scholarly journals Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

2021 ◽  
Author(s):  
Emanuele Spina ◽  
Pietro Emiliano Doneddu ◽  
Giuseppe Liberatore ◽  
Dario Cocito ◽  
Raffaella Fazio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
Tunnel Syndrome ◽  
Median Neuropathy

AbstractCompression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS demyelinating criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). Accordingly, being carpal tunnel syndrome (CTS) common in the general population, the EFNS/PNS guidelines recommend excluding the DML of the median nerve when DML prolongation may be consistent with median neuropathy at the wrist from CTS. The main aims of this study were to verify whether the inclusion of DML of the median nerve (when consistent with CTS) could improve electrophysiological diagnostic accuracy for CIDP and if the median nerve at the carpal tunnel was more prone to demyelination. We analyzed electrophysiological data from 499 patients included consecutively into the Italian CIDP Database. According to the EFNS/PNS criteria, 352 patients had a definite, 10 a probable, and 57 a possible diagnosis of CIDP, while 80 were not fulfilling the diagnostic criteria. The inclusion of DML prolongation of median nerve did not improve significantly the diagnostic accuracy for CIDP; overall diagnostic class changed in 6 out of 499 patients (1.2%) and electrodiagnostic class of CIDP changed from not fulfilling to possible in only 2 patients (2.5% of not-fulfilling patients). In conclusion, we can infer that excluding DML prolongation of median nerve does not increase the risk of missing a diagnosis of CIDP thus corroborating the current EFNS/PNS criteria.

scholarly journals Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

2015 ◽  
Vol 39 (3) ◽  
pp. E6 ◽  
Author(s):  
Sueleyman Tas ◽  
Frank Staub ◽  
Thomas Dombert ◽  
Gerhard Marquardt ◽  
Christian Senft ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Decompression ◽  
High Definition ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Tunnel Syndrome ◽  
The Mean

OBJECT Carpal tunnel syndrome causes increased cross-sectional area (CSA) of the median nerve, which can be assessed by high-definition ultrasonography. It is unclear today, however, whether high-definition ultrasonography may play a role in the postoperative period. This prospective study aimed to determine the natural history of the morphology of the median nerve at the carpal tunnel after surgical decompression assessed by high-definition ultrasonography. METHODS Between October and December 2014, patients with suspected carpal tunnel syndrome who were referred to the authors’ center for peripheral neurosurgery were prospectively enrolled and underwent pre- and postoperative (3 months) high-definition ultrasonography, electrophysiology, and clinical testing. RESULTS Eighty-one patients were enrolled in the study, and 100% were clinically better at the 3-month follow-up. The mean CSA decreased from 14.7 ± 4.9 mm2 to 12.4 ± 3.4 mm2 (mean ± SD, p < 0.0001). The mean distal motor latency decreased from 6.6 ± 2.4 msec to 4.8 ± 1.0 msec (mean ± SD, p < 0.0001). Ninety-eight percent of patients who were available for electrodiagnostic follow-up showed an improvement of the distal motor latency; only 80% had a reduction in the CSA. CONCLUSIONS The authors present the second-largest series of patients with sonographic follow-up after surgical decompression of the carpal tunnel reported in the literature so far. This study, which showed a decrease in size of the median nerve after surgical decompression, suggests that the preoperative increase in median nerve CSA at the carpal tunnel may be due to compression and that enlargement of the median nerve is (partially) reversible.

Relation between distal motor latency delay and sensory action potential absence of the median nerve in carpal tunnel syndrome

2016 ◽  
Vol 148 ◽  
pp. 45-48
Author(s):  
Masahiro Funaba ◽  
Tsukasa Kanchiku ◽  
Yasuaki Imajo ◽  
Hisashi Yamamoto ◽  
Yasuhiro Hiura ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Sensory Action ◽  
Tunnel Syndrome

scholarly journals When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

2021 ◽  
Vol 67 (4) ◽  
pp. 518-525
Author(s):  
Zuhal Özişler ◽  
Müfit Akyüz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Spontaneous Activity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Nerve ◽  
Symptom Duration ◽  
Thenar Muscle ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Tunnel Syndrome

Objectives: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). Patients and methods: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. Results: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). Conclusion: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

scholarly journals Carpal tunnel syndrome caused by cysticercosis

2010 ◽  
Vol 43 (02) ◽  
pp. 210-212
Author(s):  
S. R. Sharma ◽  
Nalini Sharma ◽  
M. E. Yeolekar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Studies ◽  
Resonance Imaging ◽  
Inflammatory Mass ◽  
Tunnel Syndrome ◽  
Median Neuropathy

ABSTRACTWe present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.

Comparison of Borderline Ultrasound and Nerve Conduction Studies for Carpal Tunnel Syndrome

Hand ◽  
2020 ◽  
pp. 155894472096496
Author(s):  
Cory Demino ◽  
John R. Fowler
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Nerve Conduction Studies ◽  
Threshold Values ◽  
Cutoff Values ◽  
Number Of Patients ◽  
Tunnel Syndrome ◽  
Median Neuropathy

Background Choosing cutoff values for nerve conduction studies (NCS) and ultrasound cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) is critical in determining the diagnostic accuracy of the tests. The goals of this study were to: (1) determine the sensitivity and specificity of various electrodiagnostic and ultrasound threshold values for diagnosis of CTS; and (2) determine the number of hands that underwent NCS and ultrasound that were within 10% of threshold values. Methods A total of 309 hands of 235 patients were included in this study. Diagnosis of median neuropathy was made based on NCS by the independent physician performing the NCS. Criteria analyzed included distal motor latency of 4.4+ ms, distal sensory latency of 3.6+ ms, difference in median-ulnar mixed nerve palmar latency of 0.4+ ms, and CSA of the median nerve of 10+ mm2. Results Median neuropathy was diagnosed in 235 hands, whereas 74 hands were found not to have median neuropathy. Overall, 141 hands (46%) had at least 1 of the 3 electrodiagnostic variables within 10% of the diagnostic cutoff values, and 137 hands (44%) had a median nerve CSA within 10% of 10 mm2. By performing ultrasound in addition to NCS for each patient, an additional 65 hands (21%) had a definitive diagnosis on at least 1 of the 2 diagnostic modalities. Conclusions Ultrasound and NCS yielded a similar number of patients within 10% of their diagnostic threshold values. When used together, the number of patients with a nonborderline diagnosis on at least 1 diagnostic modality was increased substantially.

scholarly journals Typical Carpal Tunnel Syndrome or Something More? A Plastic Surgeon’s Experience With Chronic Inflammatory Demyelinating Polyneuropathy

2017 ◽  
Vol 3 ◽  
pp. 2513826X1771645
Author(s):  
Mark K. Hewitt ◽  
Shane K. F. Seal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Demyelinating Polyneuropathy ◽  
Neurological Deficits ◽  
Clear Cut ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
History Of ◽  
Tunnel Syndrome ◽  
Peripheral Motor

Chronic inflammatory demyelinating polyneuropathy (CIDP) typically presents with widespread peripheral motor and sensory deficits that progress over a 2- to 3-month period. In this article, the authors report a case involving a 32-year-old pregnant woman presenting to hand clinic after a 3-month history of bilateral median nerve compression consistent with carpal tunnel syndrome. Carpal tunnel syndrome is a common complaint resulting from pregnancy-associated edema and is typically treated conservatively. However, upon follow-up, this patient displayed new signs of widespread peripheral neurological deficits, prompting a diagnosis of CIDP. In addition to this highly atypical presentation of CIDP, the patient’s symptoms spontaneously remitted throughout the pregnancy requiring no further treatment. This case highlights the heterogeneous nature of neurological disease presentation and the importance in considering alternative diagnosis in what may appear as clear-cut plastic surgery case.

Carpal Tunnel Syndrome: Diagnosis by Means of Median Nerve Elasticity—Improved Diagnostic Accuracy of US with Sonoelastography

Radiology ◽  
2014 ◽  
Vol 270 (2) ◽  
pp. 481-486 ◽  
Author(s):  
Hideaki Miyamoto ◽  
Ethan J. Halpern ◽  
Martin Kastlunger ◽  
Markus Gabl ◽  
Rohit Arora ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

Carpal Tunnel Syndrome: Neurophysiological Results of Surgery Based on Preoperative Electrodiagnostic Testing

1997 ◽  
Vol 22 (5) ◽  
pp. 599-601 ◽  
Author(s):  
L. PADUA ◽  
M. LO MONACO ◽  
R. PADUA ◽  
F. TAMBURRELLI ◽  
B. GREGORI ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Sensory Nerve ◽  
Middle Finger ◽  
Sensory Function ◽  
Distal Motor Latency ◽  
Electrodiagnostic Testing ◽  
Motor Latency ◽  
Tunnel Syndrome ◽  
Results Of Surgery

Fifty-three hands with carpal tunnel syndrome had pre- and postoperative evaluations of median nerve distal motor latency (from wrist to thenar muscles) and orthodromic sensory nerve conduction velocity (from thumb and middle finger to wrist). At 6 months we observed a neurophysiological return to normal in all cases with normal preoperative distal motor latency and in about 50% of the hands with preoperative distal motor latency between 4 and 6 ms. Prolongation of the distal motor latency over 6 ms was not followed by return to neurophysiological normality, although some degree of sensory function was restored in the majority of cases.

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