Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands

Abstract

Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Six hundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT-absence of thenar motor responses), severe CTS (SEV-absence of sensory response and abnormal distal motor latency-DML), moderate CTS (MOD-abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD-abnormal digit wrist conduction and normal DML), minimal CTS (MIN-exclusive abnormal segmental and/or comparative study), and negative CTS (NEG-normal findings at all tests). Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60-80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

“…Patients who met clinical 20 and electrodiagnostic 21,22 criteria for mild or moderate CTS (S- Table 1) were randomly allocated to receive either night splinting (n ¼ 10) or nerve and tendon gliding exercises (n ¼ 10; Fig. 1).…”

Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review

“…The electrophysiological classification [17,18], in agreement with the AAEM guidelines, follows the neurophysiological progression of CTS severity and includes the following classes:…”

Therapeutic Application of Musically Modulated Electromagnetic Fields in the Treatment of Musculoskeletal Disorders

“…Particularly relevant seemed the efficacy of ELF EMFs over time (followup): so, the authors hypothesized that ELF EMFs are able to interfere with the pathogenetic mechanisms of the disease, justifying their prolonged action not only limited to the symptoms. In another of our previous clinical studies (15), 30 women (mean age 58+/-3.2 years; duration of disease 2.1+/-2.2 years) affected by a mild-to-moderate form (according to electrophysiological data) of idiopathic carpal tunnel syndrome, one of the most common entrapment neuropathies (27), were exposed to ELF EMFs consisting of 2 cycles, distanced 3 months one from another, each composed by IS daily applications lasting 30 minutes. The clinical parameters significantly improved in the course of treatment in 28 patients, in particular pain , paresthesias, numbness and functional loss showed a significant decrease.…”