Median versus ulnar medial thenar motor recording in diagnosis of carpal tunnel syndrome

Saba, Emmanuel Kamal Aziz

doi:10.1016/j.ejr.2014.11.001

Cited by 11 publications

(3 citation statements)

References 28 publications

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“…For that reason, all the electrodiagnostic tests evaluating CTS were supportive to each other. There was no isolated test that could take the advantage over the others but the combination of the comparative tests can be used to complement one another in the diagnosis of patients with CTS who had normal routine sensory and motor studies [35]. The limitation of our study was the small number of patients of grade 1 CTS with normal motor and sensory routine studies and at the same time having only two abnormal comparative tests., this was perchance due to the medical attention of CTS patients about their disease with preliminary looking for medical guidance.…”

Section: Discussionmentioning

confidence: 95%

The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome

El-Hady¹

2023

Egypt Rheumatol Rehabil

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Background Electrodiagnostic tests (EDX) are the most frequent and applicable studies in early diagnosis of carpal tunnel syndrome (CTS), but the definitive sensitive and specific tests are still under study. We aimed to evaluate the role of the median versus ulnar palmar mixed nerve study (Mix M-U), and its sensitivity in comparison to other provocative comparison studies, in supporting the early diagnosis of CTS. This cross-sectional study included 142 idiopathic early CTS hands from 100 patients and 71 hands from 50 healthy subjects as a control group. We did routine median motor and sensory studies and 4 comparative tests namely median versus radial sensory study (MVR), Mix M-U, median versus ulnar sensory study (MVU), and median versus ulnar lumbrical-interossei motor study (LU-IN). Results The routine median motor and sensory latency and amplitude showed a statistically significant difference between CTS and control groups as (p< 0.05) and a highly statistically significant difference between the 2 groups as regards the 4 comparative tests as (p< 0.0001). The specificities of all the 4 comparative tests were higher than 90%. MVR test had the highest sensitivity (92.2%) and followed by Mix M-U study (82.2%) and MVU (78.7%), and the least sensitive test was the LM-IN (66.9%). Conclusions Although the patients’ results fall within the normal range according to the reference range in the literature, it showed a statistically significant difference when compared to controls. A high percentage of those symptomatic patients showed results of typical CTS when tested with the comparative studies so there is a need to use these sensitive tests to diagnose cases with early CTS. According to sensitivity studies, the selection of which tests to do in order is a challenging choice. For the diagnosis of cases with early CTS with a normal ordinary motor and sensory studies, MVR comparative technique appeared as the best sensitive and specific provocative electrophysiological test followed by the Mix M-U test. We recommend the use of a combination of both tests first in the diagnosis of early CTS and if one of them was negative we can use the other comparative studies MVU and then LM-IN studies.

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Section: Discussionmentioning

confidence: 95%

The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome

El-Hady¹

2023

Egypt Rheumatol Rehabil

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“…Precise measurements using a 1 mm precision measuring tape determined conduction distances. 19 Motor NCSs involved parameters such as a swept speed of 5 ms/division and sensitivity of 5 mV/division. The filter bandwidth ranged from 10 Hz to 10 kHz.…”

Section: Methodsmentioning

confidence: 99%

An assessment of Martin-Gruber anastomosis discrepancies between healthy individuals and patients with carpal tunnel syndrome in motor nerve conduction studies

Ertekin

2023

CJN

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Background: The Martin-Gruber anastomosis (MGA) represents a nerve innervation anomaly in the upper extremity, potentially leading to misinterpretation during standard nerve conduction studies (NCSs). This study aims to characterize the electrophysiological attributes of MGA in both healthy subjects and individuals diagnosed with carpal tunnel syndrome (CTS). Methods: This case-control study involved the electrophysiological assessment of 506 forearms, segregated into two distinct groups: a CTS positive (+) case group and a CTS negative (-) control group. The evaluations were conducted over an average period of 8 months in the neurophysiology laboratory. The study encompassed 294 forearms from 147 healthy individuals without CTS and 212 forearms from 106 patients diagnosed with CTS, both clinically and electrodiagnostically. Results: The relationship between the presence of type I MGA and the CTS (+) group was statistically significant (P = 0.002). Similarly, the relationship between the presence of type II MGA and the CTS (+) group was statistically significant (P = 0.013). On the other hand, the relationship between the presence of type III MGA and the CTS (+) group was not statistically significant (P = 0.208). Likewise, the relationship between the presence of type IV MGA and the CTS (+) group was not statistically significant (P = 0.807). The correlation between the side of type I MGA and the groups did not reach statistical significance (P = 0.770). The relationship between the side of type II MGA and the groups also did not attain statistical significance (P = 0.990). Similarly, the side of type III MGA and its association with the groups did not yield statistical significance (P = 0.402). Finally, the relationship between the side of type IV MGA and the groups was not statistically significant (P = 0.166). Conclusion: The MGA represents a relatively frequent anatomical variation observed in the upper extremity. Notably, its presence demonstrated significance in the first dorsal interosseous (FDI) muscle (type II) and the abductor digiti minimi (ADM) muscle (type I) among patients with CTS. The present study emphasizes the importance of recognizing this variation during upper extremity NCSs for a correct diagnostic approach and treatment plan to avoid misdiagnosis of median-ulnar peripheral neuropathy.

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“…The electrophysiological studies performed to the participants are illustrated in Fig. 4 [14,16,17,21]. The classification of neurophysiological severity of median neuropathy across the wrist was done depending on the Padua neurophysiological classification scale [22].…”

Section: Methodsmentioning

confidence: 99%

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

Saba

2021

Egypt Rheumatol Rehabil

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Background Carpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done. Results Regarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%). Conclusions The concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

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Median versus ulnar medial thenar motor recording in diagnosis of carpal tunnel syndrome

Cited by 11 publications

References 28 publications

The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome

The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome

An assessment of Martin-Gruber anastomosis discrepancies between healthy individuals and patients with carpal tunnel syndrome in motor nerve conduction studies

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

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