Summary
Carpal Tunnel Syndrome (CTS) can be due to a variety of different pathological conditions. These etiological and epidemiological differences may explain the non-homogeneous response to ordinary conservative therapeutical options observed in this syndrome. The aim of our study was to investigate on the possibility of identifying different sub-groups of patients among conservatively treatable CTS with different susceptibility to physiotherapeutic treatments. We decided to utilize an objective approach measuring some median motor nerve function parameters.
Short term variations of Compound Motor Action Potential (CMAP) from the thenar eminence were compared in two groups of 55 hands (CTS patients and normal controls) after performance of two different types of end range passive movement.
We found a different distribution of CMAP amplitude modifications within a sub-group of patients that suddenly improved more than the controls after two series of 10 end range passive flexions or after two series of ten end range passive extensions.
Amplitude changes proved to be much more useful than latency variation studies in the provocative test neurophysiological approach. The method we propose appears to be useful for better surgical indication and/or for improvement of conservative therapeutic choice.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Keywords
References
(1993) Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement). American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 43: 2404–2405
Akalin E, El O, Peker O, Senocak O, Tamci S, Gulbahar S, Cakmur R, Oncel S (2002) Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehab 81: 108–113
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I (1999) Prevalence of carpal tunnel syndrome in a general population. Jama 282: 153–158
Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH (1981) The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 63: 380–383
Glowacki KA, Breen CJ, Sachar K, Weiss AP (1996) Electrodiagnostic testing and carpal tunnel release outcome. J Hand Surg [Am] 21: 117–121
Katz JN, Simmons BP (2002) Clinical practice. Carpal tunnel syndrome. N Engl J Med 346: 1807–1812
Kitsis CK, Savvidou O, Alam A, Cherry RJ (2002) Carpal tunnel syndrome despite negative neurophysiological studies. Acta Orthop Belg 68: 135–140
Longstaff L, Milner RH, O’Sullivan S, Fawcett P (2001) Carpal tunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings. J Hand Surg [Br] 26: 475–480
Mondelli M, Giannini F, Giacchi M (2002) Carpal tunnel syndrome incidence in a general population. Neurology 58: 289–294
O’Connor D, Marshall S, Massy-Westropp N (2003) Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 1
Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P (2001) Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 56: 1459–1466
Padua L, Aprile I, Caliandro P, Mondelli M, Pasqualetti P, Tonali PA (2002) Carpal tunnel syndrome in pregnancy: multi-perspective follow-up of untreated cases. Neurology 59: 1643–1646
Pienimaki T (2002) Cold exposure and musculoskeletal disorders and diseases. A review. Int J Circumpolar Health 61: 173–182
Priganc VW, Henry SM (2003) The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome. J Hand Ther 16: 225–236
Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ (1998) Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther 11: 171–179
Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J (1999) Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med 14: 310–314
Stalberg EV, Trontelj JV (1994) Single fiber electromyography: studies in healthy and diseased muscles. Raven Press, New York
Tal-Akabi A, Rushton A (2000) An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther 5: 214–222
Totten PA, Hunter JM (1991) Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clin 7: 505 520
Verdugo RJ, Salinas RS, Castillo J, Cea JG (2003) Surgical versus non-surgical treatment for carpal tunnel syndrome. Co-chrane Database Syst Rev CD001552
Werner R, Armstrong TJ, Bir C, Aylard MK (1997) Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clin Biomech (Bristol, Avon) 12: 44–51
Werner RA, Hamann C, Franzblau A, Rodgers PA (2002) Prevalence of carpal tunnel syndrome and upper extremity tendinitis among dental hygienists. J Dent Hyg 76: 126–132
Wiederien RC, Feldman TD, Heusel LD, Loro WA, Moore JH, Ernst GP, Allison SC (2002) The effect of the median nerve compression test on median nerve conduction across the carpal tunnel. Electromyogr Clin Neurophysiol 42: 413–421
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag
About this paper
Cite this paper
Zalaffi, A. et al. (2005). Wrist median nerve motor conduction after end range repeated flexion and extension passive movements in Carpal Tunnel Syndrome. Pilot study. In: Alexandre, A., Bricolo, A., Millesi, H. (eds) Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery. Acta Neurochirurgica, vol 97. Springer, Vienna. https://doi.org/10.1007/3-211-27458-8_11
Download citation
DOI: https://doi.org/10.1007/3-211-27458-8_11
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-23368-9
Online ISBN: 978-3-211-27458-3
eBook Packages: MedicineMedicine (R0)