神经电生理检测对腕管综合征临床诊断的意义

目的探讨神经电生理检测对诊断腕管综合征(CTS)的临床意义。方法对42例(74侧)CTS患者正中神经的神经电位、传导速度测定,拇短展肌、小指展肌肌电图(EMG)检查,并与30例(60侧)正常者对比分析。结果42例(74侧)CTS患者做神经电生理检测,正中神经感觉传导异常100%,其中感觉传导速度(SCV)减慢85.1%,感觉电位潜伏期(DSL)延长89.2%,感觉电位波幅(SNAP)降低24.3%,感觉动作电位未引出4侧;正中神经运动传导异常97.3%,其中运动传导速度(MCV)减慢5.4%,运动末端潜伏期(DML)延长83.8%,运动电位波幅(CMAP)降低20.3%,运动动作电位未引出3侧。CTS组患者正中神经SCV、DSL、SNAP、DML、CAMP与对照组比较,差异有统计意义(P0.05)。CTS组74块拇短展肌57块(77.0%)呈神经源性损害改变。结论神经电生理检测对早期诊断CTS、确定正中神经的损伤程度具有重要价值,是临床诊断CTS的重要手段。     

糖尿病合并腕管综合征的电生理特征

目的探讨糖尿病患者腕管综合征(carpaltunnelsyn-drome,CTS)的发病情况及电生理表现。方法对223例2型糖尿病患者进行常规的神经—肌电图检测。结果223例患者中检出CTS34例,男13例,女21例,主要表现为正中神经(拇短展肌—腕)运动传导潜伏时延长,(指Ⅰ—腕)感觉传导速度减慢,波幅降低,拇短展肌松弛状态见失神经表现。结论腕管综合征在糖尿病患者中有较高的发病率,其电生理表现与一般腕管综合征各项指标无明显差异。     

糖尿病合并腕管综合征的电生理特征

目的 探讨糖尿病患者腕管综合征(carpal tunnel syndrome，CTS)的发病情况及电生理表现。方法对223例2型糖尿病患者进行常规的神经-肌电图检测。结果223例患者中检出CTS34例，男13例，女21例，主要表现为正中神经(拇短展肌-腕)运动传导潜伏时延长，(指I-腕)感觉传导速度减慢，波幅降低，拇短展肌松弛状态见失神经表现。结论腕管综合征在糖尿病患者中有较高的发病率，其电生理表现与一般腕管综合征各项指标无明显差异。主题词：腕管综合征／病理生理学；糖尿病／并发症；神经传导；肌电描记术；正中神经     

腕管综合征40例电生理检查分析

腕管综合征是常见的神经嵌压外周神经病,主要为各种原因致腕管内压力增高,正中神经在腕管内受卡压而产生其相应支配区的神经功能障碍的综合征。对我科2002-01/2007-11诊治40例分析如下。1临床资料1.1一般资料本组男9例,女31例,年龄26~64(平均41)岁,病程3个月~12 a。其中家庭妇女27例,公务员2例,农民7例,会计4例,合并糖尿病者2例,颈椎病者6例。临床表现均为腕以下手指麻木,疼痛,夜间尤甚,以桡侧3指为重,大鱼际肌萎缩17例,双侧发病者15例。1.2方法使用丹麦keypo in t肌电诱发电位仪,室温25℃左右,皮温保持30℃左右,采用顺向性感觉,运动神经传导速度检测法,检测正中神经指2→腕感觉神经传导速度及正中神经运动神经传导速度(肘→腕),腕部刺激拇短展肌记录复合肌肉动作电位潜伏期及波幅,同时刺激环指,分别记录并比较尺神经正中神经感觉神经传导速度及波幅,并对拇短展肌做针极肌电图。2结果本组正中神经指2→腕感觉神经传导速度未测出15例,减慢21例,波幅降低者18例,刺激环指分别记录并比较尺神经,正中神经感觉神经动作电位潜伏期之差值≥0.4 m s者39例,刺激患侧正中神经,拇短展肌记录...     

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。     

正中神经松解术联合屈肌腱滑膜切除治疗腕管综合征的疗效

目的 探讨正中神经松解术联合屈肌腱滑膜切除治疗腕管综合征(CTS)的疗效.方法 选择2017年1月至2018年12月上海德济医院诊治的CTS患者117例为研究对象,按照手术方式不同分为观察组(74例,接受正中神经松解术联合屈肌腱滑膜切除治疗)和对照组(43例,接受正中神经松解术治疗).比较两组疗效,手术前后握力、捏力、上肢功能评定量表(DASH)评分、上肢功能指数量表(UEFI)评分、Levine CTS问卷调查表结果,以及拇短展肌肌肉复合动作电位(CMAP)、中环指感觉神经动作电位(SNAP)的潜伏期和波幅.结果 观察组的疗效优良率为95.95％,高于对照组的81.40％,差异有统计学意义(P<0.05).治疗后两组握力、捏力、UEFI评分、拇短展肌CMAP波幅、中环指SNAP潜伏期和波幅较治疗前明显升高,DASH评分、症状评分、功能评分、钝痛评分、夜间症状评分、拇短展肌CMAP潜伏期较治疗前明显降低,差异有统计学意义(P<0.05).治疗后观察组握力、捏力、UEFI评分,以及拇短展肌CMAP波幅、中环指SNAP潜伏期和波幅高于对照组,DASH评分、症状评分、功能评分、钝痛评分、夜间症状评分,以及拇短展肌CMAP潜伏期低于对照组,差异有统计学意义(P<0.05).结论 正中神经松解术联合屈肌腱滑膜切除治疗CTS疗效显著,能够促进腕关节功能恢复,改善患者症状.     

肌电图与神经传导速度对Graves病患者神经肌肉受损的评估

目的:应用肌电图和神经传导速度检查探讨Graves病神经肌肉受损的临床诊断意义。方法:于2000-05/2003-12选择汕头大学医学院第一附属医院内分泌专科门诊的Graves病患者46例为研究对象,行肌电图和神经传导速度检查;正常对照组31例为健康志愿者,31例行肌电图检查,30例行神经传导速度检查。肌电图检测:用同心圆针电极观察三角肌、股四头肌自发电位及募集形式,记录及分析小力收缩时每块肌肉20个运动单位电位平均时限及去多相波平均时限、波幅和多相波百分比。神经传导速度检测:用表面电极分别在腕部刺激正中神经和内踝胫后神经,于外展拇短肌及拇展肌用表面电极记录正中神经和胫后神经运动末端潜伏期和复合肌肉动作电位。用指环电极分别刺激拇指、中指和趾1,用表面电极于腕部及内踝记录测定感觉神经传导速度及波幅,包括正中神经(拇指-腕,中指-腕)和胫后神经(趾1-内踝)。并用超强电刺激在正中神经腕部及胫后神经踝部检测F波潜伏期及出现率。结果:纳入受试对象77例,均进入结果分析。①Graves病组患者肌电图示小力收缩后时限缩短、波幅降低,大力收缩后其峰波幅降低。Graves病组胫后感觉神经复合肌肉动作电位波幅与正常对照组比较降低;正中感觉神经拇指-腕复合肌肉动作电位波幅降低;正中神经中指-腕感觉神经传导速度减慢;Graves病组正中神经F波潜伏期延长和异常出现率增加。②46例Graves病患者有神经肌肉临床症状26例(56%),肌电图异常39例(85%);神经传导速度异常41例(89%);以肌电图异常判断神经传导速度异常敏感性为83%,特异性为87%;以神经传导速度异常判断肌电图异常敏感性为87%,特异性为83%。结论:两种方法对Graves病神经肌肉损伤诊断敏感性高于临床症状,对慢性甲状腺功能亢进性肌病诊断异常率、敏感性和特异性相近;肌电图主要对肌源性损害敏感,神经传导速度主要对神经源性损害敏感,具互补性。     

腕管综合征279例神经电生理分析

目的探讨电生理检查指标在腕管综合征(CTS)诊断中的应用价值。方法以CTS患者279例为观察组,健康志愿者228例为对照组,行神经电生理检测。结果两组末梢运动潜伏期(DML)、复合肌肉动作电位(CMAP)波幅、前臂段运动传导速度(f MCV)、感觉神经动作电位(SNAP)波幅及腕-食指感觉传导速度(SCV)比较,差异均有统计学意义(P0.05);尺神经电生理指标间差异均无统计学意义(P0.05)。结论 CTS的诊断需要结合多项电生理检查指标以减少疾病的漏诊。     

肌电图与神经传导速度对Graves病患者神经肌肉受损的评构

目的应用肌电图和神经传导速度检查探讨Graves病神经肌肉受损的临床诊断意义.方法于2000-05/2003-12选择汕头大学医学院第一附属医院内分泌专科门诊的Graves病患者46例为研究对象,行肌电图和神经传导速度检查;正常对照组31例为健康志愿者,31例行肌电图检查,30例行神经传导速度检查.肌电图检测用同心圆针电极观察三角肌、股四头肌自发电位及募集形式,记录及分析小力收缩时每块肌肉20个运动单位电位平均时限及去多相波平均时限、波幅和多相波百分比.神经传导速度检测用表面电极分别在腕部刺激正中神经和内踝胫后神经,于外展拇短肌及拇展肌用表面电极记录正中神经和胫后神经运动末端潜伏期和复合肌肉动作电位.用指环电极分别刺激拇指、中指和趾1,用表面电极于腕部及内踝记录测定感觉神经传导速度及波幅,包括正中神经(拇指-腕,中指-腕)和胫后神经(趾1-内踝).并用超强电刺激在正中神经腕部及胫后神经踝部检测F波潜伏期及出现率.结果纳入受试对象77例,均进入结果分析.①Graves病组患者肌电图示小力收缩后时限缩短、波幅降低,大力收缩后其峰波幅降低.Graves病组胫后感觉神经复合肌肉动作电位波幅与正常对照组比较降低;正中感觉神经拇指-腕复合肌肉动作电位波幅降低;正中神经中指-腕感觉神经传导速度减慢;Graves病组正中神经F波潜伏期延长和异常出现率增加.②46例Graves病患者有神经肌肉临床症状26例(56%),肌电图异常39例(85%);神经传导速度异常41例(89%);以肌电图异常判断神经传导速度异常敏感性为83%,特异性为87%;以神经传导速度异常判断肌电图异常敏感性为87%,特异性为83%.结论两种方法对Graves病神经肌肉损伤诊断敏感性高于临床症状,对慢性甲状腺功能亢进性肌病诊断异常率、敏感性和特异性相近;肌电图主要对肌源性损害敏感,神经传导速度主要对神经源性损害敏感,具互补性.     

尺神经共同刺激影响腕管综合征正中神经远端潜伏期：避免误差的定量测定

目的研究尺神经-大鱼际复合肌肉动作电位(CMAP)潜伏期正常值,以定量分析尺神经共同刺激所致腕管综合征(CTS)患者正中神经-大鱼际潜伏期的误差。 方法正常组112例,记录224侧正中神经-拇短展肌（APB）和224侧尺神经-大鱼际的CMAP潜伏期和波幅。另对其中10例20侧正中神经,分别记录以正中神经-APB最大波幅之刺激强度的30%、50%、70%、100%刺激时的CMAP潜伏期和波幅。其中4例分别予以120%、150%和200%的超强刺激,记录CMAP潜伏期和波幅。CTS组16例,记录到正中神经-APB的CMAP最大波幅后,继续增大刺激强度,记录尺神经共同刺激效应后的正中神经-大鱼际CMAP。 结果①正常组：尺神经-大鱼际远端潜伏期为（3.17±0.25）ms,波幅为（6.60±1.07）mV;正中神经-APB远端潜伏期为(3.45±0.31)ms,波幅为(6.47±1.08)mV。当正中神经刺激强度从引出最大CMAP波幅之强度的30%、50%、70%增加至100%,正中神经远端潜伏期相应缩短0.1~0.3ms;达到最大波幅后继续增加刺激强度至120%、150%和200%的超强刺激,则潜伏期不再继续缩短。②CTS组：尺神经共同刺激所引起的正中神经-大鱼际CMAP潜伏期缩短范围为0.5~8.7ms,导致正中神经-APB的错误潜伏期范围为(2.9~4.1)ms。 结论CTS患者正中神经检测时,若正中神经-APB CMAP潜伏期随刺激强度增大而缩短超过0.3ms,并且达到2.9~4.1ms的范围,则提示可能发生了尺神经共同刺激。     

Electrodiagnosis of mild carpal tunnel syndrome

Electrophysiologic tests have been reported to detect mild carpal tunnel syndrome (CTS). Such tests include (i) absolute palmar latency of median wrist segment; (ii) comparison of median and radial distal sensory latencies in digit I; (iii) comparison of median and ulnar distal sensory latencies in digit IV; (iv) comparison of median and ulnar palmar latencies; (v) comparison of median and ulnar sensory potential amplitudes in digits II and V. To clarify the clinical utility of these tests, the parameters of all five tests were determined across four carefully established patient subgroups: group A, controls; group B, CTS referrals with normal nerve conduction studies (NCS) and normal needle electromyography (EMG); group C, CTS referrals with abnormal NCS and normal EMG; group D, CTS referrals with abnormal NCS and abnormal EMG. Special attention was focused on patients in group B who represent the diagnostic dilemma. In group B, tests ii and iii each yielded abnormal results in 44% of hands, while the combination of tests ii and iii yielded abnormal results in 51% of hands.     

Second lumbrical muscle recordings improve localization in severe carpal tunnel syndrome

OBJECTIVE: To determine how often the second lumbrical motor potential is present when the abductor pollicis brevis (APB) motor potential is absent in severe carpal tunnel syndrome (CTS). DESIGN: Prospective study of consecutive patients with severe CTS and an absent motor potential from the APB. SETTING: Single-center public hospital-based electromyography lab. PARTICIPANTS: Patients with a clinical diagnosis of CTS who had an absent median sensory response and an absent median motor response to APB on routine nerve conduction testing. Twenty-two hands of 19 patients were examined. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Presence and distal latency of motor potential to the second lumbrical. RESULTS: The second lumbrical potential was present in 17 hands (77%). The distal motor latency to the second lumbrical was prolonged in all (mean, 9.1ms; normative value, <4.1ms). CONCLUSIONS: Second lumbrical recordings improve localization in many patients with severe CTS when routine median sensory and motor conduction studies produce no potentials.     

Sensory palmar stimulation in the diagnosis of carpal tunnel syndrome

The measurement of motor and sensory latencies of the median and ulnar nerves using conventional techniques in able-bodied subjects and patients with a history compatible with carpal tunnel syndrome (CTS) is described. The results obtained by conventional techniques are compared with measurement of median nerve sensory latency obtained by palmar stimulation and the difference of median-ulnar nerve distal sensory latencies. It is concluded that the use of measurement of median palmar sensory latency under the flexor retinaculum adds to the sensitivity of the nerve conduction studies in the diagnosis of CTS. It is suggested that, in patients with suspected CTS in whom conventional nerve conduction studies are normal, other techniques such as the measurement of palmar sensory latency, difference between median and ulnar nerve distal sensory latency and examination of all the digits should be carried out.     

Somatosensory cortical plasticity in carpal tunnel syndrome--a cross-sectional fMRI evaluation

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve characterized by paresthesias and pain in the first, second, and third digits. We hypothesize that aberrant afferent input in CTS will lead to cortical plasticity. Functional MRI (fMRI) and neurophysiological testing were performed on CTS patients and healthy adults. Median nerve innervated digit 2 (D2), and digit 3 (D3) and ulnar nerve innervated digit 5 (D5) were stimulated during fMRI. Surface-based and ROI-based analyses consistently demonstrated more extensive and stronger contralateral sensorimotor cortical representations of D2 and D3 for CTS patients as compared to healthy adults (P < 0.05). Differences were less profound for D5. Moreover, D3 fMRI activation in both the contralateral SI and motor cortex correlated positively with the D3 sensory conduction latency. Analysis of somatotopy suggested that contralateral SI representations for D2 and D3 were less separated for CTS patients (3.8 +/- 1.0 mm) than for healthy adults (7.5 +/- 1.2 mm). Furthermore, the D3/D2 separation distance correlated negatively with D2 sensory conduction latency-the greater the latency, the closer the D2/D3 cortical representations (r = -0.79, P < 0.05). Coupled with a greater extent of SI representation for these CTS affected digits, the closer cortical representations can be interpreted as a blurred somatotopic arrangement for CTS affected digits. These findings provide further evidence that CTS is not manifest in the periphery alone. Our results are consistent with Hebbian plasticity mechanisms, as our cohort of CTS patients had predominant paresthesias, which produce more temporally coherent afferent signaling from affected digits.     

脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理特征的影响

目的:探讨脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理参数的影响。方法:纳入20例脑卒中伴肩关节半脱位的患者,分别对患者双上肢肩胛上神经、腋神经、肌皮神经、桡神经、正中神经、尺神经的运动神经传导及桡神经、正中神经、尺神经的感觉神经传导进行评估,并对偏瘫上肢冈上肌、三角肌、肱二头肌、伸指总肌、拇短展肌和小指展肌进行静息...     

正中神经返支卡压征的电生理研究

目的 探讨正中神经返支卡压征的临床与电生理特点。方法 总结14例正中神经返支卡压征患者的临床与电生理资料，其中男10例，女4例，平均年龄34．7岁，应用肌电诱发电位仪进行神经电生理检测。结果 14例患者正中神经末梢运动潜伏时延长，11例复合肌肉动作电位波幅降低，14例感觉传导速度、感觉动作电位波幅正常，12例前臂段运动传导速度正常；12例拇短展肌、14例拇指对掌肌见纤颤电位和／或正锐波；14例旋前方肌、小指展肌与指浅屈肌肌电图检测均正常。结论 神经电生理检测是诊断和鉴别诊断正中神经返支卡压征的可靠手段，能为临床提供客观、准确的诊断指标。     

正中神经压迫试验对腕管综合征神经传导速度的影响

目的比较正中神经压迫试验对腕管综合征（carpal tunnel syndrome,CTS）患者正中神经传导速度的影响。方法设置CTS组和对照组两个组别,共29例受试者纳入研究。CTS组为14例CTS患者,对照组为15例健康受试者。神经传导速度测定包括正中神经和尺神经的感觉传导末端潜伏期（distal sensory latency,DSL）、感觉神经动作电位（sensory nerve action potential,SNAP）、跨腕关节感觉传导速度（sensory conduction velocity,SCV）、运动传导末端潜伏期（distal motor latency,DML）及复合肌肉动作电位（compound muscle action potential,CMAP）。先测感觉传导,再测运动传导。正中神经压迫试验5min后再次测量上述指标。结果正中神经压迫试验前后电生理检查考虑诊断CTS分别为22侧和24侧。压迫正中神经后,CTS组正中神经DSL较压迫前显著延长（P〈0.05）。CTS组尺神经和对照组正中神经及尺神经的各参数在压迫前后均无显著改变（P〉0.05）。与对照组相比,在压迫试验前后CTS组的正中神经DSL和DML均明显延长（P〈0.05）,尺神经DSL和DML均无显著改变（P〉0.05）。结论正中神经压迫试验5min能使CTS患者正中神经的感觉传导末端潜伏时明显延长,有助于提高神经传导测定对早期CTS的诊断率。     

干燥综合征伴周围神经病变的临床电生理与病理特点

目的 探究干燥综合征伴周围神经病变的临床电生理与病理特点.方法 以2018年1月至2021年1月收治的50例干燥综合征伴周围神经病变患者为试验组,同时以50例干燥综合征不伴周围神经病变患者为对照组.分析试验组临床电生理以及病理特点,比较两组患者临床表现的差异性.结果 试验组感觉神经传导异常患者中,10.00％为尺神经受...     

Effect of gender on orthodromic sensory nerve action potential amplitude

OBJECTIVE: Studies in the literature have demonstrated a gender effect on sensory nerve action potential (SNAP) amplitude for the median and ulnar nerves by use of the antidromic method of recording. The objective of this study was to determine if performing orthodromic sensory nerve stimulation eliminates the gender bias by removing the finger circumference as a variable. METHODS: Fifty-five healthy subjects participated in the study. The mean age of the subjects was 37.8 +/- 5.9 yr and 35.3 +/- 5.9 yr for men and women, respectively. Orthodromic sensory nerve conduction studies were performed for the median and ulnar nerves measuring the SNAP amplitude by use of standard electrophysiologic technique. RESULTS: The mean finger circumference of the third digit was 6.5 +/- 0.58 cm for men and 5.9 +/- 0.47 cm for women, and for the fifth digit, it was 5.6 +/- 0.41 cm for men and 5.3 +/- 0.37 cm for women. The median SNAP amplitude and their percentiles of 2.5 and 97.5 for the median nerve were 30.0 microV for men and 28.0 microV for women. For the ulnar nerve, they were 16.5 microV for men and 16.0 microV for women. CONCLUSION: The study confirmed that orthodromic sensory nerve stimulation did not have any significant effect on SNAP amplitude between men and women.     

Physiological Localization by Sensory and Motor Inching Studies and Structural Abnormalities Detected by Ultrasonographic Changes in Carpal Tunnel Syndrome

ObjectiveTo study mild to moderate carpal tunnel syndrome (CTS), compare median nerve entrapment sites detected by electrophysiological inching studies with ultrasonographic abnormalities of cross-sectional area (CSA), and correlate focal points of conduction delays detected by sensory and motor inching recorded from the third digit and second lumbrical muscle.DesignAnalytic cross-sectional study.SettingDepartment of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.ParticipantsHands from 10 participants without CTS (n=15) and hands with mild to moderate CTS from 29 participants (n=40) were selected by convenience sampling (N=55).InterventionsNot applicable.Main Outcome MeasuresCorrelation of electrophysiological entrapment site localization by inching study with anatomic entrapment site detected by ultrasound (US).ResultsIn all 40 hands tested, a sharply localized latency was found to increase across a 1-cm segment, most commonly 2-3 cm distal to the distal wrist crease for both sensory and motor studies, showing a good match between the 2 with Pearson correlation coefficient value (r=0.72). US revealed a narrowing CSA of the median nerve at 1-2 cm distal to the distal wrist crease.ConclusionsThis study showed a high correlation for focal point conduction delay detected by sensory and motor nerve conduction study. Recording from the second lumbricalis facilitated motor inching along the straight course of the nerve instead of the arcuate recurrent branch innervating the abductor pollicis brevis, the muscle traditionally used. US examination also revealed a localized narrowing of the median nerve CSA at 1-2 cm distal to the distal wrist crease, a possible site for anatomic entrapment. The most enlarged CSA was seen at the distal wrist crease, a level corresponding to the inlet of the carpal tunnel.