scholarly journals Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

2017 ◽  
Vol 09 (02) ◽  
pp. 067-073
Author(s):  
Mithun Neral ◽  
Joseph Imbriglia ◽  
Lois Carlson ◽  
Ronit Wollstein
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Manual Muscle Testing ◽  
Relative Importance ◽  
Retrospective Case ◽  
Muscle Testing ◽  
Motor Testing ◽  
Tunnel Syndrome ◽  
Measured Strength

AbstractThe relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.

A Median Nerve Anterior Transposition Procedure for Multi-Recurrent Hemodialysis-Related Carpal Tunnel Syndrome

2018 ◽  
Vol 23 (01) ◽  
pp. 90-95 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Manual Muscle Testing ◽  
Maintenance Hemodialysis ◽  
Outpatient Basis ◽  
Muscle Testing ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
The Mean

Background: Some long-term hemodialysis patients suffer from multi-recurrent carpal tunnel syndrome because amyloid originating from β2-microglobulin continues to be deposited mainly in the flexor tendons, tendon sheaths and flexor retinaculum during maintenance hemodialysis. These amyloid deposits inside carpal canal (tunnel) tissues increase carpal canal pressure and this leads to compression of the median nerve. When multi-recurrent carpal tunnel syndrome occurs, previous operative scarring of soft tissue may prohibit further enlargement of the carpal canal even if any carpal canal decompression procedure is used. For this reason, we developed a median nerve anterior transposition procedure, as a new approach in the treatment of multi-recurrent hemodialysis-related carpal tunnel syndrome. Methods: Median nerve anterior transposition procedures were performed on seven hands in six patients with multi-recurrent carpal tunnel syndrome. The mean age of the patients was 68.3 years and the mean hemodialysis duration was 35.3 years. Mean follow-up period was 9.9 months. The median nerve is transposed from inside to outside of the carpal canal under local and infiltration anesthesia without a pneumatic tourniquet on an outpatient basis. This procedure is based on the same principles applied in ulnar nerve anterior transposition procedures for cubital tunnel syndrome. Results: Main preoperative patient complaints were intolerable tingling and/or pain in the diseased hands throughout the day. Following the surgeries, preoperative clinical symptoms began to subside and eventually improved in all hands. Postoperative abductor pollicis brevis muscle power using manual muscle testing improved except in one hand. Abnormal preoperative distal motor and sensory latency were improved except in two hands following the surgeries. Conclusions: The median nerve anterior transposition procedure is a beneficial treatment for patients suffering from hemodialysis-related multi-recurrent carpal tunnel syndrome.

RETROSPECTIVE ANALYSIS OF FIVE-YEAR AND LONGER CLINICAL AND ELECTROPHYSIOLOGICAL RESULTS OF THE WORLD'S FIRST ENDOSCOPIC MANAGEMENT FOR CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 317-323 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Muscle Power ◽  
Manual Muscle Testing ◽  
Endoscopic Management ◽  
Recurrence Rates ◽  
Abductor Pollicis Brevis ◽  
Muscle Testing ◽  
Tunnel Syndrome

We have analyzed postoperative long-term follow-up results of five years or more from idiopathic carpal tunnel syndrome patients that underwent our complete carpal canal release and decompression procedure that uses the Universal Subcutaneous Endoscope system. In this series, 203 hands were followed up both clinically and electrophysiologically. Final follow-up times were determined by the most recent electrophysiological measurements. Mean follow-up period was nine years. Tingling, pain (using a 3 gm needle) and touch (using a 2 gm von Frey hair) at all median nerve distribution areas recovered to normal in 92.9, 98.2, 95.2%, respectively. Abductor pollicis brevis muscle power improved from preoperative manual muscle testing of 0, 1, 2 to post-operative 4 or 5 in 82.6%. Mean detectable distal sensory latency improved from 4.3 (n = 130) to 3.1 msec (n = 200). Mean detectable distal motor latency improved from 6.2 (n = 189) to 4.1 msec (n = 200). Complication and recurrence rates were 0% and 0.5% respectively.

scholarly journals Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome

2007 ◽  
Vol 65 (3b) ◽  
pp. 779-782 ◽  
Author(s):  
Rogério Gayer Machado de Araújo ◽  
João Aris Kouyoumdjian
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Ulnar Nerve Compression ◽  
Latency Difference ◽  
Negative Peak ◽  
Tunnel Syndrome ◽  
Ice Water ◽  
Common Variable

Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU) in electrodiagnosis of carpal tunnel syndrome (CTS). Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands). Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands). PMU was obtained at the usual temperature, >32°C, and after wrist/hand cooling to <27°C in ice water. After cooling, there was a significantly greater increase in PMU and mixed ulnar palmar latency in patients versus controls. We concluded that cooling significantly modifies the PMU. We propose that the latencies of compressed nerve overreact to cooling and that this response could be a useful tool for incipient CTS electrodiagnosis. There was a significant latency overreaction of the ulnar nerve to cooling in CTS patients. We hypothesize that subclinical ulnar nerve compression is associated with CTS.

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