A carpal tunnel grading system including combined sensory index-diagnosed mild cases: Relation to presenting features and outcomes

Electrodiagnosis of Common Mononeuropathies: Median, Ulnar, and Fibular (Peroneal) Neuropathies

This article addresses common mononeuropathies seen in the electrodiagnostic laboratory. The most common mononeuropathies-median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and fibular (peroneal) neuropathy at the fibular head-are reviewed. The causes, clinical presentations, approached to the electrodiagnostic studies (including nerve conduction studies and needle electromyography), and the typical findings are discussed.

A timed Phalen's test predicts abnormal electrophysiology in carpal tunnel syndrome

OBJECTIVE

Previous studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen's test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS).

METHODS

Patients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

RESULTS

In total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant.

DISCUSSION

A positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS.

An electrodiagnostic grading system for ulnar neuropathy at the elbow

INTRODUCTION

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. Our goal was to create and analyze a grading system for UNE electrodiagnostic severity.

METHODS

We retrospectively analyzed EMG reports with UNE. We then classified 112 limbs as having mild, moderate, or severe grade UNE based on electrodiagnostic findings. The association between presenting symptoms and signs, EMG findings, treatment type, and electrodiagnostic grade was statistically analyzed.

RESULTS

Seventeen limbs (15.2%) had mild, 80 (71.4%) had moderate, and 15 (13.4%) had severe UNE. Symptoms (P = .016), exam findings (P < .001), and treatment type (P = .043) were significantly associated with electrodiagnostic grade.

DISCUSSION

Our UNE grading system was significantly related to symptoms, physical exam, and treatment selection and may be useful to measure electrodiagnostic severity.