Short-distance sensory stimulation technique in the early diagnosis of carpal tunnel syndrome

Amaç. Sinir iletim çalışmalarının normal olması karpal tünel sendromu (KTS) tanısını dışlamaz.Biz bu çalışmada, erken evre KTSde avuçiçi-bilek segmentindeki mesafeyi daha kısa tutup,median sinirin tuzaklanma bölgesi dışındaki, henüz patolojik değişikliklerden etkilenmemiş distalbölgesini çıkararak, KTS tanısında duyarlılığı artırmayı amaçladık. Yöntem. Bu prospektifçalışmada, klinik olarak KTS tanısı konan, konvansiyonel elektrofizyolojik incelemeleri normalolan 41 olguda (66 el), avuçiçi-bilek segmentinde; distal bilek çizgisinden (DBÇ) sırasıyla 8, 7, 6,5, 4 cm mesafelerden uyarım yapılmış, bu mesafelerdeki hız, latans ve latanslar arası farkları(iletim gecikmesi), kontrol grubundaki 34 olgunun (68 el) verileriyle karşılaştırılmıştır. Bulgular.4-5, 5-6, 6-7, 7-8. cm.ler arası latans farkı (iletim gecikmesi) her iki grup arasında istatistikselolarak anlamsız olup (p>0.1); 4, 5, 6, 7, 8. cm.lerdeki hız, latans değerleri her iki grup arasındaistatistiksel olarak anlamlı bulunmuştur (p

Karp al tünel sendromunun erken tanısında kısa mesaf eli duyu iletim tekniği

Aim. Normal results obtained from nerve conduction studies do not exclude the diagnosis ofcarpal tunnel syndrome (CTS). We intended to increase diagnostic sensitivity of nerve conductionstudies in the early stage CTS by stimulating shorter palm-wrist segment, and excluding distalregion outside the entrapment site of the median nerve which is unaffected from pathologicchanges. Methods. In this prospective study, 41 patients (66 hands) with clinically diagnosed CTSwith normal conventional electrophysiologic examinations were stimulated with electrodes placedat 8, 7, 6, 5, 4 cm from the distal wrist crease (DWC) on the palm-wrist segment, and theconduction velocities, latencies, and the differential latencies (conduction delay) were comparedwith those of 34 patients (68 hands) in the control group. Results. Conduction delay recordedbetween 4-5, 5-6, 6-7, 7-8 cm. away from DWC of both groups was statistically insignificant(p>0.1), while the conduction velocities and the latencies obtained from the electrodes placed on 4,5, 6, 7, and 8 cm away from DWC differed statistically significantly between two groups(p

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1. Oh SJ. Clinical electromyograhy nerve conduction studies, in 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
2. Patijn J, Vallejo R, Janssen M, Huygen F, Lataster A, van Kleef M, Mekhail N. Carpal tunnel syndrome. Pain Pract 2011; 11: 297-301.
3. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Roeén I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-8.
4. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-6.
5. Stevens JC, Sun S, Beard CM, OFallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988; 38: 134-8.
6. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg M, Hales T, Katz JN, Pransky G. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998; 88: 1447-51.
7. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44: 597-607.
8. Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve 1993; 16: 1392-414.
9. Padua L, Giannini F, Girlanda P, Insola A, Luchetti R, Lo Monaco M, Padua R, Uncini A, Tonali P. Usefulness of segmental and comparative tests in the electrodiagnosis of carpal tunnel syndrome: the Italian multicenter study. Italian CTS Study Group. Ital J Neurol Sci 1999; 20: 315-20.
10. Rahmani M, Ghasemi Esfe AR, Vaziri-Bozorg SM, Mazloumi M, Khalilzadeh O, Kahnouji H. The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests. Radiol Med 2011; 116: 489-96.
11. Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010; 31: 243-52.
12. Practice parameter for carpal tunnel syndrome (summary statement). Report of the quality standards subcommittee of the american academy of neurology. Neurology 1993; 43: 2406-9.
13. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, Wilson JR; American Association of Electrodiagnostic Medicine; American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58: 1589-92.
14. Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 2004; 107: 64-9.
15. Kang YK, Kim DH, Lee SH, Hwang M, Han MS. Tenelectrodes: a new stimulator for inching technique in the diagnosis of carpal tunnel syndrome. Yonsei Med J 2003; 44: 479-84.
16. Seror P. Comparative diagnostic sensitivities of orthodromic or antidromic sensory inching test in mild carpal tunnel syndrome. Arch Phyl Med Rehabil 2000; 81: 442-6.
17. Seror P. Orthodromic inching test in mild carpal tunnel syndrome. Muscle Nerve 1998; 21: 1206-8.
18. Brown WF, Ferguson GG, Jones MW, Yates SK. The location of conduction abnormalities in human entrapment neuropathies. Can J Neurol Sci 1976; 3: 111- 22.
19. Luchetti R, Schoenhuber R, Alfarano M, Montagna G, Pederzini L, Soragni O. Neurophysiological assessment of the early phases of carpal tunnel syndrome with the inching technique before and during operation. J Hand Surg Br 1991; 16: 415-9.
20. Kimura J. The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain 1979; 102: 619-35.
21. Nathan PA, Srinivasan H, Doyle LS, Meadows KD. Location of impaired sensory conduction of the median nerve in carpal tunnel syndrome. J Hand Surg Br 1990; 15: 89-92.
22. Seror P. Simplified orthodromic inching test in mild carpal tunnel syndrome. Muscle Nerve 2001; 24: 1595-600.
23. Padua L, Padua R, LoMonaco M, Romanini E, Tonali P. Italian multicentre study of carpal tunnel syndrome: study design. Italian CTS Study Group. Ital J Neurol Sci 1998; 19: 285-9.