Distal Motor Latency Research Articles

The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study.

Objectives Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.

Changes of median nerve conduction, cross-sectional area and mobility by radioulnar wrist compression intervention in patients with carpal tunnel syndrome

BackgroundOwing to the compressive nature of the neuropathy, patients with carpal tunnel syndrome (CTS) have prolonged distal motor latency (DML), sensory nerve latency (SNL), median nerve swelling and restricted median nerve mobility. The purpose of this study was to noninvasively augment carpal tunnel space using radioulnar wrist compression (RWC) and evaluate its effects on median nerve pathological properties in patients with CTS. It was hypothesized that the RWC intervention would reduce the median nerve DML, SNL and cross-sectional area (CSA) and enhance longitudinal median nerve mobility in patients. with CTS. MethodsEleven patients diagnosed with CTS participated in this study. A portable RWC intervention splint was developed to apply 10 N of compressive force across the wrist. Three daily sessions of RWC were performed over 4 weeks of intervention (15 min per session, 45 min per day, 7 days per week). Each 15-min session consisted of three 5-min blocks of RWC, with a 1-min rest in between consecutive blocks. Patients were evaluated at Week 0 (baseline), Week 2 (mid-intervention) and Week 4 (end of intervention). DML and SNL of the median nerve were evaluated using established nerve conduction study techniques. Median nerve CSA at the distal wrist crease was obtained by ultrasound imaging. Median nerve motion associated with finger flexion/extension was captured by dynamic ultrasound imaging and quantified using a speckle cross-correlation algorithm. Finger flexion/extension was recorded using an electrogoniometer. The slope of the regressed linear equation of median nerve displacement as a function of finger flexion angle was used to quantify nerve mobility. ResultsPatients with CTS showed significantly decreased DML (p = 0.048) and median nerve CSA (p < 0.001) and increased nerve mobility (p < 0.001) at mid-intervention compared to baseline. However, DML, CSA and mobility of the median nerve did not differ significantly between Weeks 2 and 4 (p = 0.574, 1.00 and 0.139, respectively). Median nerve SNL was not significantly affected throughout the 4-week intervention (p = 0.330 for Week 0 vs. 2; p = 1.00 for Week 2 vs. 4). ConclusionThis study revealed that RWC intervention with 10-N force applied to the wrist in the radioulnar direction could restore impaired neurophysiological and biomechanical functions of the median nerve. The beneficial effects of RWC intervention for the median nerve were in evidence after a relatively short period of two weeks. These functional improvements could be explained by intermittent decompression of the median nerve via RWC-induced augmentation of the carpal arch. The translational potential of this articleBiomechanically manipulating the carpal tunnel by RWC decompresses the median nerve and has the potential to become an alternative treatment for CTS.

The effects of cupping therapy as a new approach in the physiotherapeutic management of carpal tunnel syndrome.

Cupping therapy has been used widely as a safe and common method to tackle soft tissue lesions in most Asian countries, Central Europe, and parts of the United States. In this study, cupping therapy has been used for the treatment of carpal tunnel syndrome (CTS), which is the most common entrapment neuropathy. The aim of this study was to investigate the effect of cupping therapy on the clinical findings of patients with CTS. This is a randomized clinical trial. For this research, a total of 56 hands with CTS were studied, aged 18-60years, and of both genders. The participants were divided into two groups: test and control, regardless of the severity of their CTS. In the control group, 28 were treated with routine physiotherapy (transcutaneous electrical nerve stimulation and ultrasound), and in the test group, the other 28 were treated with routine physiotherapy with cupping therapy. The variables used to determine the effect of cupping were symptom severity scale, functional status scale, distal sensory latency, and distal motor latency. The severity of symptoms and functional status of patients was evaluated with the help of the Boston questionnaire, and the distal latency was evaluated through electromyography. The results of study demonstrated a significant improvement in symptom severity (p=0.006) and also a significant decrease in distal sensory latency (p=0.007) of the test group (routine physiotherapy with cupping) as compared with the control group (routine physiotherapy). The results showed that incorporation of cupping therapy in a routine physical therapy programme can reduce the severity of symptoms and improve the distal sensory disturbance of the median nerve. Therefore, it is suggested that cupping, as a convenient and low-cost method, can be used as a complementary therapy in the treatment of CTS.

Effects of Exercise and Enzyme Therapy in Early Occupational Carpal Tunnel Syndrome: A Preliminary Study.

Objectives Occupational carpal tunnel syndrome (CTS) due to upper extremity overuse has in recent years been the most commonly recognized occupational disease in the Czech Republic and its prevalence has steadily increased. This pilot observation aimed to assess the effects of exercise techniques and oral enzyme therapy in automotive plant workers with early CTS. Patients and Methods The observation comprised automotive plant assembly line workers in whom nerve conduction study revealed incipient CTS. The subjects were divided into three groups: a group practicing exercise techniques (exercising; N=15), a group receiving oral enzyme therapy (N=16), and a group of controls (N=14). Subjects in the control group were only observed without any specific intervention, which is a common procedure in incipient CTS. Throughout 9-week observation, the workers did their jobs. Prior to and after that period, the workers' CTS-related symptoms were ascertained through structured interviews with a physician and the following median nerve parameters were measured: sensory conduction velocity (SCV) and distal motor latency (DML). Results In both the exercise and enzyme therapy groups, statistically significant decreases in the total score for symptoms were achieved (p<0.0001), unlike controls. On final examination, both treated groups demonstrated significantly increased SCV as compared with the initial values (p=0.00013 and p<0.0001, respectively); in controls, the mean SCV did not significantly change. Similarly, a statistically significant shortening of DML was noted in the enzyme therapy group (p=0.008). Conclusion The results showed the efficiency of both exercise and oral enzyme therapy in incipient CTS. These methods may be recommended for preventing more severe forms of CTS.

Relationship of BMI and wrist joint index with carpal tunnel syndrome in manual laborers

Objective: To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index. Methods: From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients. Results: Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) . Conclusion: A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.

Early short-term PXT3003 combinational therapy delays disease onset in a transgenic rat model of Charcot-Marie-Tooth disease 1A (CMT1A).

The most common type of Charcot-Marie-Tooth disease is caused by a duplication of PMP22 leading to dysmyelination, axonal loss and progressive muscle weakness (CMT1A). Currently, no approved therapy is available for CMT1A patients. A novel polytherapeutic proof-of-principle approach using PXT3003, a low-dose combination of baclofen, naltrexone and sorbitol, slowed disease progression after long-term dosing in adult Pmp22 transgenic rats, a known animal model of CMT1A. Here, we report an early postnatal, short-term treatment with PXT3003 in CMT1A rats that delays disease onset into adulthood. CMT1A rats were treated from postnatal day 6 to 18 with PXT3003. Behavioural, electrophysiological, histological and molecular analyses were performed until 12 weeks of age. Daily oral treatment for approximately 2 weeks ameliorated motor deficits of CMT1A rats reaching wildtype levels. Histologically, PXT3003 corrected the disturbed axon calibre distribution with a shift towards large motor axons. Despite dramatic clinical amelioration, only distal motor latencies were improved and correlated with phenotype performance. On the molecular level, PXT3003 reduced Pmp22 mRNA overexpression and improved the misbalanced downstream PI3K-AKT / MEK-ERK signalling pathway. The improved differentiation status of Schwann cells may have enabled better long-term axonal support function. We conclude that short-term treatment with PXT3003 during early development may partially prevent the clinical and molecular manifestations of CMT1A. Since PXT3003 has a strong safety profile and is currently undergoing a phase III trial in CMT1A patients, our results suggest that PXT3003 therapy may be a bona fide translatable therapy option for children and young adolescent patients suffering from CMT1A.

Study of Wrist Ratio and Wrist-to-Palm Index Radio in Individuals Suffering from Carpal Tunnel Syndrome.

Background:Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy, with preponderance in females.Aims and Objective:The aim of the present study was to find out wrist ratio (WR) and wrist/palm ratio (WPR) in clinically diagnosed patients of CTS.Methodology:One hundred individuals (fifty patients of CTS and fifty as control group) aged between 30 and 50 years were recruited for the study. Early confirmation of clinically suspected patients of CTS was done by performing electrodiagnostic tests of median and ulnar nerves. Motor and sensory conduction velocities, distal motor and sensory latencies, and F-wave latencies were performed in the recruited volunteers.Results:The values for mean wrist ratio in control groups were 0.694, 0.703 respectively, and in patients with carpal tunnel syndrome, it was 0.704 and 0.719 respectively in moderate and severe type. The mean wrist to palm ratio (WPR) in control group was 0.371, while in patients with CTS, it was 0.374, 0.382, 0.387, and 0.401 based on progression of severity. Both were statistically significant for the last two groups (wrist to index finger [WIF] >4.4 m/s, moderate, and WIF nonrecordable, severe). Statistically significant (P < 0.001) decrease of motor conduction velocities for median nerve was seen in the CTS group as compared to control group. Statistically significant (P < 0.001) increase in distal motor and sensory latencies was observed for both median and ulnar nerves in CTS group with more increase in distal motor latency than sensory latency. Increase in F-wave latencies of both nerves was seen in CTS group.Conclusion:The study results confirm selective slowing of sensory and motor conduction within wrist-to-palm segment in patients of CTS. Both WR and WPR have a progressive correlation with the severity of CTS, but statistically significant changes were seen in the groups with moderate and severe CTS. Thus, WR/WPR can act as one of the essential parameters in the diagnosis of CTS with moderate-to-severe CTS.

Comparative analysis of nerve conduction study methods in patients with carpal tunnel syndrome

Background: Patients with mild-to-moderate carpal tunnel syndrome (CTS) may not be picked up by routine nerve conduction methods. Hence, this study was performed to identify the most sensitive way to detect mild-to-moderate CTS and to evaluate the sensitivity of different methods for the diagnosis of CTS. Subjects and Methods: We included 60 clinically confirmed CTS patients in our study. We recorded the clinical characteristics and laboratory features in a prescribed proforma. We also included 60 healthy age- and sex-matched asymptomatic individuals as controls in our study. We excluded patients with underlying peripheral neuropathy. We included median distal motor latency, median distal sensory latency, median-versus-ulnar second lumbrical-interossei comparison study, median-versus-ulnar wrist-to-digit four comparison study, median-versus-radial thumb sensory study, median-versus-ulnar motor distal latency difference, and median-versus-ulnar sensory latency difference tests in our study. Results: Of 60 patients, female: male ratio was 2.3:1, and the mean age was 44.28 ± 11.41 years. Mean symptom duration was 0.76 ± 0.03 years. Of 42 females, 38 (90.4%) were engaged in daily household activities. In patients group, median nerve distal motor latency was 5.024 ± 2.05 ms, whereas sensory latency was 3.53 ± 0.75 ms. Sensitivity was the highest in median-versus-ulnar wrist-to-digit four comparison study (90.19%), followed by median-versus-radial thumb sensory study (88.23%), and median-versus-ulnar second lumbrical-interossei comparison study (86.27%). Median distal motor latency test had the lowest sensitivity (72.55%). Conclusions: In patients with mild CTS, electrophysiological tests including median-versus-ulnar wrist-to-digit four comparison study, median-versus-radial thumb sensory study, and median-versus-ulnar second lumbrical-interossei comparison study should be incorporated to improve the sensitivity for the diagnosis of CTS.

Cold effect in median nerve conductions in clinical carpal tunnel syndrome with normal nerve conduction studies

Clinical diagnosis of carpal tunnel syndrome (CTS) is confirmed by nerve conduction studies (NCS). In some cases, NCS may be normal. We aimed to demonstrate changes of distal motor latency (DML) and nerve conduction velocity (NCV) pathology of demyelination in entrapment neuropathy with cold application in case of clinical CTS with normal NCS. This prospective, cross-sectional, randomise, case-control involved 15 patients (25 hands) with clinically definite unilateral or bilateral CTS and normal nerve conduction studies (NCS), and 11 controls (22 hands). Ice pack was applied to median nerve trasse at wirst with monitoring skin temperature. NCS of median nerve were examinated again. Increases of DML, decrease of velocity of median nerve were observed in two groups after post-cooling. The change in NCV was greater than the change in DML. Cold effect was evident in DML and NCV in the patient group. This could be sign of the demyelination pathology. We think that cold application is influential to determine electrophysiologic abnormalities in clinic CTS with normal NCS.

Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis.

Background:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.Objective:To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.Methods:Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.Results:A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.Conclusion:Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

Guillain-Barr\xe9 syndrome following bacterial meningitis: a case report and literature review

BackgroundWe reported a case of an adult that presented Guillain-Barré syndrome (GBS) after bacterial meningitis which was secondary to chronic suppurative otitis media (CSOM). To our knowledge, this is the first case involving an adult presenting with GBS following bacterial meningitis.Case presentationA 46-year man with type 2 diabetes and otitis media (OM) suffered with fever, headache, and vomiting for 6 days. The patient’s neck stiffness was obvious and the Kernig and Brudzinski signs were produced. The result of cerebrospinal fluid (CSF) analysis and cytological examination of the CSF supported the diagnose of bacterial meningitis. On day 17 the patient felt numbness in both hands and feet, which gradually progressed to weakness of the limbs. Bladder dysfunction occurred, which required catheterization. The patient showed a tetraparesis with emphasis on the legs. The deep tendon reflexes of limbs were absent. The patient had peripheral hypalgesia and deep sensory dysfunction. The symptoms were possibly a result of GBS. Nerve conduction study showed that the F wave latency of the upper and lower limbs was prolonged, particularly the lower limbs. 8 days later the repeated nerve conduction study showed a low compound muscle action potential (3.3 mV) with a normal distal motor latency (14.2 ms) and a low motor nerve conduction velocity (34.3 m/s) in the tibial nerve. The patient still required assistance when walking 3 months after onset.ConclusionsGBS following bacterial meningitis is rare and limbs weakness in patients with bacterial meningitis was usually considered because of weakness. This case should serve as a reminder for clinical doctors that when a patient with bacterial meningitis complains about limbs numbness or weakness, GBS should be considered, especially when the patient had diabetes mellitus (DM) history.

A treatable hypertrophic neuropathy

A 42-year-old woman was referred to our institution with 5 years of progressive proximal and distal weakness, distal paresthesia in lower and upper limbs, severe shocking pain radiating from the...

Needle EMG of Thenar Muscles in Less Severe Carpal Tunnel Syndrome.

The value of needle electromyography (EMG) in thenar muscles in patients with less severe carpal tunnel syndrome is controversial. Patients referred for electrodiagnostic testing for carpal tunnel syndrome, in which nerve conduction study demonstrated median sensory nerve conduction study abnormalities and either normal median motor nerve conduction study or only prolonged median motor distal latencies (DLs) (with normal amplitudes) were prospectively studied. Patients with low-median compound muscle action potential amplitudes or any other EMG abnormality were excluded. Needle EMG of a thenar muscle was performed to assess for the presence and grade of fibrillation potentials and motor unit potential abnormalities. The frequency of abnormalities was recorded. Statistical comparison between patients with and without needle EMG abnormalities was performed. One-hundred two patients were included (50 with normal median motor DLs and 52 with abnormal DLs). Minimal or equivocal thenar needle EMG abnormalities were found in 12% of subjects with normal DLs. In patients with abnormal DLs, 32.6% had abnormalities, 15.4% with a mild degree of fibrillation potentials, and 25.0% with mild motor unit potential abnormalities. Patients with abnormal DLs and needle EMG abnormalities had significantly lower compound muscle action potential amplitudes compared to those without needle EMG changes. Patients with carpal tunnel syndrome with no involvement of the median motor nerve conduction study are unlikely to demonstrate prominent abnormalities on needle EMG of thenar muscles, and needle EMG of the thenar muscles is not necessary. However, in patients with carpal tunnel syndrome in which the median motor DL is prolonged but compound muscle action potential amplitudes are absolutely normal, needle EMG should be considered, as it may provide value in indicating some axonal loss despite a normal median compound muscle action potential amplitude.

Ultrasonographic imaging of the effects of continuous, pulsed or sham ultrasound treatments on carpal tunnel syndrome: A randomized controlled study.

Clinical and electrophysiological effects of therapeutic ultrasound (US) were researched in many studies on patients with CTS with conflicting results. To assess the effects of continuous and pulsed US treatments by ultrasonographic imaging in addition to clinical and electrophysilogical parameters in patients with carpal tunnel syndrome (CTS). Fifty-four patients with idiopathic CTS were randomly divided into three groups. All patients used night splints for two weeks. In addition to splint therapy, continuous, pulsed or sham US treatments were applied to patients 10min/session, 5sessions/week for two weeks. Clinical situation (pain, hand function, strength), electrophysiological studies (motor distal latency, MDL, sensorial distal latency, SDL), and ultrasonographic area measurements of median nerve were evaluated. All evaluations were applied at pretreatment (baseline), posttreatment (2nd week) and in the 6th week. Whereas significant differences were detected for clinical, functional and ultrasonographic imaging findings in each group in the 2nd week and 6th week compared to baseline (p< 0.0167 for both), no electrophysiological improvements were detected in pulsed-US (p> 0.0167) and only improvement for SDL in sham US group in the 2nd week evaluation (p< 0.0167). According to the results of this study, continuous, pulsed or sham US treatments combined with splinting had similar effects on clinical, electrophysiological and ultrasonographic imaging improvements. Additionally, ultrasonographic imaging may be a preferable objective evaluation tool to prove the early posttreatment clinical improvements when electrophysiological changes could not be detected.

Very Early Neurophysiological Study in Guillain-Barre Syndrome

Purpose: The diagnosis of Guillain-Barre syndrome (GBS) in the very early stage may be challenging. Our aim was to report the neurophysiological abnormalities in GBS within 4 days of clinical onset. We expected that GBS will be diagnosed by the assistance of neurophysiological study in the very early stage. Methods: We prospectively recruited patients with a diagnosis of GBS discharged from First Affiliated Hospital of Xi’an Jiaotong University and Xi Jing Hospital. Patients were classified into 3 groups according to the onset of symptoms to electromyography examination interval (OEI). The neurophysiological findings were carried out using standard procedures. All patients were examined by the same experienced neurophysiologist. Results: There were not significant group differences in abnormal rate, distal motor latency (DML), motor nerve conduction velocity (MNCV), F response (FR), compound muscle action potential (CMAP), conduction block (CB), sensory nerve action potential (SNAP), and sensory nerve conduction velocity among OEI ≤4 days, 4< OEI ≤10 days, and OEI > 10 days groups. Motor nerves were more affected than sensory nerves in neurophysiological presentation in very early stage patients. The difference of motor nerves and sensory nerves was statistically significant in lower limbs, but was not in upper limbs. In motor nerve conduction studies, the abnormal rate of DML, MNCV, FR, CB was more common seen in ulnar and peroneal nerve than median and tibial nerve, the abnormal rate of CMAP was the same in ulnar, median, peroneal and tibial nerve. In sensory nerve conduction studies, the abnormal rate of ulnar nerve and median nerve was higher than the superficial peroneal nerve and sural nerve. The OEI was not correlated with the SNAP decrease rate of median (r = 0.10, p = 0.23) and ulnar (r = 0.26, p = 0.06) but was statistically correlated with sural SNAP decrease rate (r = 0.29, p = 0.04). The sural-sparing pattern phenomenon was the most commonly discovered phenomenon in very early stage patients (OEI ≤4 days), followed by patients with 4< OEI ≤10 days, ultimately found in patients with OEI > 10 days. Conclusions: We suggest performing neurophysiological examination as soon as possible for suspected GBS patients, particularly focusing on multi-spots inspection of ulnar and peroneal nerves, and paying close attention to sural-sparing patterns.

Comparison between the Effects of Insulin versus Corticosteroid Local Injections in Diabetic Patients with Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination through its role as neurotrophic factor. Aim of the Work: was to compare the short-term effects of insulin and corticosteroid local injections in the treatment of diabetic patients with carpal tunnel syndrome. Patients and Methods: Fifty diabetic patients with clinical and electrophysiological evidence of mild to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified into two equal groups:- Group (1): Twenty five patients have received local insulin injection of 10 IU Neutral Protamine Hagedorn (NPH) {Insulinagypt N} into the affected carpal tunnel at the first visit and the same dose of insulin after 2 weeks. Group (2): twenty five patients have received a single dose of 40 mg triamcinolone acetonide {Epirelefan} local injection into the affected carpal tunnel. Nerve conduction study (NCS), Boston Carpal Tunnel Questionnaire (BCTQ) and clinical evaluation were carried out for both groups at baseline and four weeks after second dose of insulin injection and one month after steroid injection. Results: In steroid group, significant improvement in nerve conduction study as regard distal sensory latency and sensory conduction velocity without significant improvement in distal motor latency and motor conduction velocity and significant improvement in (BCTQ). In insulin group, a more significant improvement in all parameters of nerve conduction study and also in (BCTQ) was observed with insulin injection than steroid done. Also, there were significant differences between results of both groups for insulin injection group. Conclusion: Local insulin injection is an effective treatment for restoring median nerve function in diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement in NCS and BCTQ.

Ring finger sensorial conduction studies in grading carpal tunnel syndrome: Part II.

Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS. To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings). The patients with bilateral moderate grade of CTS in whom one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings. A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 ± 0.49 msec versus 3.44 ± 0.39 msec; p< 0.001), sensory conduction velocity (SCV) was slower (33.7 ± 4.3 m/sec versus 40.2 ± 3.0 m/sec; p< 0.001), SNAP amplitude was smaller (10.3 ± 3.3 μV versus 19.1 ± 7.7 μV; p< 0.001), distal motor latency was longer (5.69 ± 0.60 msec versus 4.63 ± 0.32 msec; p< 0.001), and minimum F wave latency was longer (29.3 ± 1.7 msec versus 26.8 ± 1.4 msec; p< 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients. Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not.

A meta-analysis of surgical decompression in the treatment of diabetic peripheral neuropathy.

Background:Over the last decade, surgical decompression procedures have been commonly used in the treatment of diabetic peripheral neuropathy (DPN). However, the effectiveness of them remains to be proved.Methods:A comprehensive literature search of databases including PubMed–Medline, Ovid–Embase, and Cochrane Library was performed to collect the related literatures. The Medical Subject Headings used were “diabetic neuropathy,” “surgical decompression,” and “outcomes.” The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Analyses were performed with Review Manager (Version 5.3, The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, 2014).Results:A total of 12 literatures (including 8 prospective and 4 retrospective) encompassing 1825 patients with DPN were included in the final analysis. Only 1 literature was identified as a randomized-controlled trial. The remaining 11 literatures were observational studies; 7 of them were classified as upper-extremity nerve decompression group and 4 of them were classified as lower-extremity nerve decompression group. Meta-analysis shows that Boston questionnaire symptom severity and functional status of upper extremities, and distal motor latency and sensory conduction velocity of median nerve of DPN patients are significantly improved after carpal tunnel release. Besides, visual analog scale and 2-point discrimination are considered clinically and statistically significant in lower extremities after operation.Conclusions:The findings from our review have shown the efficacy of surgical decompression procedures in relieving the neurologic symptoms and restoring the sensory deficits in DPN patients. As there are few high-quality randomized-controlled trials or well-designed prospective studies, more data are needed to elucidate the role of surgical procedures for DPN treatment in the future.

EFFECT OF NERVE CONDUCTION STUDIES IN HYPOTHYROIDISM - AN OBSERVATIONAL STUDY

Objective: This observational study was conducted during the year 2016–2017 to assess the electrodiagnostic evidence of peripheral nerve dysfunction among newly diagnosed hypothyroid patients attending a tertiary care hospital and to find the effect of hormonal treatment after short duration. Methods: An observational study was conducted in 25 newly diagnosed hypothyroid patients with the age group of 20–60 were included. After obtaining informed consent, all participants were examined with electrodiagnostic workup performed at the initial time of diagnosis and after short duration for median and ulnar nerves of upper limb by (NeuroStim -NS2, EMG/EP/NCV, and MEDICAID SYSTEMS). Electrophysiological parameters such as distal motor latency, amplitude, and conduction velocity were evaluated. Results: The mean age of study population was 42.7±12.1 (23–61) years. The mean values of nerve conduction velocity of motor and sensory median before the treatment were 42.8±15.7 and 40.13±4.19 and motor and sensory ulnar before treatment were 41.18±22.4 and 39.46±11.9. The mean values of nerve conduction velocity of motor and sensory median after treatment were 53.35±4.7 and 57.3±5.6 and motor and sensory ulnar After treatment were 54.56±2.99 and 54.09±12.17. The result of the study. Shows that there were reduction of conduction velocity before treatment and statistically significant after 3 months duration of treatment with appropriate doses. Conclusion: After treatment, total triiodothyronine, total thyroxin, free triiodothyronine, free thyroxin, thyroid-stimulating hormone, and median and ulnar nerve motor and sensory functions were normal with appropriate treatment. The involvement of sensory fibers is more than that of the motor fibers.

Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome: Clinical and electrophysiological study

Aim of the workTo evaluate the effectiveness of platelet rich plasma (PRP) injections in carpal tunnel syndrome (CTS) in comparison to corticosteroids clinically and electrophysiologically. Patients and methodsThe study included 36 patients with idiopathic mild to moderate CTS divided into two groups: group I received PRP and group II received corticosteroid injections into the carpal tunnel. Nerve conduction studies were carried out, visual analogue scale (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) were administered to patients of both groups immediately before treatment, one and three months after treatment. ResultsThe mean age (36.6 ± 8.8 years vs 38.5 ± 8 years), disease durations (19 ± 11 months vs 14 ± 9 months) and genders were comparable. PRP injection was significantly better than corticosteroids injection as regard VAS, symptom severity scale (SSS), functional status scale (FSS) of BCTQ as well as the distal sensory latency after one and three months of injection. There was no significant difference between both groups in other assessed parameters including distal motor latency, amplitude of compound muscle action potential, motor and sensory conduction velocities of the median nerve. There was a significant correlation between VAS and distal sensory and motor latency of the median nerve in both groups before, 1 and 3 months after injection. ConclusionsSingle local injection of the PRP proved to be an effective treatment choice for CTS. PRP therapy seemed to be superior to steroid, showing more improvement clinically as regard the pain and function and electrophysiologically as regard the distal sensory latency throughout the follow-up period.