BACKGROUND: A nerve conduction study (NCS) is a useful method to diagnose and evaluate the therapeutic effect of carpal tunnel syndrome (CTS). Severe CTS often shows evidence of axonal injury, which may lead to incomplete recovery of symptoms or NCS abnormalities. To evaluate the degree of NCS recovery after decompression in patients with severe CTS, we studied NCS before and after surgical release in severe CTS with electrophysiological evidence of axonal injury. METHODS: We analyzed the NCS changes in 17 patients (21 hands) with severe CTS just before and 1 year after CTS release. The severe CTS was electrophysiologically defined with the following criteria; 1) prolonged median sensory and motor distal latencies, 2) either an absent SNAP or low amplitude/absent thenar CMAP, and 3) abnormal needle EMG findings. The patients averaged 53.3 years of age and all were females. RESULTS: The mean interval between the first and second NCS was 20.5 months and post-operation symptoms were free in 8 hands, markedly (>50%) improved in 11 hands, and symptoms remained (< 50%) in 2 hands. In 13 hands, SNAPs were not elicitable before surgery, but all were obtainable after surgery. One patient who had no CMAP did not show recovery after surgery. The mean median sensory latency, SNAP amplitude, and sensory NCV over the finger-wrist segment improved significantly (P < 0.05). The mean median motor latency and CMAP amplitude also improved significantly (P < 0.05). The parameters of NCS, however, showed incomplete and subnormal recovery after decompression except for sensory latency, amplitudes of SNAP and CMAP which recovered to the normal range. CONCLUSIONS: After CTS release even with electrophysiologically defined severe CTS patients, there were significant improvements of clinical symptoms and electrophysiological parameters. However, only some parameters(median sensory latency, SNAP amplitude and CMAP amplitude) were restored to the normal range.
Axons ; Carpal Tunnel Syndrome* ; Decompression ; Female ; Hand ; Humans ; Median Neuropathy ; Needles ; Neural Conduction* ; Reference Values

OBJECTIVE: To examine the usefulness of the second lumbrical-interosseous (2L-INT) distal motor latency (DML) comparison test in localizing median neuropathy to the wrist in patients with absent median sensory and motor response in routine nerve conduction studies. METHODS: Electrodiagnostic results from 1,705 hands of patients with carpal tunnel syndrome (CTS) symptoms were reviewed retrospectively. All subjects were evaluated using routine nerve conduction studies: median sensory conduction recorded from digits 1 to 4, motor conduction from the abductor pollicis brevis muscle, and the 2L-INT DML comparison test. RESULTS: Four hundred and one hands from a total of 1,705 were classified as having severe CTS. Among the severe CTS group, 56 hands (14.0%) showed absent median sensory and motor response in a routine nerve conduction study, and, of those hands, 42 (75.0%) showed an abnormal 2L-INT response. CONCLUSION: The 2L-INT DML comparison test proved to be a valuable electrodiagnostic technique in localizing median mononeuropathy at the wrist, even in the most severe CTS patients.
Carpal Tunnel Syndrome* ; Hand ; Humans ; Median Neuropathy ; Mononeuropathies ; Neural Conduction ; Retrospective Studies ; Wrist

OBJECTIVE: To investigate the reliability of distoproximal latency ratio of median sensory nerve as a diagnostic criterion of carpal tunnel syndrome (CTS) in patients with diabetic polyneuropathy. SUBJECT: Electrophysiologic study was performed in 264 hands of 208 patients with diabetes. Forty eight hands (24 subjects) without diabetes mellitus or CTS were included as a normal control group. Another 48 hands having CTS without diabetes mellitus were also included as a CTS control group. METHOD: Clinical and electrophysiologic findings were included to detect carpal tunnel syndrome in patients with diabetic neuropathy. Sensitivity and specificity of various electrodiagnostic parameters to confirm clinical CTS were obtained. RESULTS: Diabetic neuropathy was diagnosed in 66.3%, and median neuropathy was diagnosed in 52.7%. CTS was found in 32.2% as determined by the distoproximal latency ratio. The sensitivity of distoproximal latency ratio as a diagnostic tool for CTS was the highest (95.1%) and the specificity was the second highest (51.3%) among 5 different electrodiagnostic criteria of CTS. CONCLUSION: The results suggest that distoproximal latency ratio is an important parameter with high sensitivity in determining CTS in the patients with diabetic polyneuropathy.
Carpal Tunnel Syndrome* ; Diabetes Mellitus ; Diabetic Neuropathies* ; Electrodiagnosis* ; Hand ; Humans ; Median Neuropathy ; Sensitivity and Specificity

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.
Anatomic Variation ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Fingers ; Humans ; Hypesthesia ; Median Nerve ; Median Neuropathy ; Neural Conduction ; Sensation ; Wrist

Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.
Carpal Tunnel Syndrome ; Elbow ; Female ; Hand ; Humans ; Median Neuropathy ; Middle Aged ; Neural Conduction ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies ; Wrist

The median nerve is the most important nerve in the upper extremity, as it is responsible for most of the sensation of the hand, the fine motor functions of the thumb, and finger grasping. Median neuropathies most commonly occur as compressive neuropathy or entrapment neuropathy, but sometimes as neuritis without any compressive lesion. Carpal tunnel syndrome (CTS), anterior interosseous nerve syndrome, and pronator teres syndrome are the subtypes of median nerve neuropathies, of which CTS is the most common. Median neuropathies can be diagnosed clinically by careful history-taking and a physical examination. Typical symptoms of CTS include night pain (crying), a tingling sensation of the radial digits, numbness or paresthesia, clumsiness, and atrophy of the thenar muscles. Electrophysiologic testing can be used for confirmation of the diagnosis and for documentation before surgical treatment. Imaging modalities including ultrasonography or magnetic resonance imaging can be used to ensure diagnostic accuracy and to detect unusual causes of compression. Conservative treatments include rest, bracing, nerve stretching, non-steroidal anti-inflammatory drugs, and steroid injections. If nonsurgical approaches are unsatisfactory or the nerve damage is severe, surgical treatment should be considered. Carpal tunnel release for CTS is a relatively simple procedure that involves division of the transverse carpal ligament and decompression of the median nerve. Early diagnosis and proper management are important, as muscle atrophy and sensory loss may persist when surgical release is delayed in patients with advanced disease.
Atrophy ; Braces ; Carpal Tunnel Syndrome ; Decompression ; Diagnosis ; Early Diagnosis ; Fingers ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Ligaments ; Magnetic Resonance Imaging ; Median Nerve* ; Median Neuropathy ; Muscles ; Muscular Atrophy ; Nerve Expansion ; Neuritis ; Paresthesia ; Physical Examination ; Sensation ; Thumb ; Ultrasonography ; Upper Extremity

Occasionally, a bony spine of variable size, the supracondylar process, projects distally from the anteromedial surface about 5cm proximal to the medial epicondyle, to which it is joined by a band of fibrous tissue. It was found in one per cent of living white subjects and less often in the colored races; only in rare instances it is associated with clinical signs, usually median nerve neuralgia. Here, we reported a case of incidental finding of supracondylar process without a definite symptom.
Continental Population Groups ; Humans ; Humerus ; Incidental Findings ; Median Neuropathy ; Spine

OBJECTIVE: To investigate waveform changes of compound muscle action potentials (CMAPs) related to voluntary muscle contraction and alteration of muscle length and to evaluate the effect of peripheral neuropathy on temporal and spatial summations of CMAPs. METHOD: The influence of voluntary muscle contraction and alteration of muscle length on CMAP was studied in 37 median nerves of 21 patients with median neuropathy. RESULTS: In patients with no apparent axonopathy, temporal summation was partially disturbed without significant change of spatial summation. Shortening of muscle length or voluntary contraction produced a physiologic improvement of spatial and temporal summations. There was a decrease in temporal and spatial summations, more prominent in temporal summation, with lengthening of the muscle. In axonopathy, spatial summation was markedly deteriorated with partial reduction of temporal summation. Spatial summation was not affected by the change of muscle length or voluntary contraction. Temporal summation was improved by muscle shortening or voluntary contraction and was decreased by muscle lengthening. CONCLUSION: Peripheral neuropathy has an effects on physiological spatial and temporal summations of CMAPs. Temporal summation is preferentially decreased in cases without axonopathy. When axonopathy is apparent, spatial summation is profoundly disturbed with partial reduction of temporal summation.
Action Potentials* ; Humans ; Median Nerve ; Median Neuropathy ; Muscle Contraction ; Muscle, Skeletal* ; Peripheral Nervous System Diseases*

Lunate and perilunate dislocations are uncommon, but they have clinical importance because complications, such as median neuropathy and avascular necrosis of the lunate, can occur. Although early diagnosis enabling early surgical treatment is crucial for preventing long-term sequelae, these dislocations are frequently missed in the initial assessment. Imaging tools, such as plain radiography, magnetic resonance imaging, ultrasonography, and electrodiagnostic studies, have been used for diagnosis. The proper choice of initial evaluation tools is important for making an accurate early diagnosis. Here we present a case of lunate dislocation associated with median neuropathy in which ultrasonography, along with the electrodiagnostic study and plain radiography, played an important diagnostic role in detecting structural abnormalities. This case report reveals the complementary diagnostic role of ultrasonography in initial assessment and provides ultrasonographic images of lunate dislocation as a cause of median neuropathy.
Diagnosis ; Dislocations* ; Early Diagnosis ; Lunate Bone ; Magnetic Resonance Imaging ; Median Neuropathy* ; Necrosis ; Radiography ; Ultrasonography*

Radial nerve palsy is the most common neurological involvement in humeral shaft fractures. But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare. Combined injury to both radial and median nerve can cause significant disability. A detailed clinical examination is therefore necessary following humeral shaft fractures. We report a patient with closed diaphyseal humeral fracture (AO 12A-2.3) together with radial and median nerve palsy, its management and review of the literature. As the patient had two nerves involved, surgical exploration was planned. Fracture was reduced and fixed with a 4.5 mm narrow dynamic compression plate. There was no external injury to both radial and median nerves on surgical exploration. Neurological recovery started at 3 weeks' follow-up. Complete recovery was seen at 12 weeks. Careful clinical examination is of the utmost importance in early diagnosis of combined nerve injuries, which allows better management and rehabilitation of the patient.
Bone Plates ; Humans ; Humeral Fractures ; surgery ; Humerus ; Median Nerve ; Radial Neuropathy