Lumbrical-interosseous recording technique versus routine electrodiagnostic methods in the diagnosis of carpal tunnel syndrome

Yılmaz, Figen; Gündüz, Osman Hakan; Akyüz, Gülseren

doi:10.5606/tftrd.2017.311

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…This larger proportion of female patients compared to male patients is similar to that in previous studies [ 1 , 12 , 13 ] and may be caused by a combination of factors such as hormonal changes in women and performing more housework in the family. Consistent with previous findings [ 12 , 14 , 15 ], bilateral incidence had the highest occurrence (82%) among patients, and the number of patients with CTS on the right hand was higher than those with the disorder on the left hand. The greater incidence on the right side may be because most people are right-handed and perform more repetitive movements using the right hand than the left hand.…”

Section: Discussionsupporting

confidence: 92%

“…A simple increase in MSDL does not indicate that CTS should be diagnosed, but a comparison with the UN on the same hand and MUD calculation can provide better insight regarding the problem. Most of the previously reported MSDL cut-off values were between 2.7 and 3.8 ms (mostly around 3.7 ms), with a sensitivity of 67% ~ 90% and a specificity mostly above 90% [ 3 , 14 , 15 , 21 , 23 – 26 ]. In our study, the sensitivity of MSDL for the diagnosis of CTS was 92.2% and the specificity was 99.4%, which were similar to the results of previous studies.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…This might be due to the small latency differences in our results. This was in concordance with Yılmaz et al [28], as in their CTS group, the mean difference was found to be (1.40 ms), whereas it was (0.12ms) in the control group, indicating a significant difference between the two groups (p < 0.001). The previous study was also in agreement with findings of Ozben et al ( 2012 In the present study, we used the 7-joint US score as it combines soft tissue changes (synovitis and tenosynovitis) by gray scale (GS) and neovascularization by Power Doppler (PD) in addition to erosive bony changes and it reveals clinical correlation with diseases activity as well [21].…”

Section: Discussionsupporting

confidence: 92%

Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment

Mahmoud

El-Naby

Awad

2022

Egypt Rheumatol Rehabil

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Background Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management. Results Carpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed. Conclusion Synovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.

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“…The simple prolongation of MSDL does not indicate that CTS can be diagnosed, but comparing with its own UN and calculating MUD can explain the problem better. Most of the previously reported MSDL cut-off values were between 2.7-3.8 ms, and more were around 3.7 ms, the sensitivity is 67%~90%, and the speci city is mostly greater than 90% (3,11,12,18,(20)(21)(22)(23). In our study, the sensitivity of MSDL to diagnose CTS was 85.5%, and the speci city was 90.4%, which was similar to the results of previous studies.…”

Section: Discussionsupporting

confidence: 90%

“…The higher incidence of women may be caused by a combination of factors such as women taking on more housework in the family and changes in the hormone levels in women. Among the types of patients, bilateral incidence is the most (82%), and the number of patients on the right side is more than that on the left side, which is consistent with previous studies (9,11,12). The greater incidence on the right side than on the left may be due to the fact that the majority of people are right-handed and have more repetitive movements than left.…”

Section: Discussionsupporting

confidence: 89%

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

Wang

Chu

Wang

et al. 2021

Preprint

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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.

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Lumbrical-interosseous recording technique versus routine electrodiagnostic methods in the diagnosis of carpal tunnel syndrome

Cited by 6 publications

References 30 publications

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

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

Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment

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

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