Short-distance sensory stimulation technique in the early diagnosis of carpal tunnel syndrome

Betül Çevik; Ali Baysal

Short-distance sensory stimulation technique in the early diagnosis of carpal tunnel syndrome

Year 2013, Volume: 35 Issue: 4, 495 - 502, 05.09.2013

Betül Çevik Ali Baysal

Abstract

Abstract

Aim. Normal results obtained from nerve conduction studies do not exclude the diagnosis of carpal tunnel syndrome (CTS). We intended to increase diagnostic sensitivity of nerve conduction studies in the early stage CTS by stimulating shorter palm-wrist segment, and excluding distal region outside the entrapment site of the median nerve which is unaffected from pathologic changes. Methods. In this prospective study, 41 patients (66 hands) with clinically diagnosed CTS with normal conventional electrophysiologic examinations were stimulated with electrodes placed at 8, 7, 6, 5, 4 cm from the distal wrist crease (DWC) on the palm-wrist segment, and the conduction velocities, latencies, and the differential latencies (conduction delay) were compared with those of 34 patients (68 hands) in the control group. Results. Conduction delay recorded between 4-5, 5-6, 6-7, 7-8 cm. away from DWC of both groups was statistically insignificant (p>0.1), while the conduction velocities and the latencies obtained from the electrodes placed on 4, 5, 6, 7, and 8 cm away from DWC differed statistically significantly between two groups (p<0.001). Conclusion. In electrophysiologic examinations performed to confirm the diagnosis of CTS, assessment of shorter palm-wrist segment, and stimulation of a predetermined location 4 or 5 cm distal to DWC are sufficient to detect a slight and localized conduction delay in the carpal tunnel. This method eliminated slowing-down effect of distal segment on normal nerve conduction velocities yielding higher degrees of (up to 92.4 %) sensitivity.

Keywords: Carpal tunnel syndrome, nerve conduction studies, palm-wrist conduction, short-distance stimulation

Özet

Amaç. Sinir iletim çalışmalarının normal olması karpal tünel sendromu (KTS) tanısını dışlamaz. Biz bu çalışmada, erken evre KTS’de avuçiçi-bilek segmentindeki mesafeyi daha kısa tutup, median sinirin tuzaklanma bölgesi dışındaki, henüz patolojik değişikliklerden etkilenmemiş distal bölgesini çıkararak, KTS tanısında duyarlılığı artırmayı amaçladık. Yöntem. Bu prospektif çalışmada, klinik olarak KTS tanısı konan, konvansiyonel elektrofizyolojik incelemeleri normal olan 41 olguda (66 el), avuçiçi-bilek segmentinde; distal bilek çizgisinden (DBÇ) sırasıyla 8, 7, 6, 5, 4 cm mesafelerden uyarım yapılmış, bu mesafelerdeki hız, latans ve latanslar arası farkları (iletim gecikmesi), kontrol grubundaki 34 olgunun (68 el) verileriyle karşılaştırılmıştır. Bulgular. 4-5, 5-6, 6-7, 7-8. cm.’ler arası latans farkı (iletim gecikmesi) her iki grup arasında istatistiksel olarak anlamsız olup (p>0.1); 4, 5, 6, 7, 8. cm.’lerdeki hız, latans değerleri her iki grup arasında istatistiksel olarak anlamlı bulunmuştur (p<0.001). Sonuç. KTS tanısını doğrulamak için yapılan elektrofizyolojik incelemede, avuçiçi-bilek segmentinde, mesafenin daha kısa tutulup, uyarımın DBÇ’nin 4 ve/veya 5 cm distalinden yapılması, karpal tüneldeki hafif ve lokalize iletim gecikmesini tespit etmede yeterlidir. İletim hızı normal olan distal segmentin hafifletici etkisinin ortadan kalkmasıyla duyarlılık %92,4’e yükselmiştir.

Anahtar sözcükler: Karpal tünel sendromu, sinir ileti çalışmaları, avuçiçi-bilek iletimi, kısa mesafe stimulasyon

Keywords

Carpal tunnel syndrome, nerve conduction studies, palm-wrist conduction, shortdistance stimulation

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