Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands

Abstract

Objectives‐ To evaluate the following points about carpal tunnel syndrome (CTS): 1) characterization of a wide population; 2) sensitivity of electrodiagnostic tests, and particularly the contribution of disto‐proximal ratio test; 3) validity of a neurophysiological classification developed by us. Material and methods ‐ Prospective study in 500 hands with CTS symptoms. Neurophysiological “standard” tests were always performed: sensory nerve conduction velocity (SNCV) first‐ and third digit‐wrist and distal motor latency (DML). In “standard negative” hands disto‐proximal ratio technique (R) was performed. Neurophysiological classification: Extreme CTS (absence of median motor, sensory responses), Severe (absence of sensory response, abnormal DML), Moderate (abnormal SNCV, abnormal DML), Mild (abnormal SNCV, normal DML), Minimal (abnormal R or other segmental/comparative test, normal standard tests). Results‐ Sensibility of standard tests: 77%. R increased the diagnostic yield by 20%. CTS classification appeared reliable with significant differences between groups. Conclusion ‐ R is a useful test, the classification may be useful in clinical/therapeutical decisions.

Carpal Tunnel Syndrome in Patients with and without Diabetes Mellitus in Upper Egypt: The Impact of Electrophysiological and Ultrasonographical Studies

“…according to Delisa et al, 1994.The diagnostic criteria of electrodiagnostic tests for CTS were : Reduction in the median nerve sensory CV of less than 50 m/s, Prolongation of median nerve DML more than 4 ms, No abnormalities in the proximal median nerve. The severity of electrophysiological CTS impairment was assessed according to the modified scoring system of Padua et al [12].…”

Evaluation Of The Compound Muscle Action Potential In Diagnosis Of The Mild Carpal Tunnel Syndrome

“…The patients who have history or clinical signs suggesting systemic disease such as double-crush injury, diabetes, chronic renal failure, gout, rheumatoid arthritis, thyroid diseases and have clinical or electrophysiological signs suggesting pathological conditions such as myelopathy, polyneuropathy, radiculopathy, myopathy were excluded. We selected only the mild CTS diagnosed according to the criteria of our laboratory and used for diagnosis and classifying of the CTS [15,16].…”

Do Electrodiagnostic Variables Correlate with Functional Outcomes in Carpal Tunnel Syndrome?

“…The primary intention of every EDX study is to localize the disorder, and EDX in combination with the clinical examination can typically provide a diagnosis of CTS accurately [2]. Although the diagnostic value of EDX is unequivocal, EDX's value in predicting outcomes is unclear [3][4][5][6]. Standardized patient-reported outcome (PRO) measures such as the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire are more commonly used in clinical evaluation of CTS over EDX because of better clinical relevance.…”

“…However, it wasn't based on any standard or widely accepted norm. A 6-point severity scale [5] and a 7-point neurophysiologic grading scale [3] have also been used. Significant correlations between these classification systems with H & P findings and the Boston Carpal Tunnel Questionnaire have been reported [19], and statistically significant differences have been reported when using the 7-point scale in a large retrospective cohort [3].…”