Relationship between Gravidity, Parity, and Neurophysiological Features in Carpal Tunnel Syndrome (CTS) Patients with a History of Pregnancy

BACKGROUND

It is not yet clear if gravidity and parity have any relationships with the electrodiagnostic parameters of carpal tunnel syndrome (CTS).

OBJECTIVE

To determine whether there is a relationship between electrodiagnostic findings, gravidity, and parity number in CTS.

MATERIALS AND METHODS

Female patients over 18 years of age with CTS were included in this retrospective cohort study. The gravidity/parity number, median nerve compound muscle action potential (CMAP), and compound nerve action potential (CNAP) of the patients were analyzed. The two subgroups of the Boston carpal tunnel syndrome questionnaire (BCTSQ): The Symptom Severity Scale (SSS) and Functional Severity Scale (FSS) were applied to the patients. CTS patients were divided into two groups aged at first pregnancy ≤20 years and >20 years.

RESULTS

One hundred and eight CTS extremities (seven right-sided CTS, three left-sided CTS, 49 bilateral CTS) of 59 patients were included. The median (interquartile range: 25%-75%) number of gravidity, parity, and abortion were 3 (2-5), 3 (2-4), and 0 (0-0), respectively. Right-sided CTS patients at the age of first pregnancy ≤20 years had higher BCTSQ-SSS/FSS scores and median nerve CMAP latency compared to patients at the age of first pregnancy >20 years (P = 0.029 for SSS; P = 0.042 for FSS; and P = 0.041 for CMAP latency). A negative correlation was found between the gravidity/parity numbers and median nerve CNAP/CMAP amplitudes (P = 0.028/0.031, r = -0.293/-0.289 for CNAP amplitude; and P = 0.006/0.035, r = -0.363/-0.283 for CMAP amplitude).

CONCLUSION

Neurophysiological findings worsen as the number of gravidity and parity increase. Electrodiagnostic and clinical features of CTS may be worsening in females below 20 years at first pregnancy.

The effect of Jendrassik maneuver on the persistence of the peroneal nerve F-wave

Objectives

This study investigated whether peroneal nerve F-wave persistence increased when the Jendrassik maneuver (JM) was performed, aiming to obtain information about the physiology of F-waves and JM.

Patients and methods

Thirty healthy individuals (HIs; 17 females, 13 males; mean age: 33.6±8.2 years; range, 23-50 years) were included in the prospective experimental study conducted between June 15, 2021, and December 15, 2021. Nerve conduction studies of peroneal, superficial peroneal, posterior tibial, and sural nerves were performed in one extremity of each HI. The peroneal nerve F-wave study was performed at rest (Study 1), during JM (Study 2), and after JM (Study 3). F-wave persistence of the peroneal nerve, maximum F-wave amplitude (ampF-wavemax), mean F-wave amplitude (ampF-wavemean), minimum F-wave latency, and the ratio of ampF-wavemean to maximum M amplitude (F/M ratio) were analyzed.

Results

The mean peroneal nerve F-wave persistence in Study 1, Study 2, and Study 3 was 28.7±23.9%, 52.3±32.1%, and 34.7±29.0%, respectively. F-wave persistence in Study 2 was higher compared to Studies 1 and 3 (p<0.001 and p<0.001, respectively). Moreover, ampF-wavemax, ampF-wavemean, and F/M ratio in Study 2 were higher than Studies 1 and 3 (p=0.026 and p=0.021 for ampF-wavemean; p=0.015 and p=0.003 for ampF-wavemax; p=0.033 and p=0.015 for F/M ratio, respectively). F-wave persistence in Study 2 was positively correlated with ampF-wavemax and ampF-wavemean (p<0.001, r= 0.717; p<0.001, r=0.786, respectively).

Conclusion

This study demonstrated that JM increased F-wave persistence and amplitude. Jendrassik maneuver may show its effect through motor neuron excitability.

Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders

BACKGROUND

: Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders.

METHODS

The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities.

RESULTS

Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM.

DISCUSSION

There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.

Conduction block and positive sharp waves/fibrillation potentials in entrapment neuropathies of the ulnar, radial, and peroneal nerves

Introduction: Entrapment mononeuropathies can cause motor conduction block, positive sharp waves, and fibrillation potentials. Aim: The study aims to find whether there is a relationship between positive sharp waves/fibrillation potentials and conduction block observed in entrapment mononeuropathies. Materials and methods: Patients with ulnar neuropathy at the elbow, radial neuropathy at the spiral groove, and peroneal neuropathy at the fibular head were included in this retrospective study. Nerve conduction study and needle electromyography results of the patients were analysed. Results: The study included a total of patients with 67 ulnar neuropathy, 8 radial neuropathy, and 27 peroneal neuropathy. All radial and peroneal neuropathy patients and 30 ulnar neuropathy patients had positive sharp waves/fibrillation potentials in at least one muscle. Twenty-three ulnar neuropathy patients with these potentials, 6 radial neuropathy patients, and 18 peroneal neuropathy patients had conduction block (p < 0.001). The reduction of compound muscle action potential amplitude in percentage recorded from the abductor digiti quinti/first dorsal interosseous across the elbow segment in ulnar neuropathy patients with and without positive sharp waves/fibrillation potentials was 41.9 ± 35.9/46.6 ± 36.1% and 7.6 ± 16.5/10.4 ± 16.5%, respectively (p < 0.001/p < 0.001). The distal compound muscle action potential amplitudes of ulnar neuropathy patients with these potentials were lower than those of ulnar neuropathy patients without these potentials (p = 0.029 – abductor digiti quinti, p = 0.017 – first dorsal interosseous). No correlation was found between the severity of positive sharp waves/fibrillation potentials and muscle strength in patients with these potentials (p > 0.05). Conclusions: Positive sharp waves/fibrillation potentials and motor conduction block can be seen together in patients with entrapment mononeuropathies. We concluded that there may be no relationship between the severity of these potentials and muscle strength.

Positive sharp waves and fibrillation potentials in polio survivors with sequelae: Are they due to late deterioration or radiculopathy?

Background & Objective: Needle electromyography (EMG) abnormalities can be observed in clinically affected or unaffected muscles in polio survivors. The primary aim of this study is to evaluate the positive sharp waves (PSWs) and fibrillation potentials (FPs) that can be observed in polio survivors. In addition, the presence of post-polio syndrome and radiculopathy was investigated in patients with PSWs/FPs. Methods: Clinical features and needle EMG findings of polio survivors with sequelae who applied to our neurophysiology laboratory between August 2018 and January 2021 were analyzed retrospectively. Cervical and lumbosacral magnetic resonance imaging (MRI) of polio survivors with PSWs/FPs were included in the analyses. In addition, polio survivors were divided into groups with and without post-polio syndrome. Results: Fifty-one polio survivors (33 male, 18 female) were included in the study. The mean age of the patients was 49.5±7.5 years. There were 13 (25.5%) polio survivors with post-polio syndrome. Needle EMG findings of 590 muscles were analyzed. PSWs/ FPs were found in 11 medial gastrocnemius, four iliopsoas, four tibialis anterior, two vastus lateralis muscles, and one deltoid muscle. PSWs or FPs were present in 12 (23.5%) of patients. PSWs/FPs were present in three (23.1%) and nine (23.7%) polio survivors with and without post-polio syndrome, respectively (p>0.05). Of the 12 patients with PSWs/FPs, 11 had cervical and lumbosacral MRIs. In eight (72.7%) of these 11 patients with PSWs/FPs, the nerve segment of the muscle with PSWs/FPs and the segment of radiculopathy detected by MRI were compatible with each other. Conclusions: This study indicated that PSWs/FPs may be present in polio survivors. PSWs/FPs may be due to radiculopathy and/or late deterioration. It was concluded that PSWs/FPs are not a parameter that can be used to differentiate polio survivors with and without post-polio syndrome.

The needle electromyography findings in the neurophysiological classification of ulnar neuropathy at the elbow

Background/aim

Although ulnar neuropathy at the elbow (UNE) is the second most common entrapment mononeuropathy, there are few reports on its neurophysiological classification. In this study, we tried to find out the role of needle electromyography (EMG) in the neurophysiological classification of UNE.

Materials and methods

UNE patients who met the clinical and neurophysiological diagnostic criteria and healthy individuals were included in this study. Reference values of nerve conduction studies were obtained from healthy individuals. Needle EMG was performed to all UNE patients. According to the neurophysiological classification proposed by Padua, UNE patients were classified as mild, moderate, and severe.

Results

Thirty-one controls and thirty-five UNE patients were included in the study. There was mild UNE in 23 patients, moderate UNE in 8, and severe UNE in 4. Abnormal needle EMG findings were present in all patients with moderate and severe UNE and in 12 patients with mild UNE.

Conclusion

Abnormal needle EMG findings are seen in most of the UNE patients. Therefore, it is not practical to use needle EMG findings in the neurophysiological classification. Needle EMG abnormalities may also be present in patients with mild UNE due to axonal degeneration or motor conduction block.