Test For Diagnosis Of Carpal Tunnel Syndrome Research Articles

Study of carpal tunnel syndrome in diabetic polyneuropathy with comparison of inching method and second lumbrical-interossei test.

Background: Since diabetic generalized neuropathy affects peripheral nerves, the diagnosis of carpal tunnel syndrome (CTS) with conventional electrodiagnostic techniques (EDX) [onset latency of median sensory nerve action potential (SNAP) or distal latency of median compound muscle action potential (CMAP)] is controversial. The aim of this study is to investigate the diagnostic values of two other techniques including inching method and second lumbrical-interossei test in patients with diabetic polyneuropathy (DPN) as well as signs or symptoms of CTS. Methods: Fifteen patients (30 hands) with definite diagnosis of generalized peripheral neuropathy secondary to diabetes who developed signs and symptoms of CTS were participated. For diagnosis of CTS, sensory and motor median distal latencies were considered by nerve conduction study. In the next step, inching method and second lumbrical-interossei test were performed for all hands. Finally, sensitivity and specificity of two tests were calculated. Results: Mean age of participants was 53.87 ± 11.53 years. The sensitivity and specificity of inching method in this study were 95.65% and 85.71%, respectively, and for the second lumbrical-interossei test, they were 73.91% and 71.42%, respectively. Conclusion: Inching method was more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS among patients with diabetic peripheral neuropathy. Moreover, the sensitivity of inching method was greater than specificity.

Study of carpal tunnel syndrome in peripheral neuropathy with comparison of two methods: Inching method and second lumbrical-interossei test

Diabetes mellitus is the most common metabolic disease. The carpal tunnel syndrome (CTS) occurs frequently in this disease. In diabetes mellitus due to effects of generalized neuropathy on peripheral nerves, the diagnosis of CTS with conventional EDX criteria (onset latency of median SNAP or distal latency of median CMAP) is challenged, so another methods such as 2nd lumbrical-interossei test is used. On the other hand Inching method is a technique in which used for diagnosis and determining the site of compression in carpal tunnel. The purpose of the present study is to evaluate diagnostic value of the inching method and 2nd lumbrical-interossei test in patients with diabetic peripheral neuropathy and signs or symptoms of carpal tunnel syndrome. Thirty hands with history of diabetes mellitus and signs and symptoms of CTS that confirmed diagnosis of peripheral neuropathy with conventional electro-diagnosis were evaluated. Then for diagnosis of CTS, sensory and motor median distal latencies were measured by nerve conduction study. In the next step, inching method and second lumbrical-interossei test was performed for all hands and sensitivity and specificity of two tests was calculated. Mean age of participants was 53.87 ± 11.53 years (range 26 to 70 years). Ten participants were female and 6 participants were male. The sensitivity and specificity of inching method in this study were 95.65 and 85.71, respectively and the results for second lumbrica-interossei test 73.91 and 71.42 were calculated. In this study, we showed the inching method is more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS in diabetic peripheral neuropathy with sensitivity and specificity 95.65 and 85.71, respectively and also the sensitivity of inching method was greater than specificity.

Motor Unit Number Estimation and Motor Unit Action Potential Analysis in Carpal Tunnel Syndrome

ObjectiveTo evaluate the clinical significance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity, ultrasonographic measurement and clinical symptoms.MethodWe evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ).ResultsThe MUNE, the amplitude and the duration of MUAP of the CTS group were significantly different from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP.ConclusionMUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity.

Transcarpal motor conduction velocity in carpal tunnel syndrome.

Transcarpal motor conduction to abductor pollicis brevis (APB) was evaluated in 43 patients (70 hands) with suspected carpal tunnel syndrome (CTS). Transcarpal motor conduction was abnormal in 80% of hands compared with 11.5% with prolongated distal motor latency from wrist stimulation. Transcarpal motor conduction was comparable in sensitivity with transcarpal sensory conduction and 2nd lumbrical-interosseous latency difference. Transcarpal motor conduction is a sensitive test for diagnosis of CTS. Sensory fibers were no more susceptible than motor fibers to compression in the carpal tunnel, and fibers to APB were as susceptible as those to the 2nd lumbrical muscle.