Carpal tunnel syndrome: pathophysiology and clinical neurophysiology (original) (raw)
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Archives of Hand and Microsurgery, 2023
This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another. Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients' mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients' overall mean scores for symptom severity had substantive predictive accuracy for the patients' CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients' NCS-based carpal tunnel severity score. Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.
Median mixed and sensory nerve conduction studies in carpal tunnel syndrome1
… and Motor Control, 1998
To assess the sensitivities and specificities of velocity differences between median mixed nerve conduction across the wrist (Medmxpw) and (I) median mixed nerve conduction in the forearm (Medmxf) and (II) palm to D2 sensory conduction (MedpD2). Design and Methods: We prospectively studied 67 limbs of patients with clinically definite carpal tunnel syndrome (CTS). Medmxf and Medmxpw were performed by stimulating the median nerve at the elbow and palm respectively and recording at the proximal wrist crease. We also compared conventional median sensory (D2-wrist) and mixed (palm-wrist) tests in all patients. Thirty limbs of asymptomatic subjects served as normal controls and 21 limbs of subjects with other neuropathies served as diseased controls; control data was collected prospectively. Results: The sensitivity of the MedpD2-Medmxpw difference (0.87) was significantly greater than that of the Medmxf-Medmxpw difference (0.61, P Ͻ 0.001). Both tests were similar and highly specific (0.98 and 0.96, respectively). Conclusions: The MedpD2-Medmxpw study is among the most sensitive and specific electrophysiologic tests for CTS.
Median mixed and sensory nerve conduction studies in carpal tunnel syndrome
Electroencephalography and clinical neurophysiology, 1998
To assess the sensitivities and specificities of velocity differences between median mixed nerve conduction across the wrist (Medmxpw) and (I) median mixed nerve conduction in the forearm (Medmxf) and (II) palm to D2 sensory conduction (MedpD2). We prospectively studied 67 limbs of patients with clinically definite carpal tunnel syndrome (CTS). Medmxf and Medmxpw were performed by stimulating the median nerve at the elbow and palm respectively and recording at the proximal wrist crease. We also compared conventional median sensory (D2-wrist) and mixed (palm-wrist) tests in all patients. Thirty limbs of asymptomatic subjects served as normal controls and 21 limbs of subjects with other neuropathies served as diseased controls; control data was collected prospectively. The sensitivity of the MedpD2-Medmxpw difference (0.87) was significantly greater than that of the Medmxf-Medmxpw difference (0.61, P < 0.001). Both tests were similar and highly specific (0.98 and 0.96, respectively...
Carpal tunnel syndrome - anatomical and clinical correlations
Folia medica Cracoviensia, 2013
Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.
Use of Cross-Sectional Area of Median Nerve in Diagnosis of Carpal Tunnel Syndrome
2017
Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. It occurs due to compression of median nerve in the wrist. This study evaluates the usefulness of Cross-Sectional Area (CSA) of the median nerve in the diagnosis of CTS. The aim of the study was to determining the diagnostic value of cross-sectional area of median nerve in CTS. Materials and Methods: In this cross-sectional study, 86 cases of CTS (59 patients) and 16 normal subjects as the control group underwent ultrasonography of the wrist. The results of ultrasonography of two groups were compared. Results: The data showed a significant difference in the CSA of median nerve between the patients with CTS and control group and also we observed significant difference in CSA of the median nerve according to grading of CTS based on Nerve Conduction Study (NCS). Conclusion: Based on the study results, determining CSA of median nerve can be an effective method in CTS evaluation.
Paper : Use of Cross-Sectional Area of Median Nerve in Diagnosis of Carpal Tunnel Syndrome
2018
Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. It occurs due to compression of median nerve in the wrist. This study evaluates the usefulness of Cross-Sectional Area (CSA) of the median nerve in the diagnosis of CTS. The aim of the study was to determining the diagnostic value of cross-sectional area of median nerve in CTS. Materials and Methods: In this cross-sectional study, 86 cases of CTS (59 patients) and 16 normal subjects as the control group underwent ultrasonography of the wrist. The results of ultrasonography of two groups were compared. Results: The data showed a significant difference in the CSA of median nerve between the patients with CTS and control group and also we observed significant difference in CSA of the median nerve according to grading of CTS based on Nerve Conduction Study (NCS). Conclusion: Based on the study results, determining CSA of median nerve can be an effective method in CTS evaluation.
Sensory neural conduction of median nerve from digits and palm stimulation in carpal tunnel syndrome
1994
The median sensory nerve conduction between ring finger and wrist is a suitable parameter for early detection of carpal tunnel syndrome (CTS), although shorter segments of median nerve have also been proposed for the same goal. In order to assess the relative diagnostic value of the sensory nerve conduction velocity (SNCV) of the third palmar branch versus the SNCV of the second palmar branch, generally performed until now, we studied 62 patients with typical signs and symptoms of CTS. The following parameters were evaluated by surface recording: orthodromic SNCVs in digit-wrist segments for median (index = M2, third = M3 and ring = M4 fingers), ulnar (fourth = U4 finger) and radial (thumb = R1) nerves; SNCVs in palm-wrist segments by surface bipolar stimulation at each metacarpo-phalangeal interspace (second = P2 and third = P3 for the median nerve and fourth = P4 for the ulnar nerve); and distal motor latencies of the median and ulnar nerves. No responses at the wrist were recorded in 22.6% of patients after digital stimulation of M4, whereas the SNCV of P3, the palmar nerve branch arising from digital nerves of the medial side of M3 and the lateral side of M4, was measurable in 93.5% of patients. As significantly expressed (P < 0.001) by the increased ratio of the mean values of P2 and P3 in CTS patients, the SNCV of P3 decreased more frequently and to a greater extent than the SNCV of P2.
Muscle & Nerve, 1990
Each digital branch of the median nerve was stimulated in turn in 34 women (55 hands) with carpal tunnel syndrome (CTS). The amplitude and conduction velocity of the sensory nerve action potential (SNAP) recorded at the wrist, and the threshold for patient perception of the electrical stimu-Ius on the median innervated sides of each digit, were compared with the corresponding values in a group of asymptomatic, age-matched women. Sensory conduction velocity or SNAP amplitude were abnormal in more than 80% of all digital nerves studied apart from those in the index finger. Stimulation of digital nerves in the index finger proved the least sensitive means of detecting the electrophysiological abnormality. We conclude that selective digital nerve stimulation is a sensitive technique in the diagnosis of CTS. If ring electrodes are preferred, our results suggest that the middle rather than the index finger should be used.
Carpal Tunnel Syndrome (Diagnosis and Management)
JPHV (Journal of Pain, Vertigo and Headache), 2021
Carpal Tunnel Syndrome (CTS) is a neuropathy disease that affects the median nerve with an incidence of around 90%. Carpal Tunnel Syndrome appears in 3.8% of the general population, with the highest prevalence occurring in women. There are several risk factors associated with CTS, namely medical and non-medical factors. The mechanism of carpal tunnel syndrome until now is still very complex and is not known with certainty, but compression and traction factors in the median nerve are thought to be the most common cause of CTS. Carpal Tunnel Syndrome can manifest clinically with subjective signs such as paresthesia, proprioceptive changes, and paresis, as well as objective signs, such as changes in motor sensitivity and function, positive Tinel and Phallen tests, and thenar muscle atrophy. The diagnosis of Carpal Tunnel Syndrome is based on the classic symptoms of pain, numbness, tingling, and/or burning sensation in the distribution of the median nerve in the hand, as well as the abn...