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MILD CARPAL TUNNEL SYNDROME: EARLY ELECTROPHYSIOLOGICAL DIAGNOSIS AND POST SURGICAL FOLLOW UP
Author(s) -
Lanzillo B.,
Nucciotti R.,
Di Caprio G.,
Crisci C.,
Pappone N.,
Saltalamacchia A.M.,
Stancanelli A.,
Caruso G.
Publication year - 2000
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1046/j.1529-8027.2000.00513-32.x
Subject(s) - medicine , median nerve , surgery , nerve conduction velocity , wrist , ulnar nerve , carpal tunnel syndrome , orthodromic , electrophysiology , anesthesia , anatomy , elbow
We studied orthodromic sensory and motor conduction along median and ulnar nerves in 52 patients suspected for CTS (60 hands) and in 30 control subjects. Patients underwent electrophysiological examination before and up to 24 months after surgical decompression. We evaluated the following electrophysiological tests: 1. sensory nerve conduction velocity (SNCV) from digit III and V to wrist (dSNCV) and from palm to wrist (pSNCV) 2. pSNCV/dSNCV ratio in median nerve 3. median/ulnar pSNCV ratio 4. Distal latency (DL) 5. SNAP and CMAP amplitudes. In 3 patients, presurgical neurographic findings were normal. According to median dSNCV, the remaining 49 patients were classified into 3 groups: A = normal, B = mild slowing, C = marked slowing. In all B and C group patients, median pSNCV was significantly reduced. In group A, pSNCV was reduced in 16 patients (53%), pSNCV/dSNCV ratio was abnormal in 29 patients (97%), and median/ulnar pSNCV ratio in all subjects (100%). DL, SNAP, and CMAP amplitudes abnormalities were detected only in group B and C. Disease duration in the 3 goups was inversely correlated with SNCV and DL abnormalities. After surgery, neurographic findings returned within the normal range earlier in group A, then in group B; group C showed an incomplete recovery of digit and palm SNCV at 24 months. Median palm/digit SNCV and median/ulnar pSNCV ratios were the most sensitive tests, providing a reliable tool for the assessment of very early phase of CTS and for the subsequent surgery treatment.