Practice Parameter and Literature Review of the Usefulness of ...

Practice Parameter: Carpal Tunnel Syndromeelectrodiagnosis.96. Hansson S. The association between nerve conduction velocity andthe compound action potential amplitude during ischemic blocking.Electromyogr Clin Neurophysiol 1999;39:113-122. Criteria Met (3/6:1,3,4) Source: Medline Search. Abstract: Ischemia was produced byinflating a tourniquet around the upper arm in five healthy subjects.When antidromic median sensory NCV and SNAP amplitudes wererecorded from the third digit with stimulation at the elbow, wrist andpalm, the amplitude and CV decreased in parallel. This sequence ofchanges duplicates the blocking of nerve conduction during wristflexion in healthy subjects and CTS patients described previously(Hansson 1995).97. Hansson S, Nilsson BY. Median sensory nerve conduction blockduring wrist flexion in the carpal tunnel syndrome. Electromyogr ClinNeurophysiol 1995;35:99-105. Criteria Met (5/6: 1,2,3,5,6) Source:Medline Search. Abstract: Prospective study of the effect ofprolonged passive wrist flexion on median and ulnar sensoryamplitude and latency in 10 normal controls and 30 CTS patients witha clinical diagnosis of CTS of whom 10 had mild abnormalities ofmedian sensory latency measurements: digit wrist CV 0.4 ms.During prolonged (up to 45 min) passive wrist flexion, the antidromicmedian (wrist to 2nd finger) and ulnar (wrist to 5th finger) SNAPwere recorded. The measurements were made every 2.5 min duringsustained passive wrist flexion for up to 45 min and the time (T50) forthe amplitude to fall to 50% of the initial amplitude determined. Themedian sensory conduction (but not the ulnar) became partiallyblocked in all CTS patients and also in 8 out of 10 controls. Mediansensory nerve conduction returned to normal in all subjects 30seconds after release of flexion. At 10 minutes of wrist flexion, nosignificant increase of the median SNAP peak latency in normalsubjects (mean 0.01 ± 0.04 ms) and CTS patients (mean 0.24 ± 0.26ms) was noted. The time (T50) necessary to reach a 50% reduction inmedian SNAP amplitude in 8 out of 10 probable CTS patients and in14 out of possible 20 CTS patients was below the lowest recordedvalue in the control group (25 min). It was shown that ischemiacaused the block (reduction in median SNAP amplitude) bydemonstrating (1) that the reversal of a 70% block with release ofwrist flexion was prevented by inflating a pneumatic cuff around theupper arm to above systolic pressure for 5 minutes before release ofwrist flexion after which (2) the SNAP amplitude returned to normal30 seconds after deflating the cuff. Determination of T50 of themedian nerve SNAP during wrist flexion has the potential to add tothe sensitivity and specificity of the electrophysiological diagnosis ofCTS.98. Harmon RL, Naylor AH. Sensory and mixed nerve action potentialtemporal dispersion in median neuropathy at the wrist. Am J PhysMed Rehabil 1999;78:213-215. Criteria Met (1/6: 6) Source: MedlineSearch. Abstract: Retrospective study to determine the usefulness ofmeasuring SNAP and mixed nerve AP temporal dispersion todiagnose CTS demonstrated that increased median mixed nerve APtemporal dispersion may occur in association with peak latencyprolongation in CTS. However, the small magnitude of the increasemakes the clinical usefulness of this observation unclear.99. Healy C, Watson JD, Longstaff A, Campbell MJ. Magnetic resonanceimaging of the carpal tunnel. J Hand Surg Br 1990;15:243-248.Criteria Met (3/6: 1,2,3) Source: Medline Search.100. Herrick RT, Herrick SK. Thermography in the detection of carpaltunnel syndrome and other compressive neuropathies. J Hand SurgAm 1987;12:943-949. Criteria Met (1/6: 1) Source: Medline Search.101. *Holmgren H, Rabow L. Internal neurolysis or ligament division onlyin carpal tunnel syndrome. II. A 3 year follow-up with an evaluationof various neurophysiological parameters for diagnosis. ActaNeurochir (Wien) 1987;87:44-47. Criteria Met (2/6: 1,2) Source:Medline Search.102. *Holmgren-Larsson H, Leszniewski W, Linden U, Rabow L,Thorling J. Internal neurolysis or ligament division only in carpaltunnel syndrome—results of a randomized study. Act Neurochir(Wien) 1985;74:118-121. Criteria Met (0/6) Source: Holmgren, 1987.103. *Homan MM, Franzblau A, Werner RA, Albers JW, Armstrong TJ,Bromberg MB. Agreement between symptom surveys, physicalexamination procedures and electrodiagnostic findings for the carpaltunnel syndrome. Scand J Work Environ Health 1999;25:115-124.Background Reference. Source: Medline Search. Abstract: The goalof this study was to evaluate the concordance between various clinicalscreening procedures for carpal tunnel syndrome. The subjectpopulation consisted of 824 workers from 6 facilities. The proceduresevaluated included bilateral median sensory nerve conduction testing,physical examinations, and symptom surveys, including handdiagrams. The agreement between the outcomes of variouscombinations of these procedures was assessed by determining thekappa coefficient. There was relatively poor overlap between thereported symptoms, the physical examination findings, and theelectrodiagnostic results consistent with carpal tunnel syndrome.Overall, only 23 out of 449 subjects (5%) with at least 1 positivefinding met all 3 criteria (symptoms, physical examination findings,and electrophysiological results consistent with carpal tunnelsyndrome) for the dominant hand. The screening procedures showedpoor or no agreement with kappa values ranging between 0.00 and0.18 for all the case definitions evaluated for carpal tunnel syndrome.The poor overlap between the various screening procedures warnsagainst the use of electrodiagnostic findings alone without thesymptom presentation being considered. The results of this study alsopoint to a need for the further development and evaluation of methodsfor detecting carpal tunnel syndrome.104. Hughes ACR. An evaluation of 2 electrodiagnostic procedures inpatients with symptoms of a carpal tunnel syndrome.Electroencephalogr Clin Neurophysiol 1977;43:140. Criteria Met(0/6) (abstract only) Source: AAEM Consultant 1993.105. *Imai T, Matsumoto H, Minami R. Asymptomatic ulnar neuropathyin carpal syndrome. Arch Phys Med Rehabil 1990;71:992-994.Criteria Met (3/6: 1,3,5) Source: Medline Search.106. Imaoka H, Yorifuji S, Takahashi M, Nakamura Y, Kitaguchi M, TaruiS. Improved inching method for the diagnosis and prognosis of carpaltunnel syndrome. Muscle Nerve 1992;15:318-324. Criteria Met (5/6:2,3,4,5,6) Source: Medline Search. Abstract: A modified sensory“inching” method for the electrodiagnosis of CTS is described. Themedian nerve as stimulated at the cubital segment with 8 channelrecording electrodes placed at 15 mm intervals along the mediannerve from a point 3 cm proximal to the distal wrist crease up to themiddle finder. Eight consecutive SNAP were recorded and thenegative peak latency measured. Each latency (ms) was plottedagainst distance (mm). The results were a linear relationship (1) fromchannel 1 to 8 in 32 normal subjects and (2) from channel 1 to at leastchannel 4 in CTS patients. In 73 of 84 (87%) limbs of CTS patients,there was a conductive abnormality in the distal recordings asdetermined by discontinuous changes in the SNAP latency (greaterthan 0.6 ms) or amplitude (absence of response). The results suggestthat this method provides high sensitivity and specificity for thediagnosis of CTS. A prospective study with comparison to currenttechniques would help determine whether or not the technique hasadvantages over current recommended techniques.107. Iyer V, Fenichel GM. Normal median nerve proximal latency incarpal tunnel syndrome: a clue to coexisting Martin-Gruberanastomosis. J Neurol Neurosurg Psychiatry 1976;39:449-452.Background Reference. Source: AAEM Consultant 1993.108. Jablecki CK, Andary MT, Di Benedetto M, Horowitz SH, Marino RJ,Rosenbaum RB, Shields RW, Stevens JC, Williams FH. AmericanAssociation of Electrodiagnostic Medicine. Guidelines for outcomestudies in electrodiagnostic medicine. Muscle Nerve 1996;19:1626-1635. Source: AAEM 2000 CTS Task Force member.109. Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH.Literature review of the usefulness of nerve conduction studies andelectromyography for the evaluation of patients with carpal tunnelsyndrome. Muscle Nerve 1993;16:1392-1444. Background Reference.Source: AAEM 2000 CTS Task Force member.110. Jackson D, Clifford JC. Electrodiagnosis of mild carpal tunnelsyndrome. Arch Phys Med Rehabil 1989;70:199-204. Criteria Met(6/6: 1,2,3,4,5,6) Source: Medline Search. Abstract: This studyevaluated the following techniques: (a) median nerve stimulation inthe palm and recording proximal at the wrist (8 cm), (b) sensorylatency difference between median and radial stimulation at the wristand recording on the thumb (10 cm), (c) medial-ulnar sensory latencydifference with stimulation at the wrist and recording on the ringfinger (14 cm), (d) median-ulnar sensory latency difference withstimulation in the palm and recording at the wrist (8 cm), and (e)Muscle & Nerve Supplement X 2002 S965