Summary
In the carpal tunnel syndrome (CTS) sensory nerve conduction is more sensitive than motor conduction. However, 8%–25% of the sensory distal latencies in symptomatic hands may still be normal. A systematic study was made of the median, ulnar and radial orthodromic nerve conduction velocities (SNCV) stimulating each of the fingers separately. Four SNCVs from the median nerve, two SNCVs from the ulnar nerve and one from the radial nerve were obtained, and the ratio of the median to radial SNCV and the ratios of the median and ulnar SNCVs were estimated. The significance of these parameters in the diagnosis of the CTS was studied, and a rapid technique for the screening of nerve entrapment in the initial stages of the disease is proposed. Three hundred and seventy-five symptomatic hands were examined. Seventy-five hands showed normal distal latency, in which cases, however, the SNCV of the ring finger was always outside the normal range, while the SNCVs of the thumb, index and middle fingers were abnormal in 64%, 80% and 92% of cases respectively. The amplitudes of the sensory responses were the least sensitive of the parameters studied. Our results suggest that a study of the median nerve digital branch to the ring finger may be of value in providing an easily performed and rapid technique for screening an early median nerve entrapment at the wrist.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bhala RP, Thoppil E (1981) Early detection of carpal tunnel syndrome by sensory nerve conduction. Electromyograph Clin Neurophysiol 21:155–164
Bonney G, Gilliatt RW (1958) Sensory nerve conduction after traction lesions of the brachial plexus. Proc R Soc Med 51:365–367
Braidwood AS (1975) Superficial radial neuropathy. J Surg 57:380–383
Buchthal F, Rosenfalck A, Trojaborg W (1974) Electrophysiological findings in entrapment of the median nerve at wrist and elbow. J Neurol Neurosurg Psychiatry 37:340–360
Buchthal F, Rosenfalck A, Behse F (1984) Sensory poentials of normal and diseased nerves. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. Saunders, Philadelphia, pp 981–1015
Casey EB, Le Quesne PM (1972) Digital nerve action potentials in healthy subjects and in carpal tunnel and diabetic patients. J Neurol Neurosurg Psychiatry 35:612–623
Daube JR (1977) Percutaneous palmar median nerve stimulation for carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 43:139–140
Eklund G (1975) A new electrodiagnostic procedure for measuring sensory nerve conduction across the carpal tunnel. Ups J Med Sci 80:63–64
Felsental G, Spindler H (1979) Palmar conduction time of median and ulnar nerves of normal subjects and patients with carpal tunnel syndrome. Am J Phys Med 58:131–138
Frith RW, Litchy WT (1985) Electrophysiologic abnormalities of peripheral nerves in patients with cervical radiculopathy. Muscle Nerve 8:613
Gilliatt RW, Sears TA (1958) Sensory nerve action potentials in patients with peripheral nerve lesions. J Neurol Neurosurg Psychiatry 21:108–118
Gilliatt RW, Le Quesne PM, Logue V, Summer AT (1970) Wasting of the hand associated with a cervical rib or band. J Neurol Neurosurg Psychiatry 33:615–624
Johnson EW, Kukla RD, Wongsam PE, Piedmont A (1981) Normal values and relation to carpal tunnel syndrome. Arch Phys Med Rehabil 62:206–208
Kaeser HE (1963) Diagnostische Probleme beim Karpaltunnelsyndrom. Dtsch Z Nervenheilkd 185:453–470
Kaplan EB, Spinner M (1980) Normal and anomalous innervation patterns in the upper extremity. In: Omer GE, Spinner M (eds) Management of peripheral nerve problems. Saunders, Philadelphia, pp 75–99
Kimura J (1978) A method for determining median nerve conduction velocity across the carpal tunnel. J Neurol Sci 38:1–10
Kimura J (1979) The carpal tunnel syndrome localization of conduction abnormalities within the distal segment of the median nerve. Brain 102:619–635
Kimura I, Ayyar DR (1985) The carpal tunnel syndrome: electrophysiological aspects of 639 symptomatic extremities. Electromyograph Clin Neurophysiol 25:151–164
Kliney DG, Hackeff ER, May PR (1968) Evaluation of nerve injuries by evoked potentials in EMG. J Neurosurg 31:128–136
Lambert EH (1962) Diagnostic value of electrical stimulation of motor nerve. Electroencephalogr Clin Neurophysiol [Suppl] 22:9–16
Loong SC, Seah CS (1971) Comparison of median and ulnar sensory nerve action potentials in the diagnosis of the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 34:750–754
Marinacci AA (1964) Comparative value of measurement of nerve conduction velocity and electromyography in diagnosis of carpal tunnel syndrome. Arch Phys Med 45:548–554
Melvin JL, Schuchmann JA, Lanese RR (1973) Diagnostic specificity of motor and sensory nerve conduction variables in carpal tunnel syndrome. Arch Phys Med Rehabil 54:69–74
Mills KR (1985) Orthodromic sensory action potentials from palmar stimulation in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 48:250–255
Monga TN, Shanks GL, Poole BJ (1985) Sensory palmar stimulation in the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil 66:598–600
Perotto AO, Delagi EF (1979) Funicular localization in partial median nerve injury at the wrist. Arch Phys Med Rehabil 60:165–169
Phalen GS (1970) Reflection on 21 years experience with the carpal tunnel syndrome. JAMA 212:1365–1367
Schady W, Ochoa JL, Torebjork HE, Cheri LS (1983) Peripheral projections of fascicles in the human median nerve. Brain 106:745–760
Sedal L, McLeod JG, Walsh JC (1973) Ulnar nerve lesions associated with the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 36:118–123
Simpson JA (1956) Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry 19:275–280
Smith J (1981) Radial nerve conduction in patients with carpal tunnel syndrome. Appl Neurophysiol 44:363–367
Sunderland S (1970) Anatomical feature of nerve trunks in relation to nerve injury and nerve repair. Clin Neurosurg 4:38–62
Sunderland S (1976) The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 39:615–626
Tackmann W, Kaeser HE, Magun HG (1981) Comparison of orthodromic and antidromic sensory nerve conduction velocity measurements in the carpal tunnel syndrome. J Neurol 224:257–266
Taylor PK (1984) Non-linear effects of age on nerve conduction in adults. J Neurol Sci 66:223–234
Thomas JE, Lambert EH, Esenz KA (1967) Electrodiagnostic aspects of carpal tunnel syndrome. Arch Neurol 16:635–641
Trojaborg W (1970) Rate of recovery in motor and sensory fibers of the radial nerve: clinical and electrophysiological aspects. J Neurol Neurosurg Psychiatry 33:625
Trojaborg W, Sindrup EH (1969) Motor and sensory conduction in different segments of the radial nerve in subjects. J Neurol Neurosurg Psychiatry 32:354
Upton AR, McComas AJ (1973) Double crush in nerve entrapment syndromes. Lancet II:359–362
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cioni, R., Passero, S., Paradiso, C. et al. Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome. J Neurol 236, 208–213 (1989). https://doi.org/10.1007/BF00314501
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00314501