Nerve Conduction Study Findings Research Articles

Comparing FGFR-3 and TS-HDS Seropositive Small Fiber Neuropathy: Unique Patient Features, Symptoms, Laboratory, and Nerve Conduction Study Findings.

Small fiber neuropathy presents a significant diagnostic and therapeutic challenge. To solve this challenge, efforts have been made to identify autoantibodies associated with this condition. Previous literature has often considered tri-sulfated heparin disaccharide (TS-HDS) and fibroblast growth factor receptor 3 (FGFR3) as a singular seropositive group and/or focused primarily on symptomatic associations. One hundred seventy-two small fiber neuropathy patients with a Washington University Sensory Neuropathy panel were selected for TS-HDS seropositivity, FGFR-3 seropositivity, and seronegative controls. Data were collected to on the demographic, symptomatic, and laboratory profiles of each subgroup. Percent female (P = 0.0043), frequency of neuropathic pain symptoms (P = 0.0074), and erythrocyte sedimentation rate (P = 0.0293), vitamin D (P < 0.0001), and vitamin B12 (P = 0.0033) differed between the groups. Skin biopsy was more frequently normal within both the FGFR-3 and the TS-HDS cohort (P = 0.0253). TS-HDS and FGFR-3 display a distinct phenotype from both controls and one another. Immunoglobulin M (IgM) against FGFR-3 and IgM against TS-HDS may be individually valuable markers for the development of distinct clinical phenotypes.

Establishing the diagnosis of radial tunnel syndrome: a systematic review of published clinical series.

Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction study (NCS) findings. The purpose of this study was to identify the methods used to diagnose RTS in the literature. We queried PubMed, Embase, Web of Science, and Cochrane databases per PRISMA guidelines. Extracted data included article and patient characteristics, diagnostic assessments utilized and their respective findings, and treatments. Objective data were summarized descriptively. The relationship between reported diagnostic findings (i.e., physical exam and diagnostic tests) and treatments was assessed via a descriptive synthesis. Our review included 13 studies and 391 upper extremities. All studies utilized physical exam in diagnosing RTS; most commonly, patients had tenderness over the radial tunnel (381/391, 97%). Preoperative EMG/NCS was reported by 11/13 studies, with abnormal findings in 8.9% (29/327) of upper extremities. Steroid and/or lidocaine injection for presumed lateral epicondylitis was reported by 9/13 studies (46/295 upper extremities, 16%), with RTS being diagnosed after patients received little to no relief. It was also common to inject the radial tunnel to make the diagnosis (218/295, 74%). The most common reported intraoperative finding was narrowing of the PIN (38/137, 28%). The intraoperative compressive site most commonly reported was the arcade of Frohse (142/306, 46%). There is substantial heterogeneity in modalities used to diagnose RTS and the reported definition of RTS. This, in conjunction with many patients having concomitant lateral epicondylitis, makes it difficult to compare treatment outcomes for RTS. Level III. Systematic review of retrospective and prospective cohort studies.

Evaluation of smartphone-assisted infrared thermal imaging efficiency in carpal tunnel syndrome

BackgroundThermography is an industrial method for surface temperature measurements, and although it is medically safe and non-invasive, its place in daily practice has been limited. With the development of technology, thermal cameras have become more accessible and practical via adaptation to mobile phones. Among patients evaluated with bilateral nerve conduction studies (NCS) for suspected carpal tunnel syndrome (CTS), those with electrophysiological findings consistent with mild-to-moderate unilateral CTS were accepted for this prospective study. The hands with positive NCS findings were the study group, and the unaffected hands were the control group. The images were evaluated with the thermal analysis software (FLIR Tools ver. 6.4, Windows 10) and compared with NCS for statistical significance. In addition, thermal images were examined by three orthopaedic surgeons, and interobserver correlation was analyzed. Our study aims to evaluate the mobile phone-assisted thermal camera (FLIR One Pro, FLIR Systems, Wilsonville, OR, USA) as a suitable tool to diagnose CTS.Results48 patients, 35 women and 13 men were included in the study. Bilaterally, a total of 96 hands were evaluated. 18 patients had mild, and 30 patients had moderate NCS stages unilaterally. The mean temperature difference at the region of interest in the palm, first and third fingers were statistically significant between the study and control groups (p < 0.05). NCS values and stages were correlated with the temperature difference in the third finger (p = 0.002). The inter-observer reliability was high (ICC = 0.858) while detecting temperature differences.ConclusionsSince smartphone-assisted thermal cameras are easy and convenient to use, we think they are helpful in the daily practice of diagnosing mild-to-moderate carpal tunnel syndrome.

Novel ABCD1 variant causes phenotype of adrenomyeloneuropathy with cerebral involvement in Ukrainian siblings: first adult hematopoietic stem cell transplantation for ALD in Ukraine: a case report

BackgroundThis article presents a case study of two white male siblings of 24 and 31 years of age of self-reported Ukrainian ethnicity diagnosed with adrenomyeloneuropathy (AMN) associated with a novel splice site mutation in the ABCD1 gene. AMN represents a form of X-linked adrenoleukodystrophy (X-ALD) characterized by demyelination of the spinal cord and peripheral nerves. The case also presents the first adult haematopoietic stem cell transplant (HSCT) for adrenomyeloneuropathy in Ukraine. The rarity of this mutation and its cerebral involvement and the treatment make this case noteworthy and underscore the significance of reporting it to contribute to the existing medical knowledge.Case presentationThe patients of 24 and 31 years initially exhibited progressive gait disturbance, lower extremity pain, and urinary incontinence, with the older sibling experiencing more advanced symptoms of speech, hearing, and vision disturbances. A comprehensive genetic analysis identified an unreported splice site mutation in exon 3 of the ABCD1 gene, leading to the manifestation of AMN. The inheritance pattern was consistent with X-linked recessive transmission. The article also outlines the clinical features, magnetic resonance imaging (MRI), and nerve conduction study (NCS) findings. Moreover, it discusses the genetic profile of the affected individuals and female carriers within the family. The younger sibling underwent HSCT, which was complicated by mediastinal lymph node and lung tuberculosis, adding to the complexity of managing adult ALD patients.ConclusionsThis report emphasizes the importance of genetic testing in diagnosing and comprehending the underlying mechanisms of rare genetic disorders, such as AMN with cerebral involvement. The identification of a novel splice site mutation expands our understanding of the genetic landscape of this condition. Additionally, the challenges and complications encountered during the hematopoietic stem cell transplant procedure underscore the need for cautious consideration and personalized approaches in adult ALD patients.

Therapeutic Outcomes and Electrophysiological Biomarkers in Anti-Myelin-Associated Glycoprotein Neuropathy: A Multicenter Cohort Study in South Korea.

Unlike other immune-mediated neuropathies, anti-myelin-associated glycoprotein (MAG) neuropathy is often refractory to immunotherapy. It is necessary to compare the relative efficacies of various immunotherapies and develop objective biomarkers in order to optimize its clinical management. This study recruited 91 patients with high anti-MAG antibody titers from 7 tertiary hospitals in South Korea. We analyzed the baseline characteristics, therapeutic outcomes, and nerve conduction study (NCS) findings of 68 patients and excluded 23 false positive cases. The rate of positive responses to treatment was highest using zanubrutinib (50%) and rituximab (36.4%), followed by corticosteroids (16.7%), immunosuppressants (9.5%), intravenous immunoglobulin (5%), and plasma exchange (0%). Disability and weakness were significantly associated with multiple NCS parameters at the time of diagnosis, especially distal compound muscle action potential (CMAP) amplitudes. Moreover, the longitudinal trajectory of the average CMAP amplitudes paralleled the clinical courses, with a 16.2 percentile decrease as an optimal cutoff for predicting a clinical exacerbation (area under the receiver operating characteristic curve=0.792). Our study supports the use of NCS as an objective marker for estimating disease burden and tracking clinical changes in patients with anti-MAG neuropathy. We have described the beneficial effects of rituximab and a new drug, zanubrutinib, compared with conventional immunotherapies.

Chapter 3 - The role of electrodiagnosis in focal neuropathies

Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.

Nerve conduction study findings in females with systemic lupus erythematosus

Aim of the workTo investigate the frequency, characteristics, and associated factors of systemic lupus erythematosus-related peripheral neuropathy (SLE-PN) using nerve conduction study (NCS). Patients and methodsA retrospective chart review was conducted at the Rheumatology clinics of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from 2016 to 2020. Eligibility included systemic lupus erythematosus (SLE) diagnosed patients with at least one NCS result in their clinical records. Demographic, clinical, and biological characteristics were collected. ResultsAmong 101 female SLE patients, abnormal NCS findings were observed in 11 (10.9%) patients. Of those with abnormal NCS, 27.3% showed mixed axonal and demyelinated motor neuropathy, 18.2% had sensory-motor axonal neuropathy, another 18.2% presented with axonal left common peroneal neuropathy, and the same percentage was observed for axonal sensory neuropathy. Comparisons between abnormal and normal NCS groups in a study population revealed that the abnormal NCS group had significantly higher proportions of non-Saudi nationality, lupus nephritis, seizures, and high SLICC DI. Furthermore, this group was associated with higher ANA titers and exhibited a non-significant trend towards increased positive anti-DNA frequency. Multivariate analysis identified non-Saudi nationality and the presence of end-organ damage as two significant predictors of SLE-related PN. ConclusionPeripheral neuropathy in SLE patients in Saudi Arabia is not uncommon, specifically those with heightened disease activity, organ damage, or disadvantaged socioeconomic backgrounds. Predominantly, the condition presents as axonopathy impacting sensory nerves, with possible motor involvement. The critical role of electrophysiological studies in early detection and improved patient management is high lightened.

Changes in electrophysiological findings of spinal muscular atrophy type I after the administration of nusinersen and onasemnogene abeparvovec: two case reports

BackgroundRecently, there have been significant advances in the treatment of spinal muscular atrophy (SMA). Although clinical improvement in patients with SMA after the treatment has been reported, changes in electrophysiological findings, especially needle electromyography (EMG), have rarely been reported. Herein, we report the posttreatment changes in EMG and nerve conduction study findings over time in two patients with SMA type I.Case presentationPatient 1: A 2.5-year-old girl was diagnosed with SMA type I at 1 month of age. She received nusinersen four times and onasemnogene abeparvovec (OA) was administered at 6 months of age. The compound muscle action potential (CMAP) amplitudes of the median and tibial nerves increased over time. The needle EMG after the treatment showed high-amplitude motor unit potentials (MUPs) suggestive of reinnervation during voluntary contraction, which were not seen before the treatment. However, fibrillation potentials at rest were still seen after the treatment. Patient 2: A 2-year-old girl was diagnosed with SMA type I at 6 months of age. She had received nusinersen two times and OA was administered at 7 months of age. The CMAP amplitudes and the MUPs presented similar changes as presented in Case 1.ConclusionThis is the first report on the changes in needle EMG findings after treatment in patients with SMA type I. These findings suggested that peripheral nerve reinnervation occurred after the treatment, although active denervation was still present. The accumulation of these findings will be important for evaluating the effectiveness of treatment for SMA in the future.

Recurrent Guillain-Barré Syndrome Associated with the Second Episode of Campylobacter jejuni Infection.

Guillain-Barré syndrome (GBS) cases are generally monophasic, and recurrence is rare. However, the pathogenesis and pathophysiology of recurrent GBS remain to be fully elucidated. There are few detailed reports of patients who have been infected twice with Campylobacter jejuni and have developed GBS twice. We herein report a case of recurrent GBS in a 21-year-old man with a history of GBS caused by C. jejuni infection at 19 years old. Although our patient was reinfected with C. jejuni, several different anti-ganglioside antibodies were identified, and the clinical manifestations were more severe than those in the first GBS episode. We compared the anti-ganglioside antibodies and nerve conduction studies findings between the two GBS episodes. This case suggested that different antibodies are involved and produce different symptoms even when C. jejuni infection is the trigger in recurrent episodes.

Homozygous Mutations in GDAP1 and MFN2 Genes Resulted in Autosomal Recessive Forms of Charcot-Marie-Tooth Disease in Consanguineous Pakistani Families.

Charcot-Marie-Tooth disease (CMT) is a heritable neurodegenerative disease of peripheral nervous system diseases in which more than 100 genes and their mutations are associated. Two consanguineous families Dera Ghazi Khan (PAK-CMT1-DG KHAN) and Layyah (PAK-CMT2-LAYYAH) with multiple CMT-affected subjects were enrolled from Punjab province in Pakistan. Basic epidemiological data were collected for the subjects. Nerve conduction study (NCS) and electromyography (EMG) were performed for the patients. Whole-exome sequencing (WES) followed by Sanger sequencing was applied to report the genetic basic of CMT. The NCS findings revealed that sensory and motor nerve conduction velocities for both families were <38 m/s. EMG presented denervation, neuropathic motor unit potential, and reduced interference pattern of peripheral nerves. WES identified that a novel nonsense mutation (c. 226 G>T) in GADP1 gene and a previously known missense mutation in MFN2 gene (c. 334 G>A) cause CMT4A (Charcot-Marie-Tooth disease type 4A) in the PAK-CMT1-DG KHAN family and CMT2A (Charcot-Marie-Tooth disease type 2A) in the PAK-CMT2-LAYYAH family, respectively. Mutations followed Mendelian pattern with autosomal recessive mode of inheritance. Multiple sequence alignment by Clustal Omega indicated that mutation-containing domain in both genes is highly conserved, and in situ analysis revealed that both mutations are likely to be pathogenic. We reported that a novel nonsense mutation and a previously known missense mutation in GAPD1 gene and MFN2 gene, respectively, cause CMT in consanguineous Pakistani families.

Afterdischarges in myotonic dystrophy type 1.

Electrodiagnostic testing is an important screening test for myotonic dystrophy type 1 (DM1). Although myotonic discharges are observed on electromyography in cases of DM1, it is difficult to distinguish DM1 from other myotonic disorders clinically. In the present study, afterdischarges, another type of pathological potential revealed by electrodiagnostic testing, were analyzed, and their role in distinguishing DM1 from other myotonic disorders was explored. Data from 33 patients with myotonic discharges on electromyography were analyzed retrospectively. According to gene testing, the patients were divided into DM1 (n = 20) and non-DM1 myotonia (n = 13) groups. Afterdischarges were investigated by retrospectively evaluating the electrodiagnostic findings of motor nerve conduction studies, F-waves, and repetitive nerve stimulations. Afterdischarges were observed in 17 of the 20 patients with DM1, with an occurrence rate of approximately 85%. However, afterdischarges were absent in all patients with non-DM1 myotonia. There were significant differences in the occurrence rate between the two groups (P < 0.01). Afterdischarges may serve as a suggestive role in clinical diagnosis of DM1. The discovery that DM1 can present with afterdischarges may pave a new way to study the pathogenesis of DM1.

Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy.

Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

Comparison of ulnar, median, and sural sensory nerve conduction studies between demyelinating and axonal forms of Guillain-Barré Syndrome

Background: Guillain-Barré syndrome (GBS) is an important neurological disease that can cause disability. Axonal GBS and acute inflammatory demyelinating polyradiculoneuropathy (AIDP) are two important subgroups.&#x0D; Methods: Patients with clinical and electrodiagnostic features compatible with GBS were included in this retrospective study. The patients were divided into two groups neurophysiologically as Axonal GBS and AIDP. Medical research council (MRC) scores of the patients' muscles, median / ulnar / posterior tibial / peroneal / sural nerve conduction study findings were included in the analyses. Sural sparing pattern was considered as the absence of median/ulnar compound nerve action potential (CNAP) and present sural nerve CNAP (SS-M/SS-U).&#x0D; Results: Twelve AIDP and 10 Axonal GBS patients were included in the study. MRC scores were not different between the two groups (p=0.895). CNAPs of the right median and ulnar nerves were smaller in AIDP patients than in Axonal GBS patients (p

ANXIETY AND DEPRESSION IN TYPE 2 DIABETES MELLITUS: A STUDY INCLUDING NERVE CONDUCTION STUDY AND NEUROPATHIC PAIN

Objective: It is known that neuropathy, neuropathic pain and psychiatric disorders are associated with diabetes mellitus (DM). It was aimed to find out whether there is a relationship between nerve conduction study findings, neuropathic pain, depression and anxiety.&#x0D; &#x0D; Material and Methods: Type 2 DM patients that applied to our clinical neurophysiology laboratory between September 2021 and January 2022 were included in this study. Median, ulnar, sural, peroneal and posterior tibial nerve conduction studies were performed on the patients. Douleur Neuropathique 4 Questions (DN4) was applied to the patients to evaluate neuropathic pain. Hospital Anxiety and Depression Scale (HADS) was applied to the patients. Anxiety (HADS-A) and depression (HADS-S) scores, which are the two subsections of HADS, were included in the analysis.&#x0D; &#x0D; Results: Forty DM patients (27 males, 13 females) were included in the study. The mean age of the patients was 57.9±12.7 (min-max 23-83) years. The number of patients with neuropathic pain, polyneuropathy according to neurophysiological findings, abnormal HADS-A and HADS-D scores were 32 (80%), 23 (58%), 17 (43%), and 24 (60%), respectively. Neuropathic pain was present in 22 (96%) and 10 (59%) of the patients with and without polyneuropathy, respectively. Neuropathic pain was found in 22 (92%) patients with depression and 16 (63%) patients without depression (p=0.046). Among patients with neuropathic pain, compound nerve action potential amplitudes of median, ulnar and sural nerves were lower than those without neuropathic pain (p=0.011, p=0.027, p

Clinical Features and Differences of Miller Fisher Syndrome in Southern China: Retrospective Analysis of 72 Patients in 13 Provinces of Southern China.

We aimed to determine the clinical features of Miller Fisher syndrome (MFS) in southern China and compare them with those presenting in other countries. We collected the medical records of patients diagnosed with MFS during 2013-2016. We analyzed the age, sex, onset season, precursor events, clinical symptoms and signs, findings of nerve conduction studies (NCS), cerebrospinal fluid (CSF), therapeutic remedies, nadir time, and length of hospital stay of patients with MFS in southern China. We concurrently compared the differences between urban and rural areas and between patients with incomplete ophthalmoplegia (IO) and complete ophthalmoplegia (CO). The study enrolled 72 patients: 36 from rural areas and 36 from urban areas, and 50 males and 22 females. The mean age at onset was 47.72 years, and 30 (41.7%) and 21 (29.2%) patients developed MFS in spring and winter, respectively. The typical triad of ophthalmoplegia, ataxia, and areflexia was observed in 50 (69.4%) patients. A history of upper respiratory tract infection 1 week before onset was found in 52.8% of the patients, while 5.6% experienced gastrointestinal infections and 48 (73.8%) exhibited albuminocytological dissociation in the CSF study. Only 26 (36.1%) patients presented abnormalities in NCS. Moreover, restricted outward eyeball movement presented in 83.5% of the patients with classic MFS and acute ophthalmoplegia, and bilateral symmetrical ophthalmoplegia presented in 64.2%. With the exception of the higher proportion of NCS abnormalities in urban areas (47.2% vs. 25.0%), urban and rural differences were insignificant regarding sex ratio, age at onset, high-incidence season, precursor events, disease characteristics, and albuminocytological dissociation in the CSF. Furthermore, patients with CO were older than those with IO (64.53±7.69 vs. 43.19±14.40 years [mean±standard deviation], p<0.001). The patients with MFS were mostly male and middle-aged, and most presented in winter and (especially) spring. More than half of the patients had clear precursor events, most of which were classic MFS with the typical triad. More than 70% of the patients presented albuminocytological dissociation in the CSF. NCS abnormalities were uncommon in MFS. The age at onset was lower in patients with IO than in patients with CO; bilateral symmetrical extraocular muscle paralysis was the most common symptom, and the external rectus was the most frequently involved muscle.

Study of clinical patterns of diabetic neuropathy in patients of type 2 diabetes mellitus in a tertiary care hospital

Introduction:Diabetic neuropathy manifests with sensory, motor, and autonomic functions. The symptoms ofneuropathy are highly unpleasant, affecting the quality of life. The diagnosis of diabetic neuropathy is often delayed,so there remains a substantial need for its early diagnosis for timely management. Objective:The aim of this study was to describe patterns of diabetic neuropathy, study nerve conduction study(NCS) findings in diabetic patients with symptoms of neuropathy, and find the relationship between clinical patternsof neuropathy and worsening glycemic control. Methods:This is a hospital-based cross-sectional study of 104 known cases of diabetes mellitus patients withsymptoms of neuropathy visiting Sree Gokulam Medical College and undergoing NCS as a part of the investigation.The Fisher’s exact test was used accordingly. Results:The mean age of the study population was 63.1±6.1 years. The mean body mass index was27.1±3.2 kg/m2. Overall, 97.1% patients had HbA1c above 7%. Approximately 54.8% of patients presented withtingling sensation, 42.3% with burning sensation, 31.7% complained of pain, 16.3% presented with numbness,51% patients had abnormal NCS findings in sural and peroneal nerves, 54.8% in superficial peroneal nerve,46.2% in tibial nerve, and 31.7% patients had abnormal NCS findings in median nerve. Based on the patterns ofneuropathy, 68.2% had sensory motor polyneuropathy, 5.8% had carpal tunnel syndrome, 20.2% had small fiberneuropathy (normal NCS), 2.9% had tibial mononeuropathy, and 2.9% had ulnar mononeuropathy. No associationwas found between the clinical patterns of neuropathy and glycemic control (HbA1c). Conclusion:The most common pattern of neuropathy was sensory motor polyneuropathy. The common nervesinvolved were sural, peroneal, and superficial peroneal nerve, and the most common presenting complaintwas tingling sensation, followed by burning sensation. There was no relationship between clinical patterns ofneuropathy and worsening glycemic control.

Chapter 10 - Neuromuscular electrodiagnosis

The electrodiagnostic (EDX) study is an extension of the clinical examination, which means that the clinical features dictate the initial nerve conduction studies (NCS) performed. However, once the EDX study is started, it continues in an independent manner, meaning that the initial NCS findings dictate the subsequent studies performed. Because competent EDX study performance requires considerable knowledge (and special training), it is not possible to convey all of the basic and advanced concepts in a single chapter. Nonetheless, the most important concepts are easily conveyed by a discussion limited to EDX-pertinent anatomical, physiological, pathological, pathophysiological, and basic electrical concepts. The focus of this chapter will be on the standard NCS and needle EMG measurements made during EDX studies and their significance with regard to lesion localization and characterization. Because the most challenging portion of EDX study is motor unit action potential analysis, this topic is more extensively reviewed. The utility of the sensory NCS for identifying focal axon loss, the utility of the motor NCS for screening long nerve segments for focal demyelination and for determining lesion severity, and the utility of the needle EMG for confirming the NCS findings, better defining lesion localization, and identifying the temporal features (e.g., chronicity) and rate of progression of the lesion are also reviewed.

Nerve Conduction Studies in post COVID-19 Patients Without Neuropathic Complaints

Objective: Neurological diseases related to the coronavirus disease (COVID-19) are known. In this study, it was aimed to find out whether the peripheral nervous system is affected in patients with a history of COVID-19 (post COVID-19) without neurological findings.&#x0D; Methods: Patients with a positive history of the nose swap polymerase chain reaction test and clinical signs of COVID-19 (post COVID-19 patients), and controls who have not had COVID-19 were included in this retrospective cohort study. Neurological examinations of post-COVID-19 patients and controls should have been normal. Nerve conduction studies including median, ulnar, posterior tibial and peroneal nerves were applied to all participants.&#x0D; Results: Thirty controls (14 males, 16 females) and 32 post COVID-19 patients (19 males, 13 females) were included. The mean ages of postCOVID-19 patients and controls were 49.7±10.9 and 38.0±7.6 years, respectively. Age and gender were not different between post COVID-19 patients and controls (p=0.122, p=0.316122). Nerve conduction study findings of median, ulnar, posterior tibial and sural nerves were not different between the two groups (p&gt;0.05).&#x0D; Conclusion: This study may show that routine nerve conduction studies are not subclinically affected in post COVID-19 patients without neurological findings.

Influence of ergonomic factors on peripheral neuropathy under HAV exposure.

Hand-arm vibration (HAV) is a risk factor for carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE). It is unclear how ergonomic factors influence the relationship between HAV exposure and CTS and UNE. We aimed to assess the relationship between cumulative HAV exposure and CTS and UNE in workers exposed to HAV from two tools with different ergonomic profiles. We performed nerve conduction studies (NCSs) of the sensory and motor median and ulnar nerves and recorded symptoms indicating CTS and UNE in workers exposed to HAV from impact wrenches or from rock drills. Exposure was measured as cumulative lifetime exposure. We used linear regression adjusted for age and body mass index to assess linear relationships. Sixty-five workers participated (33 rock drill and 32 impact wrench operators). We found inverse linear associations between cumulative HAV exposure and median nerve sensory conduction velocity in impact wrench operators and ulnar nerve motor conduction velocity in rock drill operators (beta of 0.63 and 0.75). Based on NCS findings and symptoms, seven impact wrench operators had CTS and one UNE, and four rock drill operators had CTS and six UNE. Our findings indicate that ergonomic factors influence the development of CTS and UNE under HAV exposure. The ergonomic profile seems to influence which type of neuropathy workers exposed to HAV will develop. Design of occupational exposure guidelines and future studies should be based on ergonomic profile and exposure characteristics for different tools and not merely HAV.

National trends in the initial diagnosis and management of carpal tunnel syndrome: results from the ELECTS (ELEctrophysiology in Carpal Tunnel Syndrome) study.

The optimal role of nerve conduction studies (NCS) in management of carpal tunnel syndrome (CTS) is unclear, with no standardised guidance. This study aimed to identify variation in practice in the initial diagnosis of patients with suspected CTS, alongside evaluating how NCS findings influence clinical decision making. A national multicentre collaborative survey was conducted in 2021. All centres providing surgery for CTS were invited to participate, primarily via social media. All middle-senior grade orthopaedic/plastic surgeons and advanced care practitioners that regularly manage new referrals for suspected CTS were eligible to respond. Local representatives at each participating site submitted their responses to a central team who collated and analysed the results. A total of 137 healthcare professionals responded from 18 UK NHS Trusts. Of these 137, 124 (91%) reported not employing any validated clinical questionnaires in their routine practice, preferring to rely on clinical diagnosis and/or NCS if available, whereas 84 (61%) utilised NCS to aid diagnosis, with significant differences among professionals with differing experience (p < 0.01). The most common methods for determining the severity of CTS were history, examination and NCS. In symptomatic CTS with confirmatory NCS, over 50% of clinicians would choose surgical decompression as their first-line intervention. In cases of either negative NCS or atypical presentation, 37% and 51%, respectively, would consider conservative management (e.g. splintage) or steroid injection first line. With growing waiting lists for NCS and surgery, national consensus guidelines should be developed to support decision making, while maximising efficient utilisation of increasingly constrained resources.