OBJECTIVE: Carpal tunnel syndrome (CTS), a common entrapment neuropathy of the median nerve at the wrist, can be diagnosed clinically and electrophysiologically and treated successfully. The purpose of this study was to determine an association between clinical findings and the electrodiagnostic severity of this syndrome. METHOD: Medical records of 313 patients with CTS which was confirmed based on clinical and electrophysiological findings were reviewed. Clinical symptoms and signs (thenar atrophy, sensory change, positive Tinel sign and Phalen test) and electrodiagnostic values were recorded. CTS severity was determined according to the modified Stevens' criteria. The relationship between electrodiagnostic severity and clinical findings was investigated and statistically analyzed using the ANOVA and chi square tests. RESULTS: The median motor and sensory latencies became prolonged and amplitudes decreased with worsening electrophysiological severity of CTS, and the differences between severity groups were statistically significant. The frequency of symptoms and signs obtained was significantly greater in the more severe CTS groups. CONCLUSION: A positive correlation exists between the frequency of clinical findings and electrophysiological severity of CTS.
Atrophy ; Carpal Tunnel Syndrome* ; Electrodiagnosis ; Humans ; Median Nerve ; Medical Records ; Wrist

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OBJECTIVE: To acquire normal values of nerve conduction study of the superficial radial sensory nerve (SRN) distal branches to the second web space (2 WEB) and second digit (2 DIG) and compare them with the results of the conventional method. METHOD: Forty-three healthy adult subjects (25 males, 18 females) were included. Nerve conduction study was performed in both hands. Superficial radial sensory responses were obtained with 2 recording montages: 1) antidromic stimulation, recording electrode placed between the 2nd and 3rd metacarpals with stimulation 10 cm proximally on the lateral forearm (2 WEB); 2) orthodromic stimulation, stimulation at the second digit with recording 10 cm proximally at the snuff box (2 DIG). Each stimulation was performed twice, and onset latency, peak latency, and sensory nerve action potential (SNAP) amplitude (baseline-to- peak) were measured. Correlations between the values and body mass index (BMI), sex, and finger circumference were tested statistically. RESULTS: The age of the subjects was 36.0+/-10.4 years (range, 23~64 years), and the BMI was 22.6+/-2.8 kg/m2. The onset latency, peak latency and SNAP amplitude of the 2 WEB response were 1.7+/-0.1 ms, 2.2+/-0.2 ms, and 24.6+/- 8.2 micro V, respectively. The onset latency, peak latency and SNAP amplitude of the 2 DIG response were 1.6+/-0.2 ms, 2.2+/-0.2 ms, and 15.2+/-6.0 micro V, respectively. A statistically significant difference was observed between male and female subjects for both 2 WEB and 2 DIG responses. Weak correlations were found between the nerve conduction values and BMI, sex, and finger circumference. CONCLUSION: Sensory nerve action potentials can be successfully obtained from the distal branches of the superficial radial nerve.
Action Potentials ; Adult ; Body Mass Index ; Electrodes ; Female ; Fingers ; Forearm ; Hand ; Humans ; Male ; Metacarpal Bones ; Neural Conduction* ; Radial Nerve* ; Reference Values ; Tobacco, Smokeless

OBJECTIVE: To evaluate the association between neuralgic pain distribution and the severity of carpal tunnel syndrome (CTS). METHOD: Pain drawings using computerized pain chart system were collected from 131 patients (213 hands) with CTS. The presence and severity of CTS were determined by means of median motor and sensory nerve conduction studies. The severity was divided into 3 classes on the basis of electrophysiological findings: mild (93 hands), moderate (70 hands) and severe (50 hands). The similarities between pain drawing patterns and median nerve dermatome in the hands were evaluated. The pain distributions of the palmar and dorsal sides of each five fingers, palm and dorsum of hand were also evaluated. RESULTS: There were no significant differences in similarity values of pain distribution among the groups of CTS hands divided by severity: similarity values were 0.22+/-0.14 in mild CTS patients, 0.24+/-0.16 in moderate CTS patients and 0.27+/-0.14 in severe CTS patients. In the CTS patients, the pain drawings showed relatively frequent distributions in the palmar side of 2nd to 4th fingers. CONCLUSION: There was no significant correlation between pain drawing patterns and severity of CTS. The pain drawings of patients with CTS indicate distribution to be most frequent in the palmar side of 2nd to 4th fingers.
Carpal Tunnel Syndrome* ; Fingers ; Hand ; Humans ; Median Nerve ; Neural Conduction

The diagnosis of thoracic outlet syndrome (TOS) is sometimes confused by its nonspecific symptoms and various etiologies. Moreover, the paths of involving nerves and arteries are highly diverse. We report a 35 year-old man who had numbness and coldness in his left upper extremity with no improvement to medical therapy. The electrophysiologic studies were normal. Radial artery pulse was absent and the thermography revealed markedly reduced temperature below the left mid-forearm. The arteriography showed compression of the left subclavian artery between the clavicle and the 1st rib with aneurysmal change proximal to the compression. Occlusion of the left brachial artery and collateral arteries were also observed. Under the diagnosis of vascular TOS, 1st rib resection was performed and his symptoms were relieved. Vascular TOS may be considered in cases of upper limb paresthesia.
Adult ; Aneurysm ; Angiography ; Arteries ; Brachial Artery ; Clavicle ; Diagnosis ; Embolism ; Humans ; Hypesthesia ; Paresthesia ; Radial Artery ; Ribs ; Subclavian Artery ; Thermography ; Thoracic Outlet Syndrome* ; Upper Extremity

PURPOSE: To investigate the characteristics of non-glaucomatous eyes with peripapillary retinoschisis. METHODS: Six non-glaucomatous eyes with peripapillary retinoschisis were enrolled. Age, sex, refractive error, intraocular pressure, location and changes of peripapillary retinoschisis, and the presence of accompanied abnormalities were assessed. To determine possible abnormalities of the optic nerve head and macula, fundus photographs and cross-sectional images of the optic nerve head and macula obtained by optical coherence tomography were inspected. RESULTS: Three males and 3 females were enrolled. Age of the subjects ranged from 11 to 59 years (median, 45 years). Refractive error ranged from -6.25 to +1.00 diopter (median, -0.50 diopter). Peripapillary retinoschisis was located in the superior quadrant in four eyes, in the nasal quadrant in one eye, and in the inferior quadrant in one eye, respectively. No additional abnormalities were found in fundus photographs or in the cross-sectional images of the optic nerve head and macula that were obtained by optical coherence tomography. Longitudinal follow-up was available for two eyes and spontaneous resolution of peripapillary retinoschisis was observed in these eyes 6 and 9 months later, respectively. CONCLUSIONS: Peripapillary retinoschisis was observed in non-glaucomatous eyes. This finding was observed in subjects of various ranges of age and refractive error, and in both sexes, without any other accompanying abnormalities.
Female ; Follow-Up Studies ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Optic Disk ; Refractive Errors ; Retinoschisis* ; Tomography, Optical Coherence

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OBJECTIVE: To demonstrate a conduction block of the median nerve at the flexor retinaculum (FR) in carpal tunnel syndrome (CTS), comparison of potentials obtained with stimulation of median nerve at the wrist and the palm may be required. METHOD: To determine the severity and incidence of conduction block in patients with CTS, seventy hands of neurologically healthy adults (mean age, 48 years) as control, and seventy hands of patients with CTS (mean age, 51 years) were tested. We performed median motor and middle finger recorded antidromic sensory conduction study with stimulation of the wrist and palm of a distance of 5 cm. The negative peak spike duration and baseline to peak amplitude of the compound muscle action potential (CMAP), and sensory nerve action potential (SNAP) with wrist and palm stimulations were measured. From these values, the wrist to palm duration ratio and amplitude ratio were obtained. RESULTS: The criteria of median motor nerve conduction block were a wrist to palm amplitude ratio of less than 0.7 and a wrist to palm duration ratio of less than 1.13. The criteria of median sensory conduction block were a wrist to palm amplitude ratio of less than 0.61 and a wrist to palm duration ratio of less than 1.33. In the patient group, 10 hands (14.3%) showed motor conduction block and 12 hands (17.1%) showed sensory conduction block and 3 hands (4.3%) showed both. The wrist to palm amplitude ratios of CMAP and SNAP in the patient showing conduction block were 0.6+/-0.1, and 0.4+/-0.2, respectively. There was no correlation between palm CMAP or SNAP amplitude and respective wrist to palm ratios. CONCLUSION: Comparison of the amplitude and duration of CMAP or SNAP obtained with stimulation of both wrist and palm may be able to differentiate between conduction block and axonal degeneration. These values may be useful in planning treatment and predicting outcome.
Action Potentials ; Adult ; Axons ; Carpal Tunnel Syndrome* ; Fingers ; Hand ; Humans ; Incidence ; Median Nerve ; Neural Conduction ; Wrist

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.
Cadaver ; Elbow ; Forearm ; Radial Artery ; Tendons ; Upper Extremity ; Wrist

OBJECTIVE: To evaluate the pain patterns of patients with osteoarthritis (OA) of the knee. METHOD: Forty-four patients (mean age 56.1 years) with pain around the knee who met the Simons' criteria for myofascial pain syndrome (MPS). Patients drew in their pain areas on a pain drawing diagram. The pain areas were input into the Pain Chart System (PCS) software program for analysis. Physical examination, trigger point injection, and exercises for knee muscles were performed. Oral analgesics were not prescribed. RESULTS: MPS was clinically diagnosed in all 44 patients. Radiologic examination revealed degenerative changes in 49 knees. Pain patterns detected by the PCS revealed pain patterns compatible with myofascial trigger point in the vastus medialis in 37 cases, rectus femoris in 32 cases, adductor longus in 5 cases, sartorius in 2 cases, vastus lateralis in 1 case, and the popliteus in 1 case. Following treatment, 36 of the 44 patients experienced pain relief. CONCLUSION: Degenerative changes of the joint seem not to be cause of the knee joint pain. Instead, pain relief following MPS treatment indicates the cause of knee pain as MPS. We recommend that the first step in the treatment for knee pain include recognition and treatment of MPS before applying invasive treatment.
Analgesics ; Exercise ; Humans ; Joints ; Knee Joint ; Knee* ; Muscles ; Myofascial Pain Syndromes* ; Osteoarthritis* ; Physical Examination ; Quadriceps Muscle ; Trigger Points