Radial motor nerve conduction studies recorded from triceps brachii and extensor carpi radialis longus: Techniques and reference values.

Abstract

Optimal timing of nerve transfer surgery in cervical spinal cord injury (SCI) depends upon the integrity of lower motor neurons (LMNs) in recipient nerves, which is best predicted by compound muscle action potential (CMAP) amplitude. There are no established techniques for obtaining the CMAP in two recipient muscles: triceps brachii and extensor carpi radialis longus (ECRL). This study aimed to develop recording techniques for radial motor studies to triceps and ECRL, and to determine reference values for CMAP amplitudes in healthy volunteers. This was a prospective observational study of healthy adults aged 18 years and older. Motor nerve conduction studies were performed, stimulating the radial nerve in the axilla, over the axillary pulse at the pectoralis major insertion. Recording was from triceps (long head) and ECRL. CMAP amplitude, area, latency, and stimulus intensity were recorded. Reference values (RV) were calculated for CMAP amplitudes using a value 2 standard deviations below the mean. Cube root or logarithmic transformations were used to correct for non-normal distributions. Twenty-five healthy subjects participated. Triceps mean CMAP amplitude was 15.5mV (SD 4.19), with an RV of 8.1mV. ECRL mean CMAP amplitude was 11.5mV (SD 3.54), with an RV of 6.2mV. CMAP amplitude at ECRL was 75% (95% confidence interval 50%-100%) of that at triceps. We describe a technique for recording radial motor NCS from triceps and ECRL. Knowledge of normal CMAP amplitudes will help identify LMN injury in patients with cervical SCI being considered for nerve transfers.