80例腕管综合征患者的神经电生理测定

目的：观察神经电生理检测对腕管综合征(CTS)的诊断敏感性。方法：80例临床提示为CTS或不能除外CTS的患者进行神经电生理测定并进行回顾性分析。结果：80例116侧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、指至腕部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75．0％、19．8％、9．5％、88．8％及37．9％；45例65侧拇指正中／桡浅神经潜伏期差(MRLD)及环指正中／尺神经潜伏期差(MULD)检测异常率95．4％。结论：正中神经拇指至腕段的感觉传导速度测定是诊断CTS的敏感指标，采用MRLD及MULD测定，诊断敏感性更高。     

47例腕管综合症患者的神经传导检测分析

目的探讨腕管综合症（CTS）患者神经传导检测特征。方法对临床症状、体征符合CTS的47例行正中神经、尺神经的运动及感觉神经传导检测。结果47例cTs患者中女性占76．6％,其中共有82侧腕管神经出现病变,双侧病变占74．5％。82侧腕正中神经指3-腕感觉潜伏期、SCV、感觉诱发波幅及DML与正常参考值相比较,差异有统计学意义。结论神经传导检测对CTS诊断有重要意义。     

手掌混合神经电位潜伏时差诊断轻度腕管综合征的价值

目的：分析正中及尺神经手掌一腕混合神经电位潜伏时差在诊断轻度腕管综合征的价值。 方法：回顾性分析经新加坡国家脑神经科学院神经内科门诊神经内科医生临床确诊且临床症状符合腕管综合征的62例患者的正中及尺神经掌-腕混合神经电位潜伏时差，并与同期52例正常对照组的各项神经传导检测结果进行比较。对照组与腕管综合征组患者均检测正中神经、尺神经运动及感觉传导。采用片状表面电极记录运动传导末端潜伏时；采用反向法检测正中神经腕-示指感觉神经电位，主要观察感觉神经电位潜伏时；用顺向法检测正中及尺神经手掌混合神经传导，观察正中神经及尺神经混合神经电位潜伏时差。正中神经运动传导末端潜伏时、腕-示指感觉神经传导电位潜伏时、手掌正中及尺神经混合神经电位混合神经电位潜伏时差大于本实验室同期所做的52例对照组的正常参考值x^-&;#177;1．96s为延长。 结果：腕管综合征患者62例及对照组52人均采集到各项指标，全部进入结果分析。①腕管综合征组患者正中神经运动传导末端潜伏时、腕-示指感觉神经电位潜伏时均与对照组接近，差异无显著性意义（P值分别为0．494和0．144）。②腕管综合征组患者正中及尺神经手掌-腕混合神经电位潜伏时差与对照组比较明显延长，差异有显著性意义[（2．078&;#177;0．316），（1．706&;#177;0．121）ms，t=8．998，P=0．000]。③当正中及尺神经手掌-腕混合神经电位潜伏时差大于对照组x^-&;#177;1．96s时为延长，可得到正常值上限为0．398ms，腕管综合征组患者中此潜伏时差〉0．398ms者55例，占88．7％，即采用正中及尺神经手掌-腕混合神经电位潜伏时差明显的提高了腕管综合征的诊断率，但仍有7例（11．3％）腕管综合征患者其正中及尺神经手掌-腕混合神经电位潜伏时差在0．4ms以内。 结论：正中及尺神经手掌-腕混合神经电位潜伏时差在诊断轻度腕管综合征时具有较高的诊断价值。     

神经传导速度对糖尿病腕管综合征患者的评估价值

目的：探讨糖尿病周围神经病中腕管综合征患者运动、感觉神经传导速度的改变以及与临床的关系。方法：对70例糖尿病患者进行临床检查和神经电生理测定，并与年龄、性别相匹配的正常人对照。结果：腕管综合征20例(29％，20／70)，其中单纯性腕管综合征14例(70％，14／20)；无症状者12例(60％，12／20)，电生理检查显示双侧正中神经腕-指间损害13例(65％，13／20)，单侧损害7例，感觉神经传导速度、波幅及运动末端潜伏期异常者11例(55％，11／20)。轻、中度损害15例(75％，15／20)，重度损害5例(25％，5／20)。结论：糖尿病腕管综合征以无症状为特点，应用电生理检测手段，早期发现亚临床腕管综合征，正确的诊断、及时的治疗非常重要。     

神经松动技术对早中期腕管综合征患者手功能的影响

正腕管综合征(CTS)的病因主要是滑膜增厚、腕管内腱鞘囊肿、血管瘤、腕部骨折脱位等导致腕管内压增高,压迫正中神经,临床主要表现为患者桡侧3个半手指的掌面和远端指节麻木、疼痛,疼痛有时放射到肘部,以及正中神经皮肤分布区感觉迟钝、实体觉减退,拇指外展力量减退[1-2]。患者可于夜间因疼痛麻刺感而醒,后期因鱼际肌萎缩而出现手捏抓力减弱,神经传导试验可检测到神经传导异常[3]。目前临床[4]多认为腕管综合     

早期腕管综合征39例神经电生理检测与临床分析

目的探讨电生理检测两种感觉传导检测潜伏期比较法与常规感觉传导法在早期腕管综合征诊断的敏感性与特异性及对临床诊疗的指导意义。方法正中神经运动神经传导速度正常,中指至腕感觉神经传导速度(SCV)减慢<44 m/s,加作环指到正中神经(环指→腕正中)、尺神经(环指→腕尺侧)的腕上相同距离的SCV及感觉潜伏期(DSL),正中神经和桡浅神经到拇指的潜伏期及其差值,并比较两者潜伏期差。结果环指比较法(80.4%)与拇指比较法(76.5%)检测的异常率显著高于常规感觉传导法SCV(43.1%)和DSL(47.1%)(P均<0.05)。结论在临床工作中常规肌电图及神经传导检测正常时,加作环指正中/尺神经潜伏期及拇指正中神经/桡浅神经潜伏期差,可显著提高早期腕管综合征诊断阳性率和敏感性。     

神经肌电图对腕管综合征的诊断意义分析

腕管综合征是临床上常见的一种疼痛症候群，症状以腕部以下正中神经支配区，尤其是手指等部位有麻、痛、胀感为主要特征。我科自1998年1月～2001年12月间共收集54例(59腕)腕管综合征患者，并对其进行神经肌电图检查，以探讨电生理检查对该症的诊断意义。现报道如下。     

53例腕管综合征神经电生理诊断分析

目的:分析腕管综合征(CTS)的神经电生理特点。方法:对CTS患者53例进行神经电生理检测,分析其特点。结果:正中神经远端运动潜伏期延长44例,正中神经运动传导未引出电位7例,正中神经传导正常2例;正中神经SCV测定消失17例,正中神经感觉潜伏期延长、波幅降低26例,SCV减慢10例。拇短展肌可见正峰及纤颤自发电位18例。结论:神经电生理检查在CTS的诊断中有重要意义。     

腕管综合征高频超声表现

腕管综合征系腕管内正中神经受到压迫引起的手指麻木等神经症状,是周围神经中最常见的卡压症之一.以往以电生理检查及临床表现为诊断依据,但电生理检查不能提供神经压迫所致形态学改变的信息[1],高频超声可发现外周神经形态学改变,是一种非常有效的检查方法[2].     

腕管综合征神经电生理诊断

目的:探讨神经电生理检测对非典型腕管综合征(CTS)的诊断价值。方法:对16例CTS患者测定双侧正中神经运动传导速度(MCV)和感觉传导速度(SCV),其中14例用微移法(inchingtechnique)检测腕部正中神经,13例行肌电图(EMG)检查。结果:16例CTS患者中,15例正中神经末端运动潜伏期(DML)延长(≥4.5ms);14例SCV减慢(<46m/s);14例微移法检测患者均有腕部正中神经传导阻滞(≥0.5ms/cm);13例肌电图检测患者中8例有神经源性肌电改变。正中神经微移法检测是4项检查中最为敏感的指标。结论:在临床症状不明显时,神经电生理检查是发现和诊断CTS最有效的方法之一。     

多发性硬化周围神经损害的临床与神经电生理分析

目的探讨多发性硬化（MS）患者合并周围神经损害的的临床和神经电生理特点。方法分析41例MS患者周围神经损害的临床，同时采用神经传导速度（NCV）技术检测MS患者周围神经的运动传导速度（MCV）、感觉传导速度（SCV）及其潜伏期、波幅；检测正中神经、胫神经F波、H反射的潜伏期和F波的出现率。结果MS合并PNS损害的发生率为41．4％，其临床表现主要为肢体麻木12例（29．2％）、肢体乏力10例（24．3％）、神经根性疼痛2例（4．8％）；体征有末梢／根型感觉障碍9例（21．9%）、腱反射减低5例（12．1％）、肌力减低（〈Ⅳ级）5例（12．1%）、肌萎缩3例（7．3%）。神经电生理改变为F波、H反射潜伏期延长，F波的出现率下降；神经电位波幅降低；不同程度运动感觉神经传导速度减慢及末端潜伏期延长。结论MS是一种以CNS受损为主的脱髓鞘疾病，部分患者可以同时累及PNS，神经电生理检测可对周围神经损害进行定位，同时可定量反映周围神经病变的程度。     

腕管综合征和肘管综合征的超声影像学研究

目的探讨超声在腕管综合征和肘管综合征中的诊断价值。方法80例健康者为对照组,临床疑诊27例腕管综合征和32例肘管综合征患者,超声测量其正中神经、尺神经的前后径、左右径及横截面积,同时测定神经传导速度。结果腕管综合征和肘管综合征组正中神经、尺神经的前后径、左右径及横截面积均大于对照组（P〈0．01）,腕管综合征和肘管综合征组的病变神经横截面积均与运动传导速度呈负相关（r分别为-0．76、-0．80）。结论超声可为腕管综合征和肘管综合征的诊断提供影像学依据,并对其治疗及疗效评价有重要价值。     

感觉神经传导检查比较法在诊断轻度腕管综合征中的应用

目的寻找诊断轻度腕管综合征（CTS）敏感的神经电生理指标。方法回顾性分析经吉林大学第一医院手外科医生临床诊断,并经手术治疗疗效确实,但常规电生理检查提示拇短展肌复合肌肉动作电位的潜伏期（CAMP）及示、中指感觉神经传导检查正常的患者80人,共92例手的腕管综合征患者进行神经电生理分析,采用顺向法记录掌腕正中、尺神经混合神经电位潜伏期时差和环指腕正中、尺神经感觉神经电位潜伏期时差,以潜伏期时差差值≥0．4ms为阳性指标,计算其阳性符合率,并进行统计学分析。结果掌腕正中、尺神经混合神经电位潜伏期时差≥0．4ms为64例,阳性率为69．56％;环指腕正中、尺神经感觉神经电位潜伏期时差≥0．4ms为83例,阳性率为90．21％。其中两种方法均为阳性的62例,均为阴性的7例。结论环指腕正中、尺神经感觉神经电位潜伏期时差在诊断轻度腕管综合征时具有较高的诊断价值。     

Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings.

OBJECTIVE: To describe the ultrasonographic and color Doppler ultrasonographic findings in 2 patients with carpal tunnel syndrome associated with a persistent median artery and to report the frequency of this anatomic variation in healthy volunteers. METHODS: Two patients with the clinical appearance of carpal tunnel syndrome and 100 wrists and distal forearms of 50 asymptomatic volunteers were examined with ultrasonography and color Doppler ultrasonography. The frequency and size of a persistent median artery and its relationship to median nerve anatomy in the carpal tunnel were evaluated. RESULTS: A large persistent median artery of 3 mm in diameter was found in the affected hands in both patients with carpal tunnel syndrome. Findings were confirmed at surgery. Among the asymptomatic volunteers, a persistent median artery could be found in 13 (26%, 10 [20%] unilateral and 3 [6%] bilateral), with a mean diameter of 1.1 mm (range, 0.5-1.7 mm). In 10 (63%) of 16 hands, the persistent median artery was associated with high division of the median nerve or a bifid nerve configuration in the carpal tunnel. CONCLUSIONS: A persistent median artery is a common condition in healthy individuals and in most cases is related to median nerve variations such as high division or a bifid nerve. Because a persistent median artery has a superficial course close to the transverse carpal ligament, preoperative diagnosis of this anatomic variation may be of clinical importance.     

Sensitivity of median sensory nerve conduction tests in digital branches for the diagnosis of carpal tunnel syndrome

OBJECTIVE: To compare the sensitivity of median sensory nerve conduction tests performed by stimulating digital branches in patients with carpal tunnel syndrome. DESIGN: A prospective study in 506 hands of patients with carpal tunnel syndrome diagnosed electrophysiologically. RESULTS: The sensitivity of median sensory nerve conduction tests across the first three digit-to-wrist segments and palm-to-wrist segment was determined. The most common abnormal electrophysiologic finding was the slowing of sensory nerve conduction velocity over the palm-to-wrist segment, which was detected in 98.5% of the hands. Slowing of sensory nerve conduction velocity over the digit 1-, 2-, and 3-to-wrist segments of the median nerve was found in 95.4%, 88%, and 82% of the hands, respectively. CONCLUSION: The sensory nerve conduction velocity test of the digit 1-to-wrist segment has the most sensitivity among the three digital branches of the median sensory nerve, and it may be used more widely in the electrodiagnosis of carpal tunnel syndrome.     

Ulnar nerve involvement in carpal tunnel syndrome

This is a retrospective study of the involvement of the ulnar nerve in patients with electrodiagnostic evidence of carpal tunnel syndrome as defined by median sensory nerve action potential (SNAP) greater than 3.6msec at the wrist and/or motor distal latency in excess of 4.3msec. The study included 248 patients, 63 (25%) with unilateral and 185 (75%) with bilateral carpal tunnel syndrome. The electrodiagnostic criteria for ulnar nerve involvement was a SNAP peak latency greater than 3.7msec and/or motor distal latency in excess of 4.2msec. One hundred fourteen patients (46%) had delayed ulnar SNAP peak at the wrist; of these, 100 cases had bilateral ulnar nerve involvement and 14 had unilateral abnormalities. Slowing of the motor nerve conduction velocity for the elbow-wrist segment was noted in 24% and 15% of the study group for the median and ulnar nerves, respectively. An incidental finding was the presence of "double crush syndrome" in 35 patients (14%). The results of this study suggest the frequent association of ulnar nerve involvement at the wrist for sensory fibers and carpal tunnel syndrome.     

Slowed conduction velocity of the median sensory nerve across the carpal tunnel in normal adults

OBJECTIVE: To examine the difference of using onset or peak latency in the segmental conduction study of the median nerve in normal adults without carpal tunnel syndrome. DESIGN: We investigated 60 hands of 30 young healthy adults (15 men and 15 women; mean age, 27.1 yrs; range, 18-36 yrs). We performed the mid-palm segmental conduction study using antidromic and orthodromic techniques in the median sensory nerves of the second and third digits and the onset and peak latencies of the proximal (wrist-palm) and distal (palm-digit) segments were measured. The distoproximal latency ratios were compared between onset and peak latencies and were compared with the ratios of the superficial radial sensory nerve. RESULTS: Distoproximal peak latency ratios in the median and superficial radial sensory nerves were always >1.0 in both the antidromic and orthodromic conduction studies. However, distoproximal onset latency ratios in the median sensory nerve were >1.0 in only 35% and 21.7% of second digits and in only 25% and 11.7% of third digits in orthodromic and antidromic studies, respectively (P < 0.05). The results of distoproximal onset latency ratios in the superficial radial sensory nerve were 93.3% in the orthodromic study and 86.7% in the antidromic study (P < 0.05). CONCLUSION: Prolongation of onset latency across the carpal tunnel during segmental conduction study of the median sensory nerve was common in healthy adults. When comparing proximal and distal segments for diagnosis of carpal tunnel syndrome, using onset latency as a diagnostic variable may cause greater reporting of false positives.     

Differences in sensory conduction velocity between different sensory branches and segments of the median and ulnar nerves

Abnormality of absolute values of median sensory conduction velocities and differences in conduction velocity between median and ulnar nerves are used as criteria for abnormality in the diagnosis of carpal tunnel syndrome. Detailed studies of sensory conduction in various median and ulnar branches and segments indicate that conduction velocities measured and calculated by standard methods are different in the different nerves, segments and branches. In particular, the velocity in the middle digit branch of the median nerve is slower than that in the index, and that in the 3-4 palmar branch is slower than that in the 2-3 palmar branch. Median and ulnar sensory conduction velocities are not well correlated in the same hand in the same individual, so comparison of these nerves for diagnostic purposes is subject to some risk. Palmar and digital conduction velocity in the same nerve may not be identical and the median nerve may have asymptomatic palmar slowing of no clinical significance. The conclusion that abnormality is present must take these factors into account.     

Carpal tunnel syndrome in patients on long-term hemodialysis

Sixteen cases with carpal tunnel syndrome (CTS) were reported out of 412 patients on long-term hemodialysis due to chronic renal failure. Clinical symptoms included numbness in the area innervated by the median nerve in 100% of symptomatic hands and pain in the wrist and hand in 81%. This pain usually became severer at night and during hemodialysis. Muscle atrophy was noted in 41% of the hands. Nerve conduction studies revealed prolonged distal sensory latency, slowed sensory nerve conduction velocity across the wrist and normal distal motor latency in 18%, prolonged distal motor latency in 51% and no response in motor or sensory stimulation in 31%. Evidence of denervation on electromyography was seen in 36% of the hands. Patients were conservatively treated avoiding daily activities precipitating the condition with volar wrist splint only at night in 18% and in 90% with steroid hormone injection in the carpal tunnel. Median nerve release was performed in 18% of the hands. Amyloid deposit was demonstrated in 3 of 4 operated hands. Although the relation between long-term hemodialysis and the occurrence of the amyloid deposition in the carpal tunnel has not been established, the present data along with other recent reports strongly indicate that amyloid deposit in the carpal tunnel on hemodialysis patients could be one of the most possible cause of CTS.