The diagnostic contribution of motor and sensory conduction studies of the wrist-palm segment in carpal tunnel syndrome
Keywords:Carpal tunnel syndrome, Segmental conduction study
Aim: Sensory and motor segmental conduction studies have been performed to improve diagnostic sensitivity especially in cases with mild carpal tunnel syndrome, but there are very few studies comparing these methods. The purpose of this study was to determine the segmental conduction studies' contribution to the diagnosis of carpal tunnel syndrome (CTS), to compare the sensitivity and specificity of these methods.
Methods: Patients with suspected CTS referred to our electrophysiology laboratory and a control group was included. The data were collected prospectively. The following measurements made: median sensory conduction velocity wrist- digit 1 (W-1), median sensory conduction velocity wrist- digit 3 (W-3), median wrist-palm sensory conduction velocity (W-Ps), distoproximal ratio of velocity (D/P), median distal motor latency wrist- APB (MDML), median wrist- palm segment motor conduction velocity (W-Pm).
Results: The highest sensitivity for an electrodiagnostic CTS diagnosis were W- Pm (38%), D/P (33.3%), MDML (33.3%), W- 3 (31%), W- 1 (31%), W-Ps (24%), respectively. Seventeen out of 42 hands presented one or more abnormal results of routine electrophysiologic tests (W-1, W-3, MDML). Twenty-one patients were diagnosed CTS electrophysiologically after inclusion of D/ P and 24 patients were defined CTS after inclusion of W- Pm. Twenty-five of 42 hands with CTS were defined as an electrophysiologically proven CTS using routine electrophysiologic tests together with both D/P and W-Pm segmental studies. That is; diagnostic sensitivity increased nearly by 50%.
Conclusion: The results of this study suggested that motor or sensory segmental studies have an important contribution to the diagnosis, particularly for mild subjects.
Chang MH, Wei SJ, Chiang HL, Wang HM, Hsieh PF, Huang SY. Comparison of motor conduction techniques in the diagnosis of carpal tunnel syndrome. Neurology. 2002;58:1603-7.
American Academy of Electrodiagnostic Medicine Quality Assurance Committee. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve. 1993;16:1392-414.
Stevens JC. The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve. 1997;20:1477-86.
Robinson LR. Role of neurophysiological evaluation in diagnosis. J Am Acad Ortop Surg. 2000;8:190-9.
İnanç Y, İnanç Y, Ay H, Arlier Z, Kocatürk Ö. Karpal Tünel Sendromu: 126 olgunun demografik açıdan değerlendirilmesi. Journal of Harran University Medical Faculty. 2014;3(11):242-6.
Padua L, Monaco ML, Valente EM, Tonalı PA. Auseful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve. 1996;19:48-53.
Buchtal F, Rosenfalck A. Sensory conduction from digit to palm and from palm to wrist in the carpal syndrome. J Neurol Neurosurg Psychiatry. 1971;34:243-52.
Cruz Martinez A. Diagnostic yield of different electrophysiological methods in carpal tunnel syndrome. Muscle Nerve. 1991;2:183-4.
Kimura J, Ayyar DR. The carpal tunnel syndrome: electrophysiological aspects of 639 symptomatic extremities. Electromyogr Clin Neurophysiol. 1985;25:151-64.
MacDonnel RAL, Schwartz MS, Swash M. Carpal tunnel syndrome: which finger should be tested? An analysis of sensory conduction in digital branches of the median nerve. Muscle Nerve. 1990;13:601-6.
Seror P. Sensitivity of various electrophysiological studies for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 1993;16:1419.
Stevens C. AAEE minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve. 1987;10:99-113.
Robert A.W, Michael A. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clinical Neurophysiology. 2002;113:1373–81.
Cioni R, Pasero S, Paradiso C, Giannini F, Battistini N, Rushworth G. Diagnostic Specificity of Sensory and Motor Nerve Conduction Variables in Early Detection of Carpal Tunnel Syndrome. J Neurol.1989;236:208-31.
Chang MH, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clinical Neurophysiology. 2006;117:984-91.
Sheu JJ, Yuan RY, Chiou HY, Hu CJ, Chen WT. Segmental study of median nerve versus comparative tests in the diagnosis of mild carpal tunnel syndrome. Clinical Neurophsiolgy 2006;117:1249-55.
Lee WJ, Liao YC, Wei SJ, Tsai CW, Chang MH. How to make elektrodiagnosis of carpal tunnel syndome with normal distal conductions? Journal of Clinical Neurophysiolgy. 2011;28(1):45-50.
Dumitru D. Electrodiagnostic medicine. Second Edition. Chapter 5: 180. Year 2000.
Oh SJ. Clinical electromyography nerve conduction studies. Second Edition. Chapter 7:85. Year 1993.
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