Electromyoneurography in the diagnostics of rare causes of carpal tunnel syndrome

Abstract

Introduction. The paper points to the problem of electromyoneurography of the bifid median nerve as a rare cause of carpal tunnel syndrome. Carpal tunnel syndrome represents a set of symptoms caused by compression of the distal portion of the median nerve. It is important in clinical practice as it significantly effects the functionality and the quality of daily activities. One of the predisposing factors for the carpal tunnel syndrome is the bifid median nerve. Electromyoneurography is still the gold standard for the verification of the carpal tunnel syndrome. Case Report. A 48-year-old patient, after a clinical suspicion of carpal tunnel syndrome, has been confirm by ultrasonography to be suffering from moderate carpal tunnel syndrome, with a detection of ?incomplete? bifid median nerve in the carpal tunnel. Electromyoneurography also confirmed a mild level of carpal tunnel syndrome. However, as difficulties were exclusively present in the innervation area of the median nerve internal branch, and there was a possibility of incomplete correlation of electromyoneurography results, the lumbrical muscles and dorsal interossei muscles were examined, and confirmed a moderate degree of carpal tunnel syndrome. Discussion. The bifid median nerve can be the cause of the above insufficient sensitivity of this method, which is why it is necessary to apply optional electromyoneurographic techniques. Conclusion. The final practical significance lies in the fact that the presence of the diagnosed bifid median nerve could affect the choice and efficiency of certain therapeutical options.