30例腕管综合征患者的神经电生理分析

目的 观察神经电生理检测对腕管综合征(CTS)的诊断价值.方法 对30例腕管综合征患者进行神经传导速度(NCV)和肌电图检测和分析.结果 30例CTS患者共有50条患病神经,其中7条正中神经诱发波形消失,43条正中神经潜伏期延长,波幅降低或(和)感觉神经传导速度减慢.30例患者的36条正中神经运动末梢潜伏期延长或(和)动作电位波幅降低.19块正中神经支配肌有去神经电位.结论 神经电生理检查对腕管综合征的诊断与鉴别诊断有重要意义.     

48例腕管综合征患者的神经电生理与临床分析

目的分析48例腕管综合征（CTS）患者的神经电生理检查结果,以探讨其临床意义。方法神经电生理检查共测定48例腕管综合征患者83条受累正中神经的运动神经电位、感觉神经电位及80块拇短展肌肌电图检查。结果本组48例腕管综合征患者的83条受累正中神经电生理检查结果以正中神经感觉电位测定异常明显,表现为正中神经与尺神经环指感觉电位（SNAP）潜伏期（LAT）差值增大75条（94％）,感觉电位波幅降低74条（89％）,感觉神经传导速度（SCV）减慢53条（64％）。而运动电位检测则以运动神经远端潜伏期（DML）延长明显有37条（45％）。80块拇短展肌的肌电图检查中有28块（35％）呈神经源性损害改变．为放松状态出现自发电位且伴募集时电位数量减少。同时根据神经电生理检查结果进行分期,48例腕管综合征患者83条受累正中神经中属于正中神经早期受累47条,中期受累33条,晚期受累3条。结论神经电生理检查有利于临床腕管综合征患者的早期诊断,并且根据神经电生理检查分期对其临床治疗方案的采取具有一定的指导意义。     

104例腕管综合征患者的临床表现与神经电生理相关分析

目的探讨腕管综合征（CTS）的临床表现与电生理的相关性，以期获得对腕管综合征较全面的认识。方法对104例腕管综合征患者的临床表现及神经电生理检测进行回顾性分析。结果76．0%的患者为女性，以中老年居多，优势手受累为主。典型表现为腕以下正中神经分布区域疼痛与感觉异常，症状常在夜间或清晨及劳累后加重，甩手活动后减轻。神经电生理检测：104例148只手正中神经复合肌肉动作电位末端运动潜伏期和波幅、肘至腕的运动传导速度、腕部至中指的感觉传导速度及感觉神经动作电位波幅等5项指标检测异常率分别为83．1％、20．3％、6．1％、92．6％及53．4％。结论CTS的诊断除病史、神经系统体检外，电生理检测正中神经感觉传导速度测定是诊断CTS的敏感指标。     

60例腕管综合征患者的神经电生理检测与临床分析

目的 探讨腕管综合征(CTS)患者的神经电生理特征.方法 对临床症状、体征符合CTS的60例患者进行正中神经、尺神经的运动和感觉传导速度测定,及拇短展肌、小指展肌的肌电图检测.结果 60例患者中,双侧病变18例,单侧病变42例.60例CTS患者中78条正中神经感觉传导潜伏期均延长和感觉传导速度均减慢,60条正中神经感觉诱发波幅降低,74条正中神经运动远端潜伏期延长,4条正中神经运动远端潜伏期和诱发波幅正常.58块正中神经支配的拇短展肌呈神经源性损害.结论 神经电生理检查在CTS的诊断与鉴别诊断中有重要意义.     

特发性腕管综合征的MRI、临床表现及电生理检测的相关性研究

目的探讨MRI、临床表现及电生理检测对特发性腕管综合征病情程度的诊断价值。方法对30名特发性腕管综合征患者进行临床、电生理检测及腕部磁共振成像,所得参数之间进行相关性检验。结果除豌豆骨水平正中神经面积外,其它MRI参数、临床表现、电生理检测参数之间无相关性。豌豆骨水平正中神经面积与两点辨别觉呈正相关(P<0.01),与感觉潜伏时呈正相关(P<0.05),与感觉传导速度(sensoryconduction velocity,SCV)呈负相关(P<0.05)。结论经腕MRI测量的豌豆骨水平正中神经面积,是评估病情程度的一个敏感指标。     

腕管综合征的肌电图与临床分析

目的探讨肌电图检测在腕管综合征诊断中的价值。方法对30例临床诊断为腕管综合征的患者行神经传导速度和针极肌电图检查。结果 30例患者中,8条正中神经感觉传导速度测定未引出动作电位,其余均有感觉传导潜伏期延长、波幅降低和(或)感觉神经传导速度减慢。28条伴正中神经运动末端潜伏期延长和(或)波幅降低。26块拇短展肌可见失神经电位和(或)运动单位电位平均时限延长。结论肌电图检查对腕管综合征有重要诊断及鉴别诊断价值。     

腕管综合征的神经电生理特征

目的:探讨腕管综合征(CTS)患者的神经电生理特征。方法:对临床症状、体征符合CTS的患者22例(31侧)行正中神经,尺神经.桡神经运动和感觉传导速度测定,以及拇短展肌,小指展肌,伸指总肌肌电图检测。结果:在31条患病正中神经中9条感觉传导未引出反应波、22条正中神经感觉潜伏期延长、波幅降低、或(和)感觉传导速度减慢;23条正中神经运动传导远端潜伏期延长、波幅降低;18块正中神经支配肌拇短展肌呈神经源改变。结论:神经电生理检测中以正中神经感觉潜伏期异常阳性率最高(100%);其次是正中神经运动传导远端潜伏期延长(74%)和拇短展肌神经源性改变(58%)。     

中指→腕的感觉传导速度对于腕管综合征的诊断价值

腕管综合征 (ＣＴＳ)是由于多种因素引起的腕管内压力升高所致正中神经受到挤压 ,为最常见的嵌压性神经病变。典型的临床表现为腕以下正中神经分布区域的疼痛与麻木 ,电生理检查显示为选择性的腕远侧段正中神经感觉、运动传导的异常 ,因而诊断并不困难。笔者通过对我院近年经临床或外科手术证实的4 0例腕管综合征病人的神经电图进行对比分析 ,发现正中神经中指→腕段的感觉传导速度 (ＳＣＶ)对于腕管综合征的确诊、临床分型及预后判断具有重要的指导意义。1　对象和方法1 1　临床资料　共 4 0例 ,涉及 6 8只手。其中男 9例 ,女 31例。年龄最…     

腕管综合征患者正中神经区域外症状及其可能机制

腕管综合征(Carpal Tunnel Syndrome, CTS)是正中神经在腕部通过腕横韧带下方腕管处受压而出现的手部症状,是最常见的外周神经卡压神经疾病[1].一项欧洲流行病学调查显示,该病终生罹患风险为10%,在总体人群中患病率为2.7%[2].CTS的典型症状是手部正中神经分布区感觉异常、麻木、疼痛等,较大程度地影响患者的生活质量,在美国,其是工作日损失和员工赔偿金的主因之一[3].虽然CTS是正中神经损害导致的手部症状,但患者经常会有手部尺神经分布区不适以及其他正中神经区域外症状.为此,本文对CTS患者的临床表现特点,正中神经区域外症状特点,及其可能机制作一综述.     

肌电图定位定量电刺激治疗腕管综合征的疗效观察

目的观察肌电图定位定量电刺激治疗腕管综合征的临床疗效。方法对经我院确诊的100例轻中度腕管综合征的患者随机分为两组:对照组48例和治疗组52例,两组患者均给予常规药物甲钴胺治疗,治疗组同时辅予肌电图定位定量电刺激,并分别予治疗前及治疗后1个月进行肌电图检查,并结合临床表现来评价疗效。肌电图检查包括正中神经远端潜伏期(distal motor latency, DML)、感觉传导速度(sensory conduction velocity, SCV)及波幅(amplitude, AMP)。结果治疗组的肌电图改善情况即传导速度与波幅明显优于对照组,差异有统计学意义(P0.05);临床表现改善情况优于对照组。结论肌电图定位定量电刺激可有效促进受损神经修复,恢复神经功能,值得临床推广及应用。     

Sensory distribution indicates severity of median nerve damage in carpal tunnel syndrome.

OBJECTIVE: Sensory symptoms within the median nerve distribution are a primary clinical diagnostic criterion for the diagnosis of carpal tunnel syndrome (CTS). However, the distribution of the sensory symptoms in CTS varies from patient to patient. This study identifies the clinical and electrophysiological findings that correlate with the distribution of sensory symptoms in an Asian population with CTS. METHODS: In a prospective study of 105 patients with electrophysiologically confirmed CTS, clinical and educational data were correlated with sensory symptom distribution. RESULTS: Median nerve distribution was strongly associated with more severe nerve conduction abnormality, male gender, and relief by movement. Patients with a complete median sensory distribution had more electrophysiological abnormality than those with an incomplete median distribution. Extra-median distribution was associated with the least nerve conduction abnormality. Educational qualification, age, symptom duration and body mass index were not associated with the pattern of sensory symptoms. CONCLUSIONS: In carpal tunnel syndrome, sensory symptom distribution is strongly dependant on the degree of electrophysiological median nerve damage. Median nerve sensory distribution is associated with severe nerve damage. SIGNIFICANCE: This study provides clinicians with a simple clinical rule for assigning the degree of median nerve damage in patients with CTS based on sensory distribution patterns.     

Electrophysiological findings in entrapment of the median nerve at wrist and elbow

In 117 consecutive patients with carpal tunnel syndrome and 11 patients with a compression syndrome of the median nerve at elbow, motor and sensory conduction along the median and ulnar nerves and quantitative electromyography were compared with findings in 190 normal controls of the same age. In 25% of patients with carpal tunnel syndrome in whom motor conduction and EMG were normal, the lesion was located from abnormalities in sensory conduction. The fact that conduction along the same fibres was moderately slowed from digit to palm, severely slowed across the flexor retinaculum, and normal from wrist to elbow indicates that slowing was due to demyelination at the site of compression. Fifteen per cent of the patients with carpal tunnel syndrome had clinical and electrophysiological signs of ulnar involvement. In the other patients conduction along the ulnar nerve was as in 100 normal controls. Compression at the elbow was located by electromyographical findings rather than by abnormalities in conduction.     

Bilateral carpal tunnel in childhood associated with Schwartz-Jampel syndrome

The case of a 7-year-old girl, the only descendant of non-con-sanguineous parents, who presented typical features of the Schwartz-Jampel syndrome and electrophysiological evidence of bilateral carpal tunnel is reported. Conventional electromyogram (EMG) showed persistent and continuous electrical activity and high frequency discharges elicited spontaneously by movement of the needle or after voluntary activation. Electrical silence after phenytoin therapy was sometimes seen. Single fiber electromyography (SFEMG) showed that high frequency discharges had a complex configuration and multiple components. Occasionally the discharges showed a progressive decrease in amplitude. Increased jitter was also found in some potential pairs that had been isolated under voluntary contraction after phenytion therapy. Motor and sensory conduction velocities on the median nerve were slowed bilaterally across the carpal tunnel. Bilateral carpal tunnel syndrome is an unusual condition in children and its clinical picture differs from that in adults. Carpal tunnel syndrome was not clinically suspected in the patient reported in this article and the diagnosis was confirmed by the conduction velocity study.     

Transcarpal median sensory conduction: detection of latent abnormalities in mild carpal tunnel syndrome

The major slowing of nerve conduction in the carpal tunnel syndrome is located in the palm to wrist segment. The aim of this study is to develop a reliable, sensitive and accessible approach to measure transcarpal median sensory nerve conduction. For this purpose, a fast recovery amplifier with a stimulus artifact suppressor was designed by the author. On stimulation of digits II or III, evoked orthodromic sensory nerve action potentials were simultaneously recorded at the palm and at the wrist. Distances were determined with a ruler. Median sensory nerve conduction velocity was estimated from digit to palm and from palm to wrist in 80 healthy hands and 253 hands with a presumptive diagnosis of carpal tunnel syndrome. According to conventional criteria, 131 of the 253 hands from those suspected of carpal tunnel syndrome were thought to have median nerve compression. When transcarpal median sensory conduction velocity was taken into account, the diagnostic yield increased by 18.1%. The described technique provides a simple, sensitive and reliable method of diagnosing mild or early carpal tunnel syndrome.     

Ulnar nerve lesions associated with the carpal tunnel syndrome

Electrophysiological studies were performed on median and ulnar nerves in 234 cases of carpal tunnel syndrome. Abnormalities of the ulnar nerve sensory action potential were found in 39·3% of cases. The amplitude of the ulnar nerve sensory action potential was related to the amplitude of the median nerve sensory action potential, and to the median nerve motor conduction velocity in the forearm. The findings suggest that in a significant proportion of patients with carpal tunnel syndrome, a more generalized subclinical neuropathy may be present.     

Forearm mixed nerve conduction velocity: questionable role in the evaluation of retrograde axonal atrophy in carpal tunnel syndrome.

The objective of this study was to determine whether forearm mixed nerve conduction velocity (Fmix) reflects the real conduction velocity of forearm motor nerve (Fmot) and forearm sensory nerve (Fsen) fibers passing through the carpal tunnel. Forearm mixed nerve conduction velocity is presumed to be indicative of the conduction velocity of the median nerve over the forearm. Therefore, Fmix is used widely to assess the causes of slowing forearm conduction velocity in carpal tunnel syndrome. However, some authors claim that Fmix comes chiefly from the undamaged fibers in carpal tunnel syndrome, and thus cannot replace Fmot or Fsen in the evaluation of retrograde axonal atrophy. Patients with clinical symptoms and signs of carpal tunnel syndrome confirmed with standard electrodiagnosis were included. Age-matched volunteers served as control subjects. Conduction velocities across the wrist and over the forearm were measured, including those of the wrist sensory (Wsen), wrist motor (Wmot), and wrist mixed nerves (Wmix); and forearm mixed (Fmix), forearm motor (Fmot), and forearm sensory nerves (Fsen). The authors compared and correlated Wsen, Wmot, and Wmix; and Fmix, Fmot, and Fsen respectively. The mean values of Wsen, Wmot, Wmix, Fmix, Fmot, and Fsen of the control subjects less those of corresponding conduction velocity of carpal tunnel syndrome patients were designated Wsen N, Wmot N, Wmix N, Fmix N, Fmot N, and Fsen N respectively and were compared and correlated again. Wrist motor nerve conduction velocity, Wsen, and Wmix were significantly lower in carpal tunnel syndrome patients, and Fmot and Fsen but not Fmix were reduced significantly when compared with control subjects. Mean wrist sensory nerve conduction velocity, Wmot N, and Wmix N; and Fsen N and Fmot N showed good correlation except for Fmix N, suggesting that Fmix reflects the conduction velocity of undamaged fibers in carpal tunnel syndrome. Forearm mixed nerve conduction velocity cannot replace Fmot or Fsen in the assessment of retrograde axonal atrophy in carpal tunnel syndrome. In the disease state, Fmix possibly represents the conduction velocity of the palmar cutaneous branch.     

Magnetic resonance imaging of idiopathic carpal tunnel syndrome: correlation with clinical findings and electrophysiological investigation

OBJECTIVE: To compare clinical evaluation, electrophysiological investigation and magnetic resonance findings in assessing the severity of idiopathic carpal tunnel syndrome. PATIENTS AND METHODS: Seventy-four patients with idiopathic carpal tunnel syndrome were prospectively recruited. Clinical evaluation included symptoms severity score and two-point discrimination, sensory and motor nerve conduction velocities were determined by electroneuromyography and imaging parameters were obtained after wrist magnetic resonance. The Wilcoxon test was used to define the differences between measurements of median nerve area. The Pearson and Spearman correlation tests were used to determine the relationships between all the measured parameters. RESULTS: Cross-sectional area of median nerve was smaller at hamate level than at radio-ulnar joint and pisiform levels (p<0.001). With exception of median nerve area at hamate level, there was a lower degree of correlation between MRI parameters and findings obtained by clinical assessments and electrophysiological measurements. The median nerve area at hamate level correlated negatively with duration of symptoms, two-point discrimination, symptoms severity score and positively with sensory nerve conduction velocity (p<0.01). CONCLUSION: In patients with idiopathic carpal tunnel syndrome, median nerve area measured by wrist magnetic resonance at hamate level may be considered as a valuable indicator to grading the severity of disease.     

Electrophysiological evidence of “nerve entrapment syndromes” and subclinical peripheral neuropathy in progressive systemic sclerosis (scleroderma)

We report the electrophysiological findings and the management of 5 subjects with progressive systemic sclerosis (PSS) and clinical evidence of nerve entrapment. Three had carpal tunnel syndrome (CTS), 1 bilateral CTS and right tarsal tunnel syndrome (TTS) and 1 Guyon's canal syndrome. Only 1 patient (with CTS) showed significant clinical improvement after surgical decompression; the other 4 demonstrated a slight recovery of conduction without lasting clinical relief after conventional treatment. To explain these failures we hypothesized that these entrapment syndromes were the clinical expression of underlying diffuse damage to the peripheral nervous system (PNS). The conduction values of nerves unaffected by entrapment syndromes were within normal limits, but almost all distal velocities were below the mean of controls. Such subclinical distal peripheral neuropathy was also verified in a selected sample of 17 patients with PSS, without clinical symptoms or signs of PNS involvement. In these 17 cases the mean distal sensory and motor conduction findings of the median, ulnar, sural and tibial nerves were significantly lower than those of a control group, while no significant differences were found in the more proximal tracts of the same nerves. Furthermore, 3 of the 17 patients showed classical electrophysiological evidence of TCS and TTS without any clinical symptoms. We concluded that the subjects with PSS had subclinical polyneuropathy which may become plain polyneuropathy or nerve entrapment syndromes perhaps induced by other risk factors.     

Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1–2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.     

Carpal tunnel syndrome

PURPOSE OF REVIEW: Carpal tunnel syndrome, though generally successfully treated by surgical decompression, still results in significant morbidity. The causes remain unclear and there is uncertainty about appropriate investigations for diagnosis and assessment of severity. The best nonsurgical treatment is yet to be fully elucidated. Recent work has begun to cast some light on these uncertainties. RECENT FINDINGS: The pathology of idiopathic carpal tunnel syndrome is a noninflammatory fibrosis of the subsynovial connective tissue surrounding the flexor tendons. Biochemical studies of surgical specimens suggest that a variety of regulatory molecules may be inducing fibrous and vascular proliferation and that this may be a response to mechanical stresses. Ultrasound imaging has begun to demonstrate its ability to accurately image the carpal canal contents and the diagnostic value of measurements of median nerve cross-sectional area showing expansion of the nerve is becoming established. The sensitivity and specificity of such measurements may be comparable to those of nerve conduction studies, though their prognostic value remains unknown. Nonsurgical treatment with steroid injection may be a more effective treatment than previously recognized, and is under used. SUMMARY: Suspected carpal tunnel syndrome should be investigated first with nerve conduction studies but consideration should be given to the use of magnetic resonance imaging or ultrasound imaging when diagnostic uncertainty remains, or there is a suspicion of a space occupying lesion in the carpal canal, especially if endoscopic surgery is contemplated. Treatment by local steroid injection should be considered a valid alternative treatment, at least for milder cases.