Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS.
OBJECTIVES:
To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings).
MATERIAL AND METHODS:
The patients with bilateral moderate grade of CTS in whom one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings.
RESULTS:
A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 0.49 msec versus 3.44 0.39 msec; 0.001), sensory conduction velocity (SCV) was slower (33.7 4.3 m/sec versus 40.2 3.0 m/sec; 0.001), SNAP amplitude was smaller (10.3 3.3 V versus 19.1 7.7 V; 0.001), distal motor latency was longer (5.69 0.60 msec versus 4.63 0.32 msec; 0.001), and minimum F wave latency was longer (29.3 1.7 msec versus 26.8 1.4 msec; 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients.
CONCLUSION:
Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not.
AtroshiIGummessonCJohnsonROrnsteinERanstamJRosenI. Prevalence of carpal tunnel syndrome in a general population. JAMA1999; 282: 153-8.
2.
SerorP. Electroclinical correlations in the carpal tunnel syndrome. Apropos of 100 cases. Rev Rhum Mal Osteoartic1987; 54(10): 643-8.
3.
SerorP. Electrophysiologic diagnosis of carpal tunnel syndrome in 1993. Apropos of 100 cases. Rev Rhum Ed Fr1993; 60(9): 591-5.
4.
KuhlmanKAHennesseyWJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil1997; 76(6): 451-7.
5.
de CamposCCManzanoGMLeopoldinoJFNóbregaJASañudoAde Araujo PeresCCasteloA. The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist. Acta Neurol Scand2004; 110(6): 398-402.
6.
PaduaLLoMonacoMPaduaR. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci1997; 18: 145-50.
7.
AulisaLTamburrelliFPaduaRRomaniniELo MonacoMPaduaL. Carpal tunnel syndrome: indication for surgical treatment based on electrophysiological study. J Hand Surg [Am]1998; 23: 687-91.
8.
PremoselliSSioliPGrossiACerriC. Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of nightonly splint therapy. Eura Medicophys2006; 42(2): 121-126.
9.
KarsidagSSahinSHacikerim KarsidagSAyalpS. Long term and frequent electrophysiological observation in carpal tunnel syndrome. Eura Medicophys2007; 43(3): 327-32.
10.
IidaJHirabayashiHNakaseHSakakiT. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo)2008; 48(12): 554-9.
BlandJD. Do nerve conduction studies predict the outcome of carpal tunnel decompression? Muscle Nerve2001; 24(7): 935-40.
13.
TackmannWKaeserHEMagunHG. Comparison of orthodromic and antidromic sensory nerve conduction velocity measurements in the carpal tunnel syndrome. J Neurol1981; 224(4): 257-66.
14.
BuchthalFRosenfalckATrojaborgW. Electrophysiological findings in entrapment of the median nerve at wrist and elbow. J Neurol Neurosurg Psychiatry1974; 37(3): 340-60.
15.
JableckiCKAndaryMTSoYTWilkinsDEWilliamsFH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve1993; 16: 1392-1414.
16.
LoongSC. The carpal tunnel syndrome: a clinical and electrophysiological study of 250 patients. Clin Exp Neurol1977; 14: 51-65.
17.
KuntzerT. Carpal tunnel syndrome in 100 patients: sensitivity, specificity of multineurophysiological procedures and estimation of axonal loss of motor, sensory and sympathetic median nerve fibers. J Neurol Sci1994; 127(2): 221-9.
18.
SerorP. 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 Rehabil1995; 74(2): 124-9.
19.
ChangMHWeiSJChiangHLWangHMHsiehPFHuangSY. Comparison of motor conduction techniques in the diagnosis of carpal tunnel syndrome. Neurology2002; 58(11): 1603-7.
20.
AtroshiIGummessonCJohnssonROrnsteinE. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord2003; 4: 9.
21.
DemirciSSonelB. Comparison of sensory conduction techniques in the diagnosis of mild idiopathic carpal tunnel syndrome: which finger, which test? Rheumatol Int2004; 24(4): 217-20.
22.
SchrijverHMGerritsenAAStrijersRLUitdehaagBMScholtenRJde VetHC, et al. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol2005; 22(3): 216-21.
23.
ChangMHLiuLHLeeYCWeiSJChiangHLHsiehPF. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clin Neurophysiol2006; 117(5): 984-91.
24.
CioniRPasseroSParadisoCGianniniFBattistiniNRushworthG. Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome. J Neurol1989; 236(4): 208-13.
25.
RossiSGianniniFPasseroSParadisoCBattistiniNCioniR. Sensory neural conduction of median nerve from digits and palm stimulation in carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol1994; 93(5): 330-4.
26.
JohnsonEWKuklaRDWongsamPEPiedmontA. Sensory latencies to the ring finger: normal values and relation to carpal tunnel syndrome. Arch Phys Med Rehabil1981; 62(5): 206-8.
27.
UnciniALangeDJSolomonMSolivenBMeerJLovelaceRE. Ring finger testing in carpal tunnel syndrome: a comparative study of diagnostic utility. Muscle Nerve1989; 12(9): 735-41.
28.
JacksonDACliffordJC. Electrodiagnosis of mild carpal tunnel syndrome. Arch Phys Med Rehabil1989; 70(3): 199-204.
29.
CharlesNVialCChauplannazGBadyB. Clinical validation of antidromic stimulation of the ring finger in early electrodiagnosis of mild carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol1990; 76(2): 142-7.
30.
UnciniADi MuzioACutarellaRAwadJGambiD. Orthodromic median and ulnar fourth digit sensory conductions in mild carpal tunnel syndrome. Neurophysiol Clin1990; 20(1): 53-61.
31.
UnciniADi MuzioAAwadJManenteGTafuroMGambiD. Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome. Muscle Nerve1993; 16(12): 1366-73.
32.
PaduaLGianniniFGirlandaPInsolaALuchettiRLo MonacoM, et al. Usefulness of segmental and comparative tests in the electrodiagnosis of carpal tunnel syndrome: the Italian multicenter study. Italian CTS Study Group. Ital J Neurol Sci1999; 20(5): 315-20.
33.
ResendeLAAdamoASBononiAPCastroHAKimaidPAFortinguerraCHSchelpAO. Test of a new technique for the diagnosis of carpal tunnel syndrome. J Electromyogr Kinesiol2000; 10(2): 127-33.
34.
JableckiCKAndaryMTFloeterMKMillerRGQuartlyCAVennixMJ, et al. American Association of Electrodiagnostic Medicine; American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology2002; 58(11): 1589-92.
35.
SchuhfriedOVacariuGKopfAPaternostro-SlugaT. Relative slowing of the median antidromic sensory nerve conduction velocity to the ring finger in screening for carpal tunnel syndrome. J Hand Surg [Am]2004; 29(5): 947-52.
36.
LauritzenMLiguoriRTrojaborgW. Orthodromic sensory conduction along the ring finger in normal subjects and in patients with a carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol1991; 81(1): 18-23.
37.
KaulMPPagelKJ. Median sensory nonresponders in carpal tunnel syndrome workup. Arch Phys Med Rehabil2002; 83(8): 1120-2.
38.
AlemdarM. Ring finger sensorial conduction studies in grading carpal tunnel syndrome. J Back Musculoskelet Rehabil2016; 29(2): 309-315.
39.
UzarETamamYAcarAYucelYPalanciYCanseverSCevikMUTasdemirN. Sensitivity and specificity of terminal latency index and residual latency in the diagnosis of carpal tunnel syndrome. Eur Rev Med Pharmacol Sci2011; 15(9): 1078-84.
40.
LeblebiciBAdamMBağışSNafiz AkmanMN. The usefulness of latency difference tests of median-ulnar and median-radial nerves in mild carpal tunnel syndrome. Turk J Phys Med Rehab2008; 54: 22-6.
41.
AygülRUlviHKotanDKuyucuMDemirR. Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index. J Brachial Plex Peripher Nerve Inj2009; 4: 12.
42.
AygülRKotanDUlviHKuyucuMÖzdemirGErtekinAOdabaşFÖ. The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome. J Back Musculoskelet Rehabil2014; 27(1): 1-6.
43.
InukaiTUchidaKKubotaCTakamuraTNakajimaHBabaH. Second lumbrical-interossei nerve test predicts clinical severity and surgical outcome of carpal tunnel syndrome. J Clin Neurosci2013; 20(9): 1224-7.
