3DP and MRLD(81.5%), MRLD and MULD(79.2%), MULD and M3SUM(70.2%); in M3DP or LILD(100%), M3DP or M2SUM(100%), M3DP or MRLD(99.4%), M3DP or M2DP(99.4%), M3DP or MULD(99.4%), M3DP or M3SUM(99.4%). Conclusion: The most sensitive parameter was distoproximal ratio (M2DP, M3DP), as useful method in the electrodiagnosis of mild CTS but it may cause greater reporting of false positive. Additional parameters including MULD, MRLD, LILD, M2SUM, M3SUM may be of value in the diagnosis of mild CTS patients.
Abstract
Objectives: The purpose of this study is to evaluate the sensitivities and specificities of various electrodiagnostic parameters and to investigate the useful methods to increase the sensitivity in the electrodiagnosis of mild carpal tunnel syndrome (CTS). Methods: The 178 hands of 142 patients with mild CTS based on the Steven's electrodiagnostic criteria were studied. We performed seven electrodiagnostic tests: distoproximal ratio in the second or third finger (M2DP, M3DP); median-radial latency difference to the thumb (MRLD); median-ulnar latency difference to the ring finger (MULD); second lumbrical-interosseous motor latency difference (LILD); median sensory-ulnar motor latency difference to the second or third finger (M2SUM, M3SUM). The sensitivity and specificity of each test were calculated. Results: The sensitivities of electrodiagnostic parameters were noted in the M2DP(98.9%), M3DP(98.9%), MRLD(87.6%), MULD(86.5%), M3SUM(74.2%), M2SUM(55.6%), LILD(54.5%). Among electrodiagnostic parameters, M2DP(49.0%) and M3DP(68.0%) revealed relatively low specificities than others. Percentage of mild CTS hands which was abnormal at two differently combined electrodiagnostic test: in M2DP and M3DP(98.3%), M3DP and MULD(86.0%), M3DP and MRLD(81.5%), MRLD and MULD(79.2%), MULD and M3SUM(70.2%); in M3DP or LILD(100%), M3DP or M2SUM(100%), M3DP or MRLD(99.4%), M3DP or M2DP(99.4%), M3DP or MULD(99.4%), M3DP or M3SUM(99.4%). Conclusion: The most sensitive parameter was distoproximal ratio (M2DP, M3DP), as useful method in the electrodiagnosis of mild CTS but it may cause greater reporting of false positive. Additional parameters including MULD, MRLD, LILD, M2SUM, M3SUM may be of value in the diagnosis of mild CTS patients.
참고문헌 (25)
- American Association of Electrodiagnostic Medicine, "Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: Summary statement", Muscle Nerve, 16, pp.1390~1391 (1993)
- Loscher WN, "Comparison of second lumbrical and interosseous latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands", J Neurol, 247, pp.530~534 (2000)
- Seror P, "The value of special motor and sensory tests for the diagnosis of benign and minor median nerve lesion at the wrist", Am J Phys Med Rehabil, 74, pp.124~129 (1995)
- Johnson EW, "Sensory latencies to the ring finger: normal values and relation to carpal tunnel syndrome", Arch Phys Med Rehabil, 62, pp.206~208 (1981)
- Carroll GJ, "Comparison of median and radial nerve sensory latencies in the electrophysiological diagnosis of carpal tunnel syndrome", Electroencephalogr Clin Neurophysiol, 68, pp.101~106 (1987)
- Padua L, "A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome", Muscle Nerve, 19, pp.48~53 (1996)
- Preston DC, "Lumbrical and interossei recording in carpal tunnel syndrome", Muscle Nerve, 15, pp.1253~1257 (1992)
- Bodofsky EB, "A sensitive new median-ulnar technique for diagnosing mild carpal tunnel syndrome", Electomyogr Clin Neurophysiol, 45, pp.139~144 (2005)
- Stevens JC, "AAEM Minimonograph #26: the electrodiagnosis of carpal tunnel syndrome", Muscle Nerve, 20, pp.1477~1486 (1997)
- Wongsam PE, "Carpal tunnel syndrome: use of palmar stimulation of sensory fiber", Arch Phys Med Rehabil, 64, pp.16~19 (1983)
- Kimura J, "A method for determining median nerve conduction velocity across the carpal tunnel", J Neurol Sci, 38, pp.1~10 (1978)
- Johnson EW, "Median and radial sensory latencies to digit I: Normal values and usefulness in carpal tunnel syndrome", Arch Phys Med Rehabil, 68, pp.140~141 (1987)
- Simpson JA, "Electrical sign in the diagnosis of carpal tunnel and related syndromes", J Neurol Neurosurg Psychiatry, 19, pp.275~280 (1956)
- Thomas JE, "Electrodiagnostic aspects of the carpal tunnel syndrome", Arch Neurol, 16, pp.635~641 (1967)
- Seror P, "Sensitivity of the various tests for the diagnosis of carpal tunnel syndrome", J Hand Surg, 19, pp.725~728 (1994)
- Felsenthal G, "Palmar conduction time of median and ulnar nerves of normal subjects and patients with carpal tunnel syndrome", Am J Phys Med, 58, pp.131~138 (1979)
- Jackson D, "Electrodiagnosis of mild carpal tunnel syndrome", Arch Phys Med Rehabil, 70, pp.199~204 (1989)
- Felsenthal G, "Median and ulnar distal motor and sensory latencies in the same normal subject", Arch Phys Med Rehabil, 58, pp.297~302 (1977)
- Uncini A, "Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome", Muscle Nerve, 16, pp.1366~1373 (1993)
- Pease WS, "Median to radial latency difference test in mild carpal tunnel syndrome", Muscle Nerve, 12, pp.905~909 (1989)
- Preston DC, "The median-ulnar latency difference studies are comparable in mild carpal tunnel syndrome", Muscle Nerve, 17, pp.1469~1471 (1994)
- Pyun SB, "Slowed conduction velocity of the median sensory nerve across the carpal tunnel in normal adults", Am J Phys Med Rehabil, 84, pp.598~603 (2005)
- 이승엽, "수근관증후군에서 전기생리학적 척도들의 민감도 비교", 대한신경과학회지, 20(1), pp.54~59 (2002), 대한신경과학회
- Girlanda P, "Electrophysiological studies in mild idiopathic carpal tunnel syndrome", Electroencephalogr Clin Neurophysiol, 109, pp.44~49 (1998)
- 윤서라, "경도의 수근관증후군 진단시 무지에서 기록한 정중-요골 감각신경 잠시차이의 유용성", 대한 근전도∙전기진단의학회지, 1, pp.19~25 (1999)