Ring finger sensory latency difference in the diagnosis and treatment of carpal tunnel syndrome

Objective To explore the sensitivity of median and ulnar nerve sensory latency differences in diagnosing carpal tunnel syndrome (CTS) at different severities. Methods CTS patients were divided into three groups based on disease severity (mild, moderate, and severe). Distal latency of sensory nerve action potential (SNAP) for the median and ulnar nerves was recorded. The sensitivity of SNAP distal latency to CTS and its correlation with CTS severity were analyzed. Results Significant differences were found in the median nerve sensory action potential distal latency (MSDL) and in the median and ulnar sensory latency difference to ring finger (MUD) but not in the ulnar nerve sensory action potential distal latency (USDL) between CTS and control. The sensitivity and specificity were 92.2 and 99.4% with an MSDL cutoff value of 2.40 ms, respectively, and were both 100% with a MUD cutoff value of 0.33 ms. There was no significant difference in USDL among the CTS and control groups. Significant differences were found in MSDL and MUD among the CTS severities and between mild and moderate CTS, but not between mild and severe CTS or between moderate and severe CTS. Correlations with CTS severity were observed for MSDL and MUD but not for USDL. Conclusion The ulnar nerve of the CTS patients was not damaged. A smaller MSDL reflected median nerve damage, which can be used for the early diagnosis of CTS. MUD correlated with CTS severity with a higher sensitivity than MSDL, which can provide therapeutic insight without pain to patients.

Ring Finger Sensory Latency Difference in the Diagnosis and Treatment of Carpal Tunnel Syndrome

Objective: To explore the evaluation value of the sensitivity of the median/ulnar nerve sensory latency difference in the diagnosis of carpal tunnel syndrome and the evaluation value of severity.Methods: 122 patients with CTS and 42 normal controls were collected from the department of Neurology in Renmin Hospital of Wuhan University from July 2019 to January 2021. Electrophysiological tests were performed on the CTS patients group and the control group. The distal latency of the sensory nerve action potential (SNAP) of the median nerve and the ulnar nerve of the two groups was recorded. According to electrophysiological results，the patients were divided into three grades: mild, moderate and severe, the sensitivity of the nerve sensory action potential distal latency (SDL) to the diagnosis of CTS patients were analyzed, and the relationship with the severity of CTS was analyzed.Results: ①There were significant differences between the median nerve sensory action potential distal latency (MSDL) of 179 affected hands and the control group; And median and ulnar sensory latency difference to ring finger (MUD) was significantly different from the control group; But ulnar nerve sensory action potential distal latency （USDL） was not significantly different from the control group (P=0.182). When the cutoff value of MSDL is 2.465ms, the sensitivity is 85.5% and the specificity is 90.4%; when the cutoff value of MUD is 0.38ms, the sensitivity is 100% and the specificity is 100%. ②In the mild, moderate, severe and control group, there was no significant difference in USDL between all the groups (P=0.56)a; between the control group and the mild group, moderate group, and severe group, and between the mild and moderate, significant differences were found in the MSDL and MUD. No significant difference between mild and severe (P=0.66), moderate and severe (P=1.00). ③ MSDL and MUD are correlated with the severity of CTS. There is no correlation between USDL and CTS severity.Conclusion: The ulnar nerve is not damaged in CTS; a smaller MSDL can reflect median nerve damage, which is beneficial to the early diagnosis of CTS; MUD is more sensitive than MSDL in diagnosing CTS; MUD is correlated with severity, which is beneficial to pain for patients who are more sensitive and cannot tolerate electrical stimulation, perhaps only measuring MUD can reflect the severity, relieve the patient's pain, and can be used to evaluate the therapeutic effect.

PENGARUH INJEKSI STEROID LOKAL TERHADAP LATENSI DISTAL SENSORIK DAN MOTORIK PADA SINDROM TEROWONGAN KARPAL

THE EFFECT OF LOCAL STEROID INJECTION ON DISTAL SENSORY AND MOTOR LATENCY IN PATIENTS WITH CARPAL TUNNEL SYNDROMEABSTRACTIntroduction: Carpal tunnel syndrome (CTS) is the most common type of neuropathy found in upper extremities. The syndrome can cause disability and leads to the decrease in productivity. Local steroid injection can help alleviate the symptoms, delay operation, and improve electrophysiologic parameter in a concise period.Aims: To determine the effect of steroid injection on distal sensory and motor latency in patients with CTS.Methods: Clinical trial with non-randomized paralel group design on patients in dr. Wahidin Sudirohusodo Hospi- tal from March to August 2017. Patients were divided into two groups, treatment group who were injected with intracanal steroid (n=20) and control who were treated with oral steroid (n=20). Electroneuromyography (ENMG) evaluation was done on the first day and one week after steroid injection. Statistical analysis was done with Statistical Packages for Social Sciences (SPSS) version 22. Wilcoxon sign-ranked and Mann-Whitney U test were used to analyze the difference between the treatment and control groups.Results: Distal sensory and motor latency improved significantly in both groups. Distal sensory latency after steroid were improved in both groups. But the improvement was more significant in steroid injection group compared to control group in sensory (0,30mSec vs 0,06mSec), and also motor distal latency (0,53mSec vs 0,09mSec).Discussion: Steroid injection improves distal sensory dan motor latency in patients with carpal tunnel syndrome.Keywords: Carpal tunnel syndrome, distal motor latency, distal sensory latency, steroid injectionABSTRAKPendahuluan: Sindrom terowongan karpal (STK) adalah jenis neuropati yang paling sering terjadi pada ekstremi- tas atas. Sindrom ini menyebabkan disabilitas dan menurunkan produktivitas. Injeksi steroid lokal (intrakanal) dapat mer- ingankan gejala, menunda operasi, dan memperbaiki parameter elektrofisiologi dalam jangka pendek.Tujuan: Mengetahui pengaruh injeksi steroid terhadap latensi distal sensorik dan motorik pada pasien dengan STK.Metode: Uji klinis dengan desain grup paralel terhadap pasien dengan STK yang berobat di RSUP Dr. Wahidin Sudirohusodo dari bulan Maret hingga Agustus 2017. Subjek dibagi menjadi kelompok perlakuan yang diberi injeksi ste- roid (lokal) intrakanal (n=20) dan kelompok kontrol yang diberikan steroid oral (n=20). Pemeriksaan elektroneuromiografi (ENMG) dilakukan pada hari pertama subjek datang ke RS dan satu minggu pascaterapi steroid. Analisis statistik dilaku- kan dengan program Statistical Packages for Social Sciences (SPSS) versi 22. Uji Wilcoxon signed-rank dan Mann-Whitney U digunakan untuk meneliti hubungan antar kelompok injeksi steroid lokal dan oral.Hasil: Terdapat pemendekan latensi distal sensorik dan motorik secara signifikan pasca pemberian steroid pada kedua kelompok. Namun pemendekan tersebut terjadi lebih besar dan lebih signifikan pada kelompok injeksi steroid lokal dibandingkan oral, baik pada latensi distal sensorik (0,30mdet vs 0,06mdet), maupun pada latensi distal motorik (0,53mdet vs 0,09mdet).Diskusi: Injeksi steroid intrakanal memperpendek latensi distal sensorik dan motorik pada pasien dengan sindrom terowongan karpal secara bermakna.Kata kunci: Injeksi steroid, latensi distal motorik, latensi distal sensorik, sindrom terowongan karpal

Potential Risk of Developing Peripheral Neuropathy in Heavy Motor Vehicle Driving: A Cross-sectional Study

Introduction: There is a growing concern regarding increasing road traffic accidents due to overburdened drivers, which also affect their general health. Drivers maintain the extreme position of arm, forearm, and legs which during distant journeys may put increased constraint on nerves passing in forearm and legs in addition to the vibrations transmission i.e., Hand Arm Vibration Syndrome (HAVS) and Foot Transmitted Vibration (FTV). Aim: To find out if chronic repeated movements at wrist and foot along with vibration transmitted from steering wheel and pedals influence the nerve conduction parameters and to find out which nerves are more prone to neurological conduction defects. Materials and Methods: A cross-sectional study was conducted over a period of two years in Neurophysiology Lab, Department of Physiology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. Mean peak sensory and motor latency, mean motor and sensory Nerve Conduction Velocity (NCV), Sensory Nerve Action Potential (SNAP) and Compound Muscle Action Potential (CMAP) of median, ulnar and common peroneal nerve in Professional Heavy Vehicle Drivers (PHVD) was compared with non-drivers using Medicaid System’s (Electromyography) EMG/ (Nerve Conduction Velocity) NCV equipment with Neuroperfect Software. Student’s unpaired t-test was used to assess the significance of difference in nerve conduction study findings. Results: Heavy vehicle drivers showed slow Sensory Nerve Conduction Velocity (SNCV) (drivers: 51.40±3.30, non-drivers: 53.66±3.60 in right hand p-value 0.0001) and (drivers: 52.51±3.78, non-drivers: 53.87±3.61 in left hand p-value=0.0145) and increase in sensory latency (drivers: 3.71±0.72, non-drivers: 2.89±0.56 in right hand p-value<0.0001 and drivers: 3.4±0.81 non-drivers: 2.76±0.70 in left hand p-value <0.0001) of median nerve. Ulnar nerve sensory latency was prolonged (drivers: 2.98±0.52, non-drivers: 2.76±0.42 in right hand p-value 0.0021 and drivers: 2.97±0.42, non-drivers: 2.80±0.65 in left hand p-value 0.0386) and sural nerve sensory latency was prolonged (drivers: 3.05±0.55, non-drivers: 2.78±0.54 in right leg p-value=0.0011 and drivers: 2.92±0.45, non-drivers: 2.69±0.40 in left leg p-value 0.0004).There was no significant difference in Motor Nerve Conduction Velocity (MNCV), motor latency, SNAP and CMAP of median, ulnar and common peroneal nerve among heavy vehicle drivers in comparison to non-drivers. Conclusion: We conclude that pressure and vibrations transmitted at hand and foot along with repeated movements at forearm wrist and pedals leads to more neurological conduction defects in median nerve than in ulnar and sural nerve. Flexibility in delivery time, incorporating judicious breaks in duty, better ergonomics design may help in improving work conditions of drivers.

Relationship between electrodiagnostic findings and sleep disturbance in carpal tunnel syndrome: A controlled objective and subjective study

Objective This controlled objective and subjective study aimed to evaluate the relationship between insomnia severity and electrodiagnostic findings in patients with carpal tunnel syndrome (CTS). Methods Twenty-one patients with an established clinical and electrodiagnostic diagnosis of CTS before surgery were included. Sleep characteristics were monitored objectively over 4 to 9 nights by means of actigraphy. On the following morning, participants completed a sleep log that conveyed their subjective impressions of how they had slept. All patients also completed the Insomnia Severity Index questionnaire. The correlation of these findings with patients’ motor latency and sensory latency was evaluated using Spearman correlation analysis. Results We found no correlation between sensory or motor latencies and all sleep measures. Conclusion Electrodiagnostic findings and sleep severity in patients with CTS appear to be independent measures, and they do not correlate with each other.

Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship–trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

Clinical Evaluation and Diagnostic Utilities of Different Nerve Conduction Tests in 100 Patients with Carpal Tunnel Syndrome

ABSTRACT Background and Purpose: The purpose of the study is to determine whether the clinical profile of patients with carpal tunnel syndrome (CTS) has been same over the years with the help of routine and comparative electrodiagnostic tests. Methods: A prospective study of 100 patients with suspected CTS was conducted without controls. Three provocative maneuvers were performed. Routine and comparison nerve conduction tests were performed, i.e., second lumbrical interossei motor latency difference (2 LIMLD), digit 4 median-ulnar sensory latency difference (D4MUSLD), palm wrist distal sensory latency difference (PWDSLD), and digit 1 median-radial sensory latency difference (D1MRSLD). Data entry, analysis, and statistical evaluation were done using International Business Machines Corporation Statistical Package for the Social Sciences statistics package (IBM, SPSS). Results: A total of 195 hands of 100 patients met the criteria for CTS. Forty-three percentage of patients were homemakers. Considering the rapidly changing communication technology, we observed 84% patients had aggravation of symptoms with continuous long-term daily mobile phone use (>30 min per session per day). We noted positive Tinel's sign in only 25%. Phalen's sign was positive in 53 right hands with mean duration of 11.49s (standard deviation [SD] ± 2.54 s) and was positive in 26 left hands with mean being 10.4 s (SD ± 1.91 s). The mean motor distal latency of median was 4.67 ms (SD ± 1.71 ms) and mean sensory distal latency of median was 3.24 ms (SD ± 1 ms). On internal comparison testing, mean difference in 2 LIMLD was 0.7 ± 0.3 ms, in D4MUSLD was 0.81 ± 0.32, in PWDSLD was 0.71 ± 0.20, and in D1MRSLD was 0.76 ± 0.32. Conclusion: Further analysis of clinical profile needs to be done, and new risk or provoking factors should be analyzed in patients with CTS.

Effect of pregnancy on median and ulnar nerve conduction

Background: Pregnancy causes altered function of excitable membranes such as muscle and nerve, due to hormonal changes and edema. We failed to find any studies focusing on the issue of nerve conduction during pregnancy, in India. Thus present study aims to see the difference between nerve conduction parameters viz. motor and sensory conduction, in pregnant and non-pregnant women.Methods: This was a cross-sectional study carried out in randomly selected 30 pregnant women, of any age, in 28-40 weeks of gestation and age matched non-pregnant controls. We studied distal motor latency, compound muscle action potential amplitude, motor nerve conduction velocity, F-minimum latency, sensory latency, sensory nerve action potential amplitude and sensory nerve conduction velocity in bilateral median and ulnar nerves using Aleron-RMS.Results: Present study found no statistically significant difference between motor and sensory conduction of above said nerves in pregnant and nonpregnant women, except F minimum latency of left median nerve in pregnant women and sensory latency of left ulnar nerve in non-pregnant women were prolonged significantly (p<0.05).Conclusions: All motor and sensory parameters of bilateral median and ulnar nerves were normal as compared to non-pregnant controls.