Nerve Conduction Studies of Median Motor Nerve and Median Sensory Branches According to the Severity of Carpal Tunnel Syndrome
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Objective To evaluate each digital branch of the median sensory nerve and motor nerves to abductor pollicis brevis (APB) and 2nd lumbrical (2L) according to the severity of carpal tunnel syndrome (CTS).Methods A prospective study was performed in 67 hands of 41 patients with CTS consisting of mild, 23; moderate, 27; and severe cases, 17. Compound muscle action potentials (CMAPs) were obtained from APB and 2L, and median sensory nerve action potentials (SNAPs) were recorded from the thumb to the 4th digit. Parameters analyzed were latency of the median CMAP, latency difference of 2L and first palmar interosseous (PI), as well as latency and baseline to peak amplitude of the median SNAPs.Results The onset and peak latencies of the median SNAPs revealed significant differences only in the 2nd digit, according to the severity of CTS, and abnormal rates of the latencies were significantly lower in the 2nd digit to a mild degree. The amplitude of SNAP and sensory nerve conduction velocities were more preserved in the 2nd digit in mild CTS and more affected in the 4th digit in severe CTS. CMAPs were not evoked with APB recording in 4 patients with severe CTS, but obtained in all patients with 2L recording. 2L-PI showed statistical significance according to the severity of CTS.Conclusion The branch to the 4th digit was mostly involved and the branch to the 2nd digit and 2L were less affected in the progress of CTS. The second digit recorded SNAPs and 2L recorded CMAPs would be valuable in the evaluation of severe CTS.
Abstract
Objective To evaluate each digital branch of the median sensory nerve and motor nerves to abductor pollicis brevis (APB) and 2nd lumbrical (2L) according to the severity of carpal tunnel syndrome (CTS).Methods A prospective study was performed in 67 hands of 41 patients with CTS consisting of mild, 23; moderate, 27; and severe cases, 17. Compound muscle action potentials (CMAPs) were obtained from APB and 2L, and median sensory nerve action potentials (SNAPs) were recorded from the thumb to the 4th digit. Parameters analyzed were latency of the median CMAP, latency difference of 2L and first palmar interosseous (PI), as well as latency and baseline to peak amplitude of the median SNAPs.Results The onset and peak latencies of the median SNAPs revealed significant differences only in the 2nd digit, according to the severity of CTS, and abnormal rates of the latencies were significantly lower in the 2nd digit to a mild degree. The amplitude of SNAP and sensory nerve conduction velocities were more preserved in the 2nd digit in mild CTS and more affected in the 4th digit in severe CTS. CMAPs were not evoked with APB recording in 4 patients with severe CTS, but obtained in all patients with 2L recording. 2L-PI showed statistical significance according to the severity of CTS.Conclusion The branch to the 4th digit was mostly involved and the branch to the 2nd digit and 2L were less affected in the progress of CTS. The second digit recorded SNAPs and 2L recorded CMAPs would be valuable in the evaluation of severe CTS.
참고문헌 (21)
- Quality Standards Subcommittee of the American Academy of Neurology., "Practice parameter for carpal tunnel syndrome(summary statement)", Neurology, 43, pp.2406~2409 (1993)
- Atroshi I., "Prevalence of carpal tunnel syndrome in a general population", JAMA, 282, pp.153~158 (1999)
- Jablecki CK., "Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee", Muscle Nerve, 16, pp.1392~1414 (1993)
- Bernstein WJ., "The electrodiagnosis of carpal tunnel syndrome", Muscle Nerve, 22, pp.139~140 (1999)
- Jablecki CK., "WITHDRAWN : Second AAEM literature review of the usefulness of nerve conduction studies and needle electromyography for the evaluation of patients with carpal tunnel syndrome", Muscle Nerve 2002 (2002)
- Sheean GL., "Lumbricalinterosseous latency comparison in the diagnosis of carpal tunnel syndrome", Electroencephalogr Clin Neurophysiol, 97, pp.285~289 (1995)
- Aydin G., "Sensitivity of median sensory nerve conduction tests in digital branches for the diagnosis of carpal tunnel syndrome", Am J Phys Med Rehabil, 83, pp.17~21 (2004)
- Terzis S., "Early diagnosis of carpal tunnel syndrome : comparison of sensory conduction studies of four fingers", Muscle Nerve, 21, pp.1543~1545 (1998)
- Werner RA., "Carpal tunnel syndrome : pathophysiology and clinical neurophysiology", Clin Neurophysiol, 113, pp.1373~1381 (2002)
- Boonyapisit K., "Lumbrical and interossei recording in severe carpal tunnel syndrome", Muscle Nerve, 25, pp.102~105 (2002)
- 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)
- Preston DC., "Lumbrical and interossei recording in carpal tunnel syndrome", Muscle Nerve, 15, pp.1253~1257 (1992)
- Lee HJ., "Electrophysiologic classification of severity of carpal tunnel syndrome", J Korean Assoc EMG-Electrodiagn Med, 6, pp.1~3 (2004)
- Pyun SB., "How to deal with the latency of unobtainable responses in the statistical analysis", J Korean Acad Rehabil Med, 22, pp.1056~1059 (1998)
- Macdonell RA., "Carpal tunnel syndrome : which finger should be tested? an analysis of sensory conduction in digital branches of the median nerve", Muscle Nerve, 13, pp.601~606 (1990)
- Tsaiweichao-Shozawa Y., "Patterns of nerve conduction abnormalities in severe carpal tunnel syndrome", J Clin Neurophysiol, 25, pp.281~286 (2008)
- Padua L., "Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands", Acta Neurol Scand, 96, pp.211~217 (1997)
- Lauritzen M., "Orthodromic sensory conduction along the ring finger in normal subjects and in patients with a carpal tunnel syndrome", Electroencephalogr Clin Neurophysiol, 81, pp.18~23 (1991)
- Cioni R., "Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome", J Neurol, 236, pp.208~213 (1989)
- Kuntzer T., "Carpal tunnel syndrome in 100 patients : sensitivity, specificity of multi-neurophysiological procedures and estimation of axonal loss of motor, sensory and sympathetic median nerve fibers", J Neurol Sci, 127, pp.221~229 (1994)
- Sunderland S., "The intraneural topography of the radial, median and ulnar nerves", Brain, 68, pp.243~299 (1945)