Evaluation Of The Compound Muscle Action Potential In Diagnosis Of The Mild Carpal Tunnel Syndrome

Yıl 2016, Special Issue (2016), 266 - 270, 01.12.2016

Veysel Alcan , Murat Zinnuroğlu Gülçin Kaymak Karataş Mehmet Rahmi Canal

https://doi.org/10.18100/ijamec.280468

Öz

Carpal tunnel syndrome (CTS) is the most common entrapment
neuropathy. In most patients, the diagnosis can be proposed based on patient
history and clinical symptoms, with electrophysical findings. The mild CTS may
not produce any nerve conduction abnormalities and this can make standard
conventional tests not enough in diagnosis the mild CTS. The aim of this study
was to evaluate Compound Muscle Action Potential (CMAP) morphology as more sensitive
and specific parameters without any additional testing for diagnosis the mild
CTS. A total of seventy seven clinically diagnosed patients with CTS were
prospectively enrolled. Data was evaluated from seventy normal hands and forty
six hands with the diagnosis of the mild CTS with standard electrodiagnostic
(EDX) tests and clinical findings. The specificity and sensitivity rate were
calculated to evaluate the utility of CMAP negative peak (NP) morphology
parameters evaluated duration (CMAP NP_{Half-Duration} and CMAP NP_{Full-Duration})
and area (CMAP NP_Half-Area and CMAP NP_Full-Area) by
comparing the standard EDX test (Median Distal Motor Latency (DML) and peak to
peak amplitude of CMAP (CMAP NP_Amplitude) recorded from the abductor
policies brevis (APB) muscle. Although CMAP NP_{Half-Duration} and CMAP
NP_{Full-Duration} had no statistically significantly difference
between the mild CTS and normal group (p>0.05), DML, CMAP NP_Amplitude,
CMAP NP_Half-Area and CMAP NP_Full-Area in the mild CTS
group were statistically significantly different (p<0.05). The present study
shown CMAP NP_Full-Area had the highest sensitivity and moderate
specificity rate (90.0% and 42.2%, respectively). Furthermore, it was confirmed
again that DML was a valuable motor nerve conduction technique for the
diagnosis of the mild CTS with high sensitivity and moderate specificity (84.8%
and 47.6%, respectively), and it had more sensitive than CMAP NP_Half-Area high
sensitivity and moderate specificity (80.0% and 38.7%, respectively).This study
provided the evidence of CMAP NP_Full-Area and CMAP NP_Half-Area that
could be predictors of the mild CTS

Anahtar Kelimeler

carpal tunnel syndrome, motor nerve conduction study, signal processing

Kaynakça

• [1] Bradlley W.G. and Daroff R.B. Neurology in clinical practice, Carpal Tunnel Syndrome, 2nd ed., Boston, 2002, pp.1893-1894.
• [2] Roquelaure Y., Ha C., Pelier-Cady M.C., et al. Work increases the incidence of carpal tunnel syndrome in the general population, Muscle Nerve, Vol. 37, 2008, pp. 477-482.
• [3] Preston D.C. and Shapiro B.E., Median neuropathy. In: Electromyography and neuromuscular disorders: Clinical electrophysiologic correlations, Butterworth Heinemann, Boston 231, 1998.
• [4] Jablecki C.K., Andary M.T., Floeter M.K., et al. Second AAEM literature review of the usefulness of nerve conduction studies and needle electromyography for the evaluation of patients with carpal tunnel syndrome, Muscle Nerve, Vol.26, 2002, pp.S1–S53.
• [5] Jablecki C.K., Andary M.T., Floeter M.K., et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome: report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Neurology, Vol.58, 2002b, pp.1589–1592.
• [6] Jablecki C.K., Andry M.T., So Y.T., Wilkins D.E., Williams F.H. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome, Muscle Nerve. Vol.16, 1993, pp.1392-1414.
• [7] Rosenbaum R. Carpal tunnel syndrome and the myth of El Dorado, Muscle Nerve, Vol. 22, 1999, pp. 1165–1167.
• [8] Keith MW, Masear V, Chung KC, Maupin K, Andary M, Amadio PC, et al. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am, Vol. 91, 2009, pp.2478-2479.
• [9] Kilmer DD, Davis BA. Electrodiagnosis in carpal tunnel syndrome. Hand Clin, Vol.18, 2002, pp.243-247
• [10] Homan M.M., Franzblau A., Werner R.A., Albers J.W., Armstrong T.J., Bromberg M.B., Agreement between symptom surveys, physical examination procedures and electrodiagnostic findings for the carpal tunnel syndrome. Scand J Work Environ Health, Vol.25, 1999, pp.115–124.
• [11] Szabo R.M., Slater R.R., Farver T.B., Stanton D.B., Sharman W.K. The value of diagnostic testing in carpal tunnel syndrome, J Hand Surg Am, Vol.24, 1999, pp.704-714.
• [12] Kohara N. Clinical and electrophysiological findings in carpal tunnel syndrome, Brain Nerve, Vol.59, 2007, pp. 1229-1238.
• [13] Di Guglielmo G., Torrieri F., Repaci M., Uncini A. Conduction block and segmental velocities in carpal tunnel syndrome, Electroencephalogr Clin Neurophysiol, Vol.105, 1997, pp.321–327.
• [14] Thaisetthawatkul P., Logigian E.L., Herrmann D.N., Dispersion of the distal compound muscle action potential as a diagnostic criterion for chronic inflammatory demyelinating polyneuropathy, Neurology Vol.59, 2002, pp.1526–1531.
• [15] Padua L., LoMonaco M., Gregori B., Valente E.M., Padna R., Tonali P., Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands,” Acta Neurol Scand, Vol.96, 1997,.pp.2117.
• [16] Baysal A., Kuruoğlu R., Beyazova M., et.al. Normal popülasyonda sinir iletimi değerleri,”.Ege Nörolojik Bilimler Dergisi, Vol.6, 1989, pp.9-15.
• [17] Katirji B., Kaminski H. J., Ruff R. L., Neuromuscular Disorders in Clinical Practice, 2nd ed., Newyork, USA, Springer, 2014.
• [18] Cleland J.C., Logigian E.L., Thaisetthawatkul P., Herrmann D.N., Dispersion of the distal compound muscle action potential in chronic inflammatory demyelinating polyneuropathy and carpal tunnel syndrome, Muscle Nerve, Vol.28, 2003, pp.189 –193.
• [19] Singh, G. Determination of Cutoff Score for a Diagnostic Test, The Internet Journal of Laboratory Medicine, Vol.2, 2006, pp.1.
• [20] Nashed J., Hamilton-Wright A., Stashuk D.W., Faris M., McLean L., Assessing motor deficits in compressive neuropathy using quantitative electromyography, Journal of Neuro Engineering and Rehabilitation, Vol.7, 2010, pp.39.
• [21] Cleland J.C., Malik K., Thaisetthawatkul P., Herrmann D.N. and Logigian E. L., Acute Inflammatory Demyelınatıng Polyneuropathy: Contrıbutıon Of A Dıspersed Distal Compound Muscle Action Potential to Electrodiagnosis, Muscle Nerve, Vol.33, 2006, pp.771–777.
• [22] Rajaballya Y. A., Lagardeb J., Cassereauc J., Vialab K., Fournierb E. and Nicolas G., A European multicentre reappraisal of distal compound muscle action potential duration in chronic inflammatory demyelinating polyneuropathy, European Journal of Neurology, Vol.19, 2012, pp.638–642.
• [23] Lewelt A.J., Krosschell K.J., Scott C., et al., Compound Muscle Action Potential and Motor Function in Children with Spinal Muscular Atrophy, Muscle Nerve. Vol. 42, Iss.5, 2010, pp.703–708.
• [24] Lagarde J., Viala K., and E. Fournier. Is Total Duration Of Distal Compound Muscle Actıon Potential Better Than Negative Peak Duratıon In The Diagnosis Of Chronic Inflammatory Demyelinating Polyneuropathy?, Muscle Nerve, Vol.49, 2014, pp.895–899.
• [25] Cleland J.C., Logigian E.L., Thaısetthawatkul P. and Herrmann D.N., Dispersıon Of The Distal Compound Muscle Action Potential In Chronic Inflammatory Demyelinating Polyneuropathy And Carpal Tunnel Syndrome, Muscle Nerve, Vol.28, 2003, pp.189–193.
• [26] Isose1 S., Kuwabara1 S., Kokubun N., et al., Utility of the distal compound muscle action potential duration for diagnosis of demyelinating neuropathies, Journal of the Peripheral Nervous System, Vol.14, 2009, pp.151–158.