Dengue hemorrhagic fever is a severe form of dengue presenting commonly with bleeding diathesis, but rarely with peripheral nervous system manifestations. Proximal median neuropathy comprises 1% of upper limb compression syndromes, and this case is the first to report injury to the proximal median nerve due to compression from hematoma formation. This case report presents the rehabilitation process of a 25-year-old Filipino female median nerve entrapment from venipuncture-associated hematoma presenting as burning sensation on the medial elbow, forearm and hand, weak flexion movement of her left thumb, index, and middle fingers. The patient was managed conservatively with pain medications, range of motion, gross and fine motor, and sensory re-education exercises. At 12 months, there was partial but functional recovery of median motor distribution and full recovery of median sensory distribution, as evidenced by improved sensory nerve action potential conduction velocity and amplitude, and compound motor action potential conduction velocity, with persistent decreased amplitude at 50%, and decrease in cross-sectional area of the left median nerve.

This paper highlights the functional outcomes of a conservatively managed median nerve entrapment from venipuncture hematoma from dengue hemorrhagic fever. This case report also emphasizes that in the presence of severe bleeding risk of surgery in the background of severe thrombocytopenia, timely rehabilitation medicine referral with monitoring through clinical evaluation, musculoskeletal ultrasound, and electrodiagnostic study presents a viable alternative in the management of compression neuropathy.

BACKGROUND: The terminal latency index (TLI) is a calculated value that adjusts the distal motor latency for the terminal distance and the proximal motor nerve conduction velocity. The purpose of this study is to evaluate the sensitivity of the median TLI in the diagnosis of carpal tunnel syndrome (CTS) and compare it with other electrophysiological parameters. METHODS: We prospectively studied 32 patients with nerve conduction studies using a conventional surface technique in the median and ulnar nerves. The distal distance for the CMAP was measured in 5 cm using Oh's techniques. Based on the clinical diagnosis, 32 patients (59 hands) were judged to have CTS. Control data were obtained from 40 healthy hands utilizing identical techniques. RESULTS: The mean TLI was 0.24 +/- 0.04 in the CTS group and 0.30 +/- 0.02 in the control group (P<0.01). The 32 patients had a mean age of 57 years (SD +/- 13 years; 73% women). Twenty subjects with an average age of 46 years (SD +/- 15 years; 65% women) were evaluated for control data. The calculated lower limit of normal from the control group (mean-2SD) was 0.26. The sensitivity of the TLI was 73%. The TLI was statistically better than the median motor distal latency and sensory nerve conduction velocity in the second digit-wrist segment. In four patients from the CTS group, the TLI was the only abnormal electrophysiological parameter. CONCLUSIONS: The median TLI is an easy, inexpensive, highly informative test and is therefore extremely useful in the diagnostic work-up of patients with CTS.
Carpal Tunnel Syndrome* ; Diagnosis ; Hand ; Humans ; Median Nerve* ; Neural Conduction ; Prospective Studies ; Reference Values* ; Ulnar Nerve

BACKGROUND: Electrophysiological study has been known as a useful method to evaluate the therapeutic effect of operation in idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the clinical and electrophysiological changes after carpal tunnel release (CTR) compared to the preoperative results. METHODS: We analyzed the changes of nerve conduction study (NCS) before and after minimal open carpal tunnel release in 18 patients (25 hands) with CTS. Follow-up study was performed over 6 months after operation. RESULTS: Clinical improvement was seen in all cases after CTR. In contrast, electrophysiological improvement was various depending on the parameters; the mean median sensory latency and nerve conduction velocity (NCV) improved significantly (p = 0.001). The mean median motor latency also improved, but NCV and compound muscle action potential (CMAP) amplitude did not change. The extent of improvement was evident in moderate CTS, but not in severe CTS. CONCLUSIONS: In this preliminary study, all subjects who underwent CTR achieved a clinical relief along with a significant improvement of electrophysiological parameters such as median sensory latency, sensory NCV and median distal motor latency. After CTR, a number of cases with mild to moderate CTS showed a prominent improvement of clinical and electrophysiological parameters, while fewer improvements were seen in severe CTS, although it did not reach the statistical significance.
Action Potentials ; Carpal Tunnel Syndrome ; Electrophysiology ; Follow-Up Studies ; Hand* ; Humans ; Median Nerve ; Neural Conduction

OBJECTIVE: To evaluate each digital branch of the median sensory nerve and motor nerves to abductor pollicis brevis (APB) and 2nd lumbrical (2L) according to the severity of carpal tunnel syndrome (CTS). METHODS: A prospective study was performed in 67 hands of 41 patients with CTS consisting of mild, 23; moderate, 27; and severe cases, 17. Compound muscle action potentials (CMAPs) were obtained from APB and 2L, and median sensory nerve action potentials (SNAPs) were recorded from the thumb to the 4th digit. Parameters analyzed were latency of the median CMAP, latency difference of 2L and first palmar interosseous (PI), as well as latency and baseline to peak amplitude of the median SNAPs. RESULTS: The onset and peak latencies of the median SNAPs revealed significant differences only in the 2nd digit, according to the severity of CTS, and abnormal rates of the latencies were significantly lower in the 2nd digit to a mild degree. The amplitude of SNAP and sensory nerve conduction velocities were more preserved in the 2nd digit in mild CTS and more affected in the 4th digit in severe CTS. CMAPs were not evoked with APB recording in 4 patients with severe CTS, but obtained in all patients with 2L recording. 2L-PI showed statistical significance according to the severity of CTS. CONCLUSION: The branch to the 4th digit was mostly involved and the branch to the 2nd digit and 2L were less affected in the progress of CTS. The second digit recorded SNAPs and 2L recorded CMAPs would be valuable in the evaluation of severe CTS.
Action Potentials ; Carpal Tunnel Syndrome ; Hand ; Humans ; Median Nerve ; Muscles ; Neural Conduction ; Prospective Studies ; Thumb

We analyzed 177 diabetic patients(80 males, 97 females) with the nerve con duction study (NCS) performed twice or more at the interval of more than one year in Severance Hospital from Jan 1, 1984 through Dec 31, 1994. We conclude as follows: 1)The NCS follow-ups showed that diabetic polyneuropathy was getting worsened electrophysiologically as time goes by. 2)The NCS revealed that the earlier change was noticed on the distal portion of sensory nerve fiber, though diabetes was known to cause a damage to both sensory and motor nerve fibes. 3)Considering that the NCS follow-ups revealed earlier and more marked changes in amplitude than in nerve conduction velocity, axonal degeneration seems to be more responsible for the pathogenesis of diabetic polyneuropathy rather than segmental demyelination.
Axons ; Demyelinating Diseases ; Diabetic Neuropathies ; Follow-Up Studies* ; Humans ; Male ; Nerve Fibers ; Neural Conduction*

OBJECTIVE: To establish the cutoff value of cross-sectional area (CSA) of the median nerve at the wrist, for determination of electrophysiologically moderate and severe carpal tunnel syndrome (CTS). METHODS: The prospective study was conducted among patients suspected of having CTS. A total of 106 patients (185 symptomatic wrists) received nerve conduction study (NCS) and ultrasonography. To establish a cutoff value, various diagnostic properties were calculated across a range of the CSA. RESULTS: A mean±standard deviation of CSA of the median nerve of normal and mild, moderate and severe CTS was 9.4±2.1, 12.0±2.7, 13.8±4.7, and 15.4±4.1 mm², respectively. The positive relationship between CTS severities and CSA was observed (rs=0.56). A 14 mm² CSA had sufficient power to rule in moderate and severe CTS, with a specificity of 91.4% and sensitivity of 42.3%. In addition, it showed a post-test probability (positive predictive value) of 86.3% as against a pre-test probability of 56.2%. CONCLUSION: Patients who had ≥14 mm² of median nerve CSA had very high probability of moderate to severe CTS.
Carpal Tunnel Syndrome* ; Electrophysiology ; Humans ; Median Nerve* ; Neural Conduction ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Wrist*

Measuring motor nerve conduction (MNC) in the hypoglossal nerve is an uncommon electrophysiologic study. However, this measurement can be easily performed with a wooden tongue depressor, to which a bipolar bar electrode is fixed by skin tape. We measured the MNC of the hypoglossal nerve in a patient with idiopathic unilateral weakness of the tongue. In the initial MNCs of the hypoglossal nerves, the CMAP amplitude was decreased and the latency was delayed in the lesion site when compared to the healthy site. In the follow-up study after 3 months, similar findings were found. Comparing the initial study with the follow-up one, however, the CMAP amplitude was increased and the latency was shortened in the lesion site. In conclusion, the MNC in the hypoglossal nerve is easy to measure and is useful for the evaluation of the hypoglossal nerve damage.
Electrodes ; Follow-Up Studies ; Humans ; Hypoglossal Nerve* ; Neural Conduction ; Surgical Tape ; Tongue*

BACKGROUND: Anesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop. METHODS: Practicing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA. RESULTS: Survey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure. CONCLUSIONS: Participation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.
Anesthesia, Conduction* ; Catheters ; Education ; Follow-Up Studies ; Lectures ; Manikins ; Nerve Block ; Teaching ; Ultrasonography

BACKGROUND: Although nerve conduction study (NCS) is the method most frequently used to confirm clinical diagnosis of carpal tunnel syndrome (CTS), ultrasonographic (US) measurement can give additional information to confirm the diagnosis and also exclude other conditions of nearby soft tissues. However, whether or not the degree of swelling of median nerve (MN) reflects clinical severity has not been proven before. This study is aimed to investigate the further clinical usefulness of US in assessing CTS severity. METHODS: One hundred and twenty-four patients (248 hands) with electrophysiologically confirmed CTS were evaluated. Clinical severity was examined by Historic and Objective (Hi-Ob) scale. Padua scale was used for the severity of electrophysiological impairment. For US study, cross-sectional area (CSA) of the median nerve was measured at the proximal inlet of the carpal tunnel and graded. RESULTS: Ninety-four patients were female (75%) and median disease duration was 19 weeks. There was a good correlation between electrophysiological impairment and CSA of median nerve (correlation coefficient=0.442, p<0.001), and CSA was graded as US severity scale by electrophysiological severity of patients. A statistically significant correlation was found among US severity scale of the MN at wrist, clinical severity scale (correlation coefficient=0.397, p<0.001), and electrophysiological severity scale (correlation coefficient=0.371, p<0.001). CONCLUSIONS: This observation suggests MN swelling in CTS may reflect in itself the degree of nerve damage as expressed by the clinical picture. US measurement could also give additional information about severity of MN involvement above the diagnosis of CTS.
Bays ; Carpal Tunnel Syndrome ; Cross-Sectional Studies ; Female ; Humans ; Median Nerve ; Neural Conduction ; Wrist

BACKGROUND: Conventional nerve conduction studies (NCS) are used in the diagnosis of carpal tunnel syndrome (CTS). The median terminal latency index (TLI) and median residual latency (RL) are parameters calculated to identify abnormalities in distal segments of the median motor nerve. The objective of this study was to determine the sensitivity and specificity of TLI and RL together with NCS in the diagnosis of CTS. METHODS: This prospective study involved 83 hands of 47 patients with suspected CTS. Conventional NCS were performed using Oh's method. Control data were obtained from the 68 hands of 40 healthy volunteers. The diagnostic sensitivity and specificity of TLI and RL were calculated and compared with those of conventional NCS. We divided the CTS patients into four groups based on their electrophysiological severity, and compared the TLI and RL values between these groups. RESULTS: TLI and RL were 0.20+/-0.03 (mean+/-SD) and 3.62+/-0.90, respectively, in the patients, while the corresponding values, in the healthy control, were 0.29+/-0.03 and 2.08+/-0.30. The sensitivities of TLI and RL in diagnosing CTS were 75.9% and 86.3%, respectively. Compared with median motor terminal latency, the sensitivities of TLI and RL in diagnosing CTS was found to be higher. Moreover, the diagnostic sensitivities of TLI and RL were significant better for the severe group than for the mild and moderate severity group. CONCLUSIONS: We conclude that measuring TLI and RL of the median nerve may increase the sensitivity in diagnosing CTS and also provide information about its electrophysiological severity.
Carpal Tunnel Syndrome* ; Diagnosis* ; Hand ; Healthy Volunteers ; Humans ; Median Nerve ; Neural Conduction ; Prospective Studies ; Sensitivity and Specificity*