ADDITIONAL METHOD FOR DIAGNOSIS OF CARPAL TUNNEL SYNDROME: VALUE OF THE SECOND LUMBRICAL-INTEROSSEI TEST (2L-INT)

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 49-52 ◽  
Author(s):  
Tomoo Inukai ◽  
Kenzo Uchida ◽  
Chikara Kubota ◽  
Takaharu Takamura ◽  
Hideaki Nakajima ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Standard Test ◽  
Additional Method ◽  
Abductor Pollicis Brevis ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

We examined 57 hands referred with suspected carpal tunnel syndrome (CTS) using the second lumbrical-interossei nerve test (2L-INT) as well as standard test. Sensory nerve conduction velocity (SCV) was detectible in 67% of patients (38/57), the abductor pollicis brevis-compound muscle action potential (APB-CMAP) in 84% (48/57), 2L-CMAP in 96% (55/57) and the first interossei palmares muscle (INT-CMAP) in 100% (57/57). ABP-CMAP was not recorded in patients in whom severe atrophy of the abductor pollicis brevis muscle was evident. As 2L-CMAP is maintained even in the most severe cases of CTS, the 2L-INT method is a valuable test for improving the accuracy of preoperative diagnosis in the electrophysiological diagnosis of CTS.

scholarly journals Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality

2019 ◽  
Vol 8 (12) ◽  
pp. 2094
Author(s):  
Stephan Payr ◽  
Thomas M. Tiefenboeck ◽  
Veith Moser ◽  
Edvin Turkof
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Muscle Action ◽  
Patient’S Satisfaction ◽  
Muscle Action Potential ◽  
Tunnel Syndrome ◽  
Tissue Flap

This prospective study was conducted to investigate electrophysiological qualities and patient’s satisfaction of a synovial gliding tissue flap in treating true recurring carpal tunnel syndrome. In 14 patients (11 women, three men), 15 median nerves were included in this retrospective study. For all 15 nerves, motor and sensory nerve conduction velocity, compound muscle action potential, a Visual Analogue Scale-score (VAS-score) questionnaire and an adapted Levine-Test were evaluated pre- and postoperatively. All participants underwent operative neurolysis of the median nerve, which was then enwrapped by a synovial gliding tissue flap. Eleven procedures were completed by integument enlargement. Follow-up period was 12 months. Postoperatively, distal latency decreased significantly by 15.6%. Compound muscle action potential and sensory nerve conduction velocity did not improve significantly. VAS score regarding pain reduced highly significantly with 74.1%. The adapted Levine-Test function score improved highly significantly with 39.2%. The synovial gliding tissue flap lead to an excellent patient’s satisfaction for treating true recurring carpal tunnel syndrome. Primary wound closure should be completed with integument enlargement if needed.

scholarly journals Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuichi Sasaki ◽  
Tohru Terao ◽  
Emiko Saito ◽  
Keiichiro Ohara ◽  
Shotaro Michishita ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Sensory Nerve Action Potential ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Sensory Nerve Action ◽  
Tunnel Syndrome

Abstract Background Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. Methods In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland’s classification of grade 5 or 6, and assessed for the changes in Bland’s classification grade before and after surgery. Those who showed improvement from preoperative grades 5–6 to postoperative grades 1–4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. Results Among the 60 hands of 46 patients who had a preoperative Bland’s classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland’s classification grade was correlated with the degree of clinical symptom improvement. Conclusions Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.

THUMB OPPOSITION IN SEVERE CARPAL TUNNEL SYNDROME WITH UNDETECTABLE APB-CMAP

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 199-204 ◽  
Author(s):  
Tatsuki Ebata ◽  
Katsumi Imai ◽  
Susumu Tokunaga ◽  
Yuji Takahasi ◽  
Yoshihiro Abe
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Muscle Atrophy ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Abductor Pollicis Brevis ◽  
Thenar Muscle ◽  
Needle Electromyography ◽  
Muscle Action Potential ◽  
Muscle Innervation ◽  
Tunnel Syndrome

Thumb opposition does not always represent the function of the median nerve due to variations in thenar muscle innervation. One hundred and thirty hands of 109 idiopathic carpal tunnel syndrome (CTS) patients with an undetectable compound muscle action potential of the abductor pollicis brevis (APB-CMAP) were classified into one of four groups; Type 1 (86.2%) had thenar muscle atrophy and could not perform thumb opposition; Type 2 (10.8%) had thenar muscle atrophy but could perform thumb opposition; Type 3 (2.3%) did not have thenar muscle atrophy and could perform thumb opposition, but needle electromyography of the APB showed neurogenic changes and Type 4 (0.8%) had no thenar muscle atrophy, could perform thumb opposition, and needle electromyography showed no neurogenic changes. Over 10% of severe CTS patients have mild or no muscle atrophy and intact thumb opposition. The purpose of this study was to investigate the variations in thenar muscle innervation in patients with severe CTS.

Electrophysiological and Clinical Improvement in Non-Invasive Treatment of Carpal Tunnel Syndrome

2020 ◽  
Vol 20 ◽  
Author(s):  
Riccardo Marvulli ◽  
Giancarlo Ianieri ◽  
Grazia Devenuto ◽  
Marta Falcicchio ◽  
Giulia A. Gallo ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Conduction Velocity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Pantothenic Acid ◽  
Sensory Nerve ◽  
Sensory Nerve Conduction Velocity ◽  
Tunnel Syndrome

Background and Objective: Carpal tunnel syndrome (CTS) is the most common form of nerve entrapment. Clinically, various signs and symptoms compare due to overexposure to mechanical vibrations transmitted to the wrist bones and cartilage, resulting in compression of the sensory and motor nerve fibers of median nerve. Early symptoms include nocturnal paresthesia and electromyography reveals reduced sensory nerve conduction velocity. Aim of this study was to evaluate the efficacy of a dietary integrator composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins in patients with early (minimal) carpal tunnel syndrome. Methods: 36 patients (28 female and 8 male) with early CTS characterized by sensory nerve demyelination and inflammation of the transverse carpal ligament. Patients were divided into two groups, group A (18 patients received physical therapy) and group B (18 patients, received physical therapy and an oral integrator). Clinical (sleep quality questionnaire to measure severity of paresthesia) and neurophysiological assessment (Sensory Nerve Conduction Velocity) performed at baseline, and then at 30 and 60 days after treatment. Results: Sleep quality and Sensory Nerve Conduction Velocity data analysis show improvement in both groups at 30 and 60 days, with statistically difference between them in both time of analysis. Conclusions: In the early CTS, with sensory fibers damage, use of dietary integrator, such as Micronil Dol®, composed composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins can be effective in quick recovery of median nerve sensory.

A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential

2020 ◽  
Vol 65 (1) ◽  
pp. 61-71
Author(s):  
Veysel Alcan ◽  
Hilal Kaya ◽  
Murat Zinnuroğlu ◽  
Gülçin Kaymak Karataş ◽  
Mehmet Rahmi Canal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Confusion Matrix ◽  
Maximum Power ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Tunnel Syndrome ◽  
The Mean

AbstractConventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.

scholarly journals The Diagnosis of Carpal Tunnel Syndrome

1997 ◽  
Vol 22 (1) ◽  
pp. 34-37 ◽  
Author(s):  
L.-G. GUNNARSSON ◽  
A. AMILON ◽  
P. HELLSTRAND ◽  
P. LEISSNER ◽  
L. PHILIPSON
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Gold Standard ◽  
Nerve Conduction Velocity ◽  
Sensory Nerve ◽  
Study Group ◽  
Atypical Symptoms ◽  
History Of ◽  
Tunnel Syndrome ◽  
History Of Pain

The study group consisted of 100 persons referred with suspected carpal tunnel syndrome. Clinical and neurophysiological examinations were performed blinded from each other. The gold standard for the carpal tunnel syndrome (CTS) diagnosis was based on the results of these examinations but relief of CTS symptoms after surgery was also required. The sensitivity and specificity for the combined results of the clinical examinations were 94% and 80% respectively, and for the neurophysiological examinations, 85% and 87%. Of the neurophysiological methods used, the quotient of sensory nerve conduction velocity between palm to wrist and wrist to elbow was best and the cut-off for this test was studied by means of an ROC-curve. According to our results clinical examination by an experienced doctor seems to be sufficient if there are typical symptoms of carpal tunnel syndrome, but if there is a history of pain, atypical symptoms or earlier fractures in the arm, wrist or hand, it is important to add a neurophysiological examination.

scholarly journals Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome

2003 ◽  
Vol 61 (2A) ◽  
pp. 194-198 ◽  
Author(s):  
Joao Aris Kouyoumdjian ◽  
Maria P.A. Morita ◽  
Amalia F.P. Molina ◽  
Dirce M.T. Zanetta ◽  
Adriana K. Sato ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
P Value ◽  
Long Term Outcomes ◽  
Patient’S Satisfaction ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69%). Patient's satisfaction after surgical and non-surgical were respectively, 77.6% and 16% ("cure"), 13.6% and 52% (much improved), 5.4% and 9.3% (little improved), 2.7% and 16% (unchanged), 0.7% and 6.7% (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome.

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