Abstract
Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Sixhundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT — absence of thenar motor responses), severe CTS (SEV — absence of sensory response and abnormal distal motor latency — DML), moderate CTS (MOD — abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD — abnormal digit-wrist conduction and normal DML), minimal CTS (MIN — exclusive abnormal segmental and/or comparative study), and negative CTS (NEG — normal findings at all tests) Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60–80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.
Sommario
Seguendo le linee guida elettrodiagnostiche stabilite dall'AAEM abbiamo messo a punto una classificazione neurofisiologica della sindrome del tunnel carpale (CTS). Sono state studiate prospetticamente 600 mani con diagnosi clinica di CTS (età media 51.4 anni, rapporto femmine/maschi: 5.5/1, destra/sinistra: 1.8/1). Le mani sono state divise in sei classi di gravità sulla base dei reperti elettrodiagnostici del nervo mediano: CTS “estrema” (EXT — assenza della risposta motoria tenare), “grave” (SEV — assenza della risposta sensitiva e patologica latenza distale motoria — DML), “media” (MOD — reperti patologici della conduzione sensitiva dito-polso e della DML), “lieve” (MILD — conduzione sensitiva del segmento dito-polso patologica e DML normale), “minima' (MIN — anormalità solo dei test segmentari e/o comparativi), “negativa” (NEG reperti normali in tutti i test). L'utilizzo di tale classificazione ha evidenziato che i gruppi CTS sono distribuiti in modo “normale” (EXT 3% dei casi; SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%) e che l'età dei pazienti ed i reperti clinici sono correlati con le anormalità neurofisiologiche. Sono state inoltre osservate tra i diversi gruppi differenze statisticamente significative di parametri neurofisiologici del nervo mediano non inclusi nella classificazione (come la velocità di conduzione palmo-polso).
L'analisi dei gruppi CTS ha mostrato che: 1) la maggior parte dei casi avanzati (EXT e SEV) sono stati osservati nei pazienti più anziani (60–80 anni), 2) la maggior parte dei casi lievi (MIN e MILD) sono stati osservati nelle donne giovani.
Scopo di questo studio è di standardizzare la valutazione neurofisiologica del CTS.
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References
AAEM Quality Assurance Committee,Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 1993; 16: 1392–1414.
AAEM, AAN, AAPMR.Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 1993; 16: 1390–1391.
AAN, AAEM, AAPMR.Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Neurology 1993; 43: 2404–2405.
Carroll GJ.Comparison of median and radial nerve sensory latencies in the electrophysiological diagnosis of carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 1987; 68: 101–106.
Chang CW, Lien IN.Comparison of sensory nerve conduction in the palmar cutaneous branch and first digital branch of the median nerve: a new diagnostic method for carpal tunnel syndrome. Muscle Nerve 1991; 14: 1173–1176.
Cioni R, Passero S, Paradiso C, Giannini F, Battistini N andRushworth G.Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome. J Neurol 1989; 236: 208–213.
Cruz Martinez A.Diagnostic yield of different electrophysiological methods in carpal tunnel syndrome. Muscle Nerve 1991; 2: 183–184.
Kuntzer T.Carpal tunnel syndrome in 100 patients: sensitivity, specificity of multi-neurophysiological procedures and estimation of axonal loss of motor, sensory and sympathetic median nerve fibers. J Neurol Sci 1994; 127: 221–229.
Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN.A self administered questionnaire for the assessment of severity of symptom and functional status in carpal tunnel syndrome. J Bone and Joint Surg, 75-A, 11, 1993: 1585–92.
Padua L, LoMonaco M, Gregori B, Tonali P..Surgical prognosis in carpal tunnel syndrome: usefulness of a preoperative neurophysiological assessment. Acta Neurol Scand 1996; 94: 343–346
Padua L, LoMonaco M, Gregori B., Tonali P.Bilateral acute carpal tunnel syndrome and hyperthyroidism: a case report. Eur J Neurol, 1996; 3: 399–401.
Padua L, LoMonaco M, Gregori B., Valente EM, andTonali P.Double-peaked potential in the neurophysiological evaluation of carpal tunnel syndrome. Muscle Nerve 1996; 19: 679–680.
Padua L, LoMonaco M, Valente EM, Tonali P.A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve 1996; 19: 48–53.
Pavesi G, Olivieri MF, Misk A, Mancia D.Clinicalelectrophysiological correlations in the carpal tunnel syndrome. Ital J Neurol Sci 1986; 7: 93–96.
Rossi S, Giannini F, Passero S, Paradiso C, Battistini N, Cioni R.Sensory neural conduction of median nerve from digits and palm stimulation in carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 1994; 93: 330–334.
Sheean GL, Houser MK, Murray NMF.Lumbrical-interosseus latency comparison in the diagnosis of carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 1995; 97: 285–289.
Stevens C.AAEE Minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1987; 10: 99–113.
Uncini A, Di Muzio A, Awad J, Manente G, Tafuro M, Gambi D.Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome. Muscle Nerve 1993; 16: 1366–1373.
Uncini A, Lange DJ, Solomon M, Soliven B, Meer J, Lovelace RE.Ring finger testing in carpal tunnel syndrome: a comparative study of diagnostic utility. Muscle Nerve 1989; 12: 735–741.
Wintemann BI, Winters SC, Jelbermann RH, Katz JN.Carpal tunnel release. Correlation with pre-operative symptomatology. Clin Orthop 1996; 326: 135–145.
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This study was presented in part at the meeting “Giornata Neurofisiologica Romana — Sindrome del tunnel carpale“ — Roma 27-Sept-96.
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Padua, L., Lo Monaco, M., Padua, R. et al. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neuro Sci 18, 145–150 (1997). https://doi.org/10.1007/BF02048482
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DOI: https://doi.org/10.1007/BF02048482