Electrodiagnostic evaluation of carpal tunnel syndrome
01 Oct 2011-Muscle & Nerve (Wiley Subscription Services, Inc., A Wiley Company)-Vol. 44, Iss: 4, pp 597-607
TL;DR: The need to use reference values for populations such as diabetics and active workers, where normative values differ from conventional cutoffs used to confirm suspected CTS, is presented and the value of needle electromyography (EMG) is examined.
Abstract: Carpal tunnel syndrome (CTS) is the most common nerve entrapment. Electrodiagnostic (EDX) studies are a valid and reliable means of confirming the diagnosis. This monograph addresses the various EDX techniques used to evaluate the median nerve at the wrist. It also demonstrates the limitations of EDX studies with a focus on the sensitivity and specificity of EDX testing for CTS. The need to use reference values for populations such as diabetics and active workers, where normative values differ from conventional cutoffs used to confirm suspected CTS, is presented. The value of needle electromyography (EMG) is examined.
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TL;DR: As one of the part of book categories, nerves and nerve injuries always becomes the most wanted book.
Abstract: If you really want to be smarter, reading can be one of the lots ways to evoke and realize. Many people who like reading will have more knowledge and experiences. Reading can be a way to gain information from economics, politics, science, fiction, literature, religion, and many others. As one of the part of book categories, nerves and nerve injuries always becomes the most wanted book. Many people are absolutely searching for this book. It means that many love to read this kind of book.
466 citations
TL;DR: The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.
Abstract: Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.
428 citations
TL;DR: The appropriate indications for the diagnosis, treatment and follow-up of carpal tunnel syndrome are summarized, accompanied, whenever possible, by the levels of evidence and strength of recommendations.
Abstract: The carpal tunnel syndrome is a compressive neuropathy with high incidence rates, and its correct diagnosis, treatment and follow-up may lead to significant benefits in healthcare, social and economic terms. In this review, based on systematic review databases and guidelines, we summarise the appropriate indications for the diagnosis, treatment and follow-up, accompanied, whenever possible, by the levels of evidence and strength of recommendations.
168 citations
References
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Journal Article•
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TL;DR: About 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing, which indicates symptoms of pain, numbness, and tingling in the hands are common in the general population.
Abstract: Context Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling
in the hands and is an important cause of work disability. Although high prevalence
rates of CTS in certain occupations have been reported, little is known about
its prevalence in the general population. Objective To estimate the prevalence of CTS in a general population. Design General health mail survey sent in February 1997, inquiring about symptoms
of pain, numbness, and tingling in any part of the body, followed 2 months
later by clinical examination and nerve conduction testing of responders reporting
symptoms in the median nerve distribution in the hands, as well as of a sample
of those not reporting these symptoms (controls). Setting A region in southern Sweden with a population of 170,000. Participants A sex- and age-stratified sample of 3000 subjects (age range, 25-74
years) was randomly selected from the general population register and sent
the survey, with a response rate of 83% (n=2466; 46% men). Of the symptomatic
responders, 81% underwent clinical examination. Main Outcome Measures Population prevalence rates, calculated as the number of symptomatic
responders diagnosed on examination as having clinically certain CTS and/or
electrophysiological median neuropathy divided by the total number of responders.
Results Of the 2466 responders, 354 reported pain, numbness, and/or tingling
in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence
interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects
were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI,
3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal
tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%).
Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed
CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically
examined, electrophysiological median neuropathy was found in 23 (18.4%; 95%
CI, 12.0%-26.3%). Conclusion Symptoms of pain, numbness, and tingling in the hands are common in
the general population. Based on our data, 1 in 5 symptomatic subjects would
be expected to have CTS based on clinical examination and electrophysiologic
testing.
1,698 citations
Book•
01 Jan 1983
TL;DR: This book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test, and is of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods.
Abstract: With each subsequent edition, Dr. Kimura has built upon his extensive experience teaching electromyography (EMG) around the world and has transferred his knowledge to the book. It is intended for clinicians who perform electrodiagnostic procedures as an extension of their clinical examination, and will be of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods, particularly those practicing electromyography (EMG). The book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test.New to this edition:intra-operative monitoringstudies for the pediatric and geriatric populationsdata analysis and reporting, which should help facilitate daily practice
1,503 citations
Journal Article•
TL;DR: This report presents national estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 2006, based on data collected through the 2006 National Survey of Ambulatory Surgery.
Abstract: Objectives—This report presents national estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 2006. Data are presented by types of facilities, age and sex of the patients, and geographic regions. Major categories of procedures and diagnoses are shown by age and sex. Selected estimates are compared between 1996 and 2006. Methods—The estimates are based on data collected through the 2006 National Survey of Ambulatory Surgery by the Centers for Disease Control and
1,073 citations
TL;DR: The exclusion of the relatively normal distal latency made it possible to demonstrate mild slowing across the carpal tunnel in 36 (21Per cent) sensory and 40 (23 per cent) motor axons of 172 affected nerves when the conventional terminal latencies were normal.
Abstract: Palmar stimulation was used to assess median nerve conduction across the carpal tunnel in 61 control patients and 105 patients with the carpal tunnel syndrome. With serial stimulation from midpalm to distal forearm the sensory axons normally showed a predictable latency change of 0.16 to 0.21 ms/cm as the stimulus site was moved proximally in 1 cm increments. In 47 (52 per cent) of 91 affected nerves tested serially, there was a sharply localized latency increase across a 1 cm segment, most commonly 2 to 4 cm distally to the origin of the transverse carpal ligament. In these hands, the focal latency change across the affected 1 cm segment (mean +/- SD: 0.80 +/- 0.22 ms/cm) averaged more than four times that of the adjoining distal (0.19 +/- 0.09 ms/cm) or proximal 1 cm segments (0.19 +/- 0.08 ms/cm). In the remaining 44 (48 per cent) hands, the latency increase was distributed more evenly across the carpal tunnel. Unlike the sensory axons the motor axons were difficult to test serially because of the recurrent course of the thenar nerve, which may be contained in a separate tunnel. The wrist-to-palm latency was significantly greater in the patients with carpal tunnel syndromes than in the controls for sensory (2.18 +/- 0.48 ms v 1.41 +/- 0.18 ms) and motor axons (2.79 +/- 0.93 ms v 1.50 +/- 0.21 ms). Consequently, there was considerable difference between the carpal tunnel syndromes and controls in SNCV (38.5 +/- 7.5 m/s v 57.3 +/- 6.9 m/s), and MNCV (28.2 +/- 4.5 m/s v 49.0 +/- 5.7 m/s). In the remaining distal segment, however, there was only a small difference between the two groups in sensory (1.48 +/- 0.28 ms v 1.41 +/- 0.22 ms) and motor latency (2.15 +/- 0.34 ms v 2.10 +/- 0.31 ms). The exclusion of the relatively normal distal latency made it possible to demonstrate mild slowing across the carpal tunnel in 36 (21 per cent) sensory and 40 (23 per cent) motor axons of 172 affected nerves when the conventional terminal latencies were normal. Sensory or motor conduction abnormalities were found in all but 13 (8 per cent) hands. Without palmar stimulation, however, an additional 32 (19 per cent) hands would have been regarded as normal.
729 citations