1
|
Daşar U, Mutlu T. The Effect of Diabetes Mellitus on Decompression Surgery in Carpal Tunnel Syndrome. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.463198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
2
|
Thomsen NOB, Andersson GS, Björk J, Dahlin LB. Neurophysiological recovery 5 years after carpal tunnel release in patients with diabetes. Muscle Nerve 2017; 56:E59-E64. [PMID: 28241376 DOI: 10.1002/mus.25633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The long-term results of neurophysiological recovery after carpal tunnel release in patients with diabetes have not been studied. METHODS Thirty-five patients with diabetes and carpal tunnel syndrome (CTS) were matched with 31 patients without diabetes who had idiopathic CTS, and 27 and 30 patients, respectively, participated in this follow-up study. Nerve conduction results at 5 years were compared with previously published results at baseline and 1 year. RESULTS Significant neurophysiological improvement continued from 1 to 5 years after carpal tunnel release for patients with and without diabetes. However, wrist-palm sensory conduction velocity was still abnormal for 85% and 43% of patients with and without diabetes, respectively. Although diabetes had an impact on 4 of 10 measured neurophysiological parameters, the influence of peripheral neuropathy seemed insignificant. DISCUSSION After carpal tunnel release, significant long-term neurophysiological improvement is possible for patients with diabetes, and it is not influenced by the presence of peripheral neuropathy. Muscle Nerve 56: E59-E64, 2017.
Collapse
Affiliation(s)
- Niels O B Thomsen
- Department of Hand Surgery, Skåne University Hospital, SE-205 02, Malmö, Sweden.,Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
| | - Gert S Andersson
- Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund University, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, SE-205 02, Malmö, Sweden.,Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
| |
Collapse
|
3
|
Kim DH, Choi JH, Park YG. Thoracic Radiculopathy Resulting From Retrograde Neuronal Degeneration. PM R 2015; 8:706-8. [PMID: 26548966 DOI: 10.1016/j.pmrj.2015.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 11/16/2022]
Abstract
We report a case of thoracic radiculopathy caused by retrograde degeneration from an intercostal nerve mass. A 74-year-old woman presented with thoracic radicular pain in the T4 dermatome. Needle electromyography revealed abnormal spontaneous activity in the left paraspinal muscle. Magnetic resonance imaging of the thoracic spine showed no signs of a herniated thoracic disk or root compression but revealed a mass along the intercostal space. The pathologic findings included perineural infiltration. A mass located along the intercostal space approximately 1.8 cm from the dorsal root ganglion may cause thoracic radiculopathy via retrograde degeneration.
Collapse
Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea(∗)
| | - Jung Hwa Choi
- Department of Rehabilitation Medicine, Seonam University College of Medicine, Myongji Hospital, Goyang, Republic of Korea(†)
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea(‡).
| |
Collapse
|
4
|
Mondelli M, Aretini A. Low sensitivity of F-wave in the electrodiagnosis of carpal tunnel syndrome. J Electromyogr Kinesiol 2014; 25:247-52. [PMID: 25561074 DOI: 10.1016/j.jelekin.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Previous studies showed "F-wave inversion" (F-INV) as a sensitive method in the electrodiagnosis of early stage of carpal tunnel syndrome (CTS). This study aimed at evaluating the sensitivity and specificity of F-wave and nerve conduction velocity (NCV) testing in CTS. METHODS We consecutively enrolled 244 cases and 108 controls. F-waves analysis included: Fwave minimum and mean latencies, F-wave persistence and chronodispersion, mean-F/CMAP amplitude ratio, F-INV. Specificity and sensitivity of F-waves parameters were calculated in the whole sample of CTS patients and by grouping the patients according to CTS severity. Multivariate logistic regression was also performed using F-INV as a dependent variable. RESULTS In the whole sample the sensitivity of F-mean-INV and of median-ulnar NCV comparative testing was 50.8% and 93.7%, respectively. F-INV sensitivity dropped to 8% in CTS early stage. F-INV could be predicted only by distal motor latency of the median nerve. The sensitivity of all F-wave parameters increased only in the most severe stages of CTS. CONCLUSIONS This study does not confirm the electrodiagnostic usefulness of F-INV in early stage of CTS. All F-wave parameters, including F-INV, are much less sensitive than conventional NCV in CTS electrodiagnosis. F-wave does not add further useful information specifically related to CTS.
Collapse
|
5
|
Boët C, Fugier S, Marsault J, Toublan D, Valot ME, Cheval A, Amyot d'Inville G, Niel S, Guihéneuc P, Guihard G. High-velocity low-amplitude thrust manipulation of the lumbar spine immediately modifies soleus T reflex in asymptomatic adults. INT J OSTEOPATH MED 2013. [DOI: 10.1016/j.ijosm.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Alves JSM, Leal-Cardoso JH, Santos-Júnior FFU, Carlos PS, Silva RC, Lucci CM, Báo SN, Ceccatto VM, Barbosa R. Limb immobilization alters functional electrophysiological parameters of sciatic nerve. Braz J Med Biol Res 2013; 46:715-21. [PMID: 23969978 PMCID: PMC3854417 DOI: 10.1590/1414-431x20132626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 05/03/2013] [Indexed: 11/22/2022] Open
Abstract
Immobilization, used in clinical practice to treat traumatologic problems, causes
changes in muscle, but it is not known whether changes also occur in nerves. We
investigated the effects of immobilization on excitability and compound action
potential (CAP) and the ultrastructure of the rat sciatic nerve. Fourteen days after
immobilization of the right leg of adult male Wistar rats (n=34), animals were killed
and the right sciatic nerve was dissected and mounted in a moist chamber. Nerves were
stimulated at a baseline frequency of 0.2 Hz and tested for 2 min at 20, 50, and 100
Hz. Immobilization altered nerve excitability. Rheobase and chronaxy changed from
3.13±0.05 V and 52.31±1.95 µs (control group, n=13) to 2.84±0.06 V and 59.71±2.79 µs
(immobilized group, n=15), respectively. Immobilization altered the amplitude of CAP
waves and decreased the conduction velocity of the first CAP wave (from 93.63±7.49 to
79.14±5.59 m/s) but not of the second wave. Transmission electron microscopy showed
fragmentation of the myelin sheath of the sciatic nerve of immobilized limbs and
degeneration of the axon. In conclusion, we demonstrated that long-lasting leg
immobilization can induce alterations in nerve function.
Collapse
Affiliation(s)
- J S M Alves
- Universidade Estadual do Ceará, Instituto Superior de Ciências Biomédicas, FortalezaCE, Brasil
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Kasius KM, Claes F, Verhagen WIM, Meulstee J. The segmental palmar test in diagnosing carpal tunnel syndrome reassessed. Clin Neurophysiol 2012; 123:2291-5. [PMID: 22608474 DOI: 10.1016/j.clinph.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/16/2012] [Accepted: 04/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test our hypothesis that comparing the sensory nerve conduction velocity of the median nerve across the wrist with that of the forearm is more sensitive than comparing it with that of the palm in the electrodiagnostic confirmation of carpal tunnel syndrome (CTS). METHODS One hundred and fifty seven consecutive patients with clinically defined CTS were prospectively included and electrophysiologically examined. Antidromic nerve conduction velocities were measured in 3 segments of the median nerve: forearm, wrist, and palm. Differences and ratios in nerve conduction velocities were computed between the forearm and wrist and between the palm and wrist segments. RESULTS Comparing the median nerve conduction velocities of the forearm with the wrist segment provides a greater sensitivity (79.6% and 82.8% for the second and third digit, respectively) than comparing the palm with the wrist segment (65.6% and 65.0%). Applying the ratio leads to slightly higher sensitivities for both comparisons. CONCLUSIONS The modified segmental palmar test is a sensitive, robust and easily applicable method in diagnosing CTS. SIGNIFICANCE We recommend to use the median nerve sensory conduction velocity in the forearm as a reference in the segmental palmar test instead of that in the palm.
Collapse
Affiliation(s)
- Kristel M Kasius
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|
8
|
Bonfiglioli R, Botter A, Calabrese M, Mussoni P, Violante FS, Merletti R. Surface electromyography features in manual workers affected by carpal tunnel syndrome. Muscle Nerve 2012; 45:873-82. [PMID: 22581542 DOI: 10.1002/mus.23258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Alterations in surface electromyographic (sEMG) signals of the abductor pollicis brevis muscle were evaluated in 24 non-manual workers and 40 manual workers (25 asymptomatic and 15 reporting CTS symptoms). METHODS The initial value (IV) and the normalized rate of change (NRC) of average rectified value (ARV), mean frequency of the power spectrum (MNF), and muscle fiber conduction velocity (MFCV) were calculated during contractions at 20% and 50% of maximal voluntary contraction (MVC). Neuromuscular efficiency (NME) and kurtosis of the sEMG amplitude distribution were estimated. RESULTS With respect to controls, manual workers showed higher NME, lower ARV IV, and reduced myoelectric manifestations of fatigue (lower MNF NRC for both contraction levels, and lower MFCV NRC at 50% MVC). Kurtosis at 20% MVC showed higher values in symptomatic manual workers than in the other two groups. CONCLUSIONS Kurtosis seems to be a promising parameter for use in monitoring individuals who develop CTS.
Collapse
Affiliation(s)
- Roberta Bonfiglioli
- Department of Internal Medicine, Geriatrics, and Nephrology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Influence of Age and the Severity of Median Nerve Compression on Forearm Median Motor Conduction Velocity in Carpal Tunnel Syndrome. J Clin Neurophysiol 2011. [DOI: 10.1097/wnp.0b013e31823cc0df.] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
11
|
Influence of Age and the Severity of Median Nerve Compression on Forearm Median Motor Conduction Velocity in Carpal Tunnel Syndrome. J Clin Neurophysiol 2011; 28:642-6. [DOI: 10.1097/wnp.0b013e31823cc0df] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Gunasekera SM, Wijeskara RL, Sesath HGR. Proximal axonal changes after peripheral nerve injury in man. Muscle Nerve 2011; 43:425-31. [PMID: 21321957 DOI: 10.1002/mus.21879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Peripheral nerve injury leads to changes in the proximal axon. Traumatic nerve injuries in humans were investigated to characterize such electrophysiological changes. Mixed nerve conduction studies (MNCS) and motor conduction studies (MCS) were performed proximal to the injury. Control values were obtained from the uninjured limb. Median (n = 24) and ulnar (n = 35) nerve injuries were studied. The injured nerves had significant mixed nerve action potential (MNAP) amplitude reductions (median: P < 0.0001; ulnar: P < 0.0001). The majority of the MNAP amplitude reductions were severe and early. There was slowing in the mixed nerve conduction velocity (MNCV) (median: P = 0.09; ulnar: P = 0.04) and motor conduction velocity (MCV) (median: P = 0.046; ulnar: P = 0.005). Axonal loss appears to play a significant role in producing the MNCS changes observed, and its early occurrence is noteworthy. Proximal MCV reduction could be secondary to the effects of injury as well as collateral sprouting of uninjured axons. Proximal axonal changes may have an impact on recovery.
Collapse
Affiliation(s)
- Sudath M Gunasekera
- Department of Clinical Neurophysiology, Institute of Neurology, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
| | | | | |
Collapse
|
13
|
Neurophysiologic recovery after carpal tunnel release in diabetic patients. Clin Neurophysiol 2010; 121:1569-1573. [PMID: 20413347 DOI: 10.1016/j.clinph.2010.03.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 02/27/2010] [Accepted: 03/15/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare nerve conduction study results, before and after surgical carpal tunnel release, in diabetic and non-diabetic patients. METHODS In a prospective study (2004-2007), we included 35 consecutive diabetic patients with carpal tunnel syndrome (CTS), who were age and gender matched with 31 non-diabetic patients having idiopathic CTS. Preoperatively, and at the 1 year follow-up, nerve conduction studies were performed of the median and ulnar nerve. Presence of neuropathy was based on abnormal preoperative neurophysiologic values in both the sural and the peroneal nerve. RESULTS Diabetic patients demonstrated significantly impaired nerve conduction parameters, before as well as after surgical carpal tunnel release, compared to non-diabetic patients. However, neurophysiologic recovery after carpal tunnel release was not different between the two patient groups or between diabetic patients with or without peripheral neuropathy. In general, the largest neurophysiologic recovery was demonstrated for parameters with the greatest impairment, but normal values were seldom reached. CONCLUSIONS Marked neurophysiologic impairment of the median nerve, or signs of peripheral neuropathy, does not preclude significant recovery after carpal tunnel release in diabetic patients. SIGNIFICANCE Diabetic patients with CTS should be offered the same opportunities for surgical carpal tunnel release as non-diabetic patients.
Collapse
|
14
|
Shibuya R, Kawai H, Yamamoto K. Neurophysiological study to assess the severity of each site through the motor neuron fiber in entrapment neuropathy. J Brachial Plex Peripher Nerve Inj 2009; 4:7. [PMID: 19534764 PMCID: PMC2711066 DOI: 10.1186/1749-7221-4-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/17/2009] [Indexed: 11/10/2022] Open
Abstract
Background The double crush hypothesis (DCH) that had been widely accepted seems to have been dismissed recently. Prior to the DCH, retrograde changes in the proximal median nerve in carpal tunnel syndrome (CTS) were reported. There has been no report of quantitative analyzing about the effect of one site's compression on another site all through the same peripheral nerve in CTS patients. Methods We measured the central motor conduction time (CMCT), motor conduction latency of the cervical root region (CRL), peripheral path latency from the rootlet to the wrist (PL) and motor distal latency (MDL) in the median nerve and ulnar nerves, respectively in CTS patients. Results MDL, PL and CRL were prolonged selectively in the median nerve, but not in the ulnar nerve of CTS patients. And in the median nerve measurement, MDL was high (r = 0.59, p < 0.0001) while PL showed a significant (r = -0.28, p < 0.05) relationship with CRL. MDL was large (r = 0.58, p < 0.0001) and showed a close (r = 0.59, p < 0.0001) relationship with the amplitude of CMAP. There was no significant difference between the amplitude of the normal CRL group and that of the prolonged CRL group. This quantitative analysis showed a linear relationship among MDL, CRL and CMAP amplitude. Conclusion Dual entrapment lesions did not unexpectedly exaggerate the vulnerability or total damage. The vulnerability and the damage were proportional to the severity of each lesion. If the DCH term presented to an unexpectedly exaggerated degree, the cases of double crush symdrome in the CTS patients were rare, but if the term DCH refers to only this linear relationship, the DCH should not be dismissed.
Collapse
Affiliation(s)
- Ryoichi Shibuya
- Department of Rehabilitation, Osaka Rosai Hospital, Sakai, Japan
| | - Hideo Kawai
- Department of Orthopaedic Surgery, Hosigaoka Kouseinenkin Hospital, Hirakata, Japan
| | - Kouji Yamamoto
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| |
Collapse
|
15
|
The Real Role of Forearm Mixed Nerve Conduction Velocity in the Assessment of Proximal Forearm Conduction Slowing in Carpal Tunnel Syndrome. J Clin Neurophysiol 2008; 25:373-7. [DOI: 10.1097/wnp.0b013e31818e7930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
16
|
Chang MH, Lee YC, Hsieh PF. The role of forearm mixed nerve conduction study in the evaluation of proximal conduction slowing in carpal tunnel syndrome. Clin Neurophysiol 2008; 119:2800-3. [PMID: 18976952 DOI: 10.1016/j.clinph.2008.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 09/12/2008] [Accepted: 09/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE A decrease of forearm median motor conduction velocity (CV) is a common electrophysiological finding in carpal tunnel syndrome (CTS), ascribed to two possible mechanisms: either conduction block or slowing of the fastest myelinating fibers in the carpal tunnel, or retrograde axonal atrophy (RAA) with retrograde conduction slowing (RCS). We hope to utilize both direct and derived forearm median mixed nerve conduction studies to clarify the mechanism of the decrease of forearm median motor CV in CTS. METHODS Seventy-five CTS patients and 75 age-matched control subjects received conventional motor and sensory nerve conduction studies of median and ulnar nerves and forearm median mixed nerve conduction techniques. First, direct measurement of forearm median mixed conduction velocity (Forearm mixed CV) and nerve action potential amplitude (Forearm mixed amplitude) was determined with recording at elbow and stimulation at wrist. Then, stimulating electrode was placed over palm and recording at elbow and then at wrist to calculate the derived Forearm mixed CV. Electrophysiological parameters, including direct Forearm mixed CV and amplitude and derived Forearm mixed CV, were compared between CTS patients and controls. RESULTS CTS patients had significantly prolonged wrist-palm sensory and motor conduction, significantly decreased forearm median motor CV, and normal ulnar nerve conduction. The direct Forearm mixed amplitude was significantly decreased in CTS patients. The direct Forearm mixed CV was similar in CTS patients and controls, but there was a significant decrease in derived Forearm mixed CV in CTS group. The difference between direct and derived Forearm mixed CV was significantly greater in the CTS, suggesting that direct and derived Forearm mixed CV represent CV from different nerve fibers, one passing outside carpal tunnel without undergoing RAA or the other through the carpal tunnel with occurrence of RAA. CONCLUSION A decrease of direct Forearm mixed amplitude really occurs in CTS, implying that RAA and RCS will develop over proximal median nerve at distal nerve injury and the decreased forearm median motor CV is best ascribed to RAA and RCS. Furthermore, in CTS, the direct Forearm mixed CV measures the CV from undamaged nerve fibers without passing through carpal tunnel, resulting in the misinterpretation of the cause of proximal conduction slowing secondary to conduction block or slowing over the wrist. SIGNIFICANCE We provide a direct evidence of the occurrence of RAA and RCS that would explain the cause of proximal median nerve conduction slowing. However, the clinical significance of RAA and RCS is uncertain.
Collapse
Affiliation(s)
- Ming-Hong Chang
- Section of Neurology, Taichung Veterans General Hospital, No. 160, Chung-Kang Road, Section 3, Taichung 40705, Taiwan
| | | | | |
Collapse
|