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Protokol nevrofizioloških meritev pri sindromu zapestnega prehoda[sub]1 = Protocol of neurophysiologic studies in the carpal tunnel syndrome
Podnar, Simon
Background: Entrapment of the median nerve at the wrist, called also Ćcarpal tunnel syndromeĆ (CTS), is the most common neuropathy. Clinically it presents as tingling in the first 3,5 fingers that ...are worst during the night or in themorning, and get relieved by hand shaking. To confirm CTS nerve conduction studies (NCS) are very useful. The aim of the present study was to present andvalidate standardized protocol for neurophysiologic studies in patients with suspected CTS. Methods: A standard NCS protocol includes bilateral median(pathologic latency > 4.4 ms) and unilateral ulnar motor NCS, and 3 comparison sensory studies of median nerve 2 with ulnar nerve (4th i nger detection, and across the wrist; pathologic latency diferences > 0.4 and > 0.3), and 1 with radial nerve (1st finger detection; pathologic > 0.6 ms). In addition, the Carpal Sensory Index (CSI) was calculated by summation of all 3 sensory differences (pathologic > 0.9 ms). A group of 91 patients referred forNCS by plastic surgeons due to suspected CTS, and a group of 52 asymptomatic controls were studied using this protocol. Sensitivity, specificity, positive and negative predictive values were calculated.Results: In controls all motor, and sensory responses were obtained. CTS was confirmed in 155 of 182 (85 %) hands at er motor and 4th finger sensory studies were concluded. Calculation of CSI demonstrated CTS in additional 11/15 (73 %) hands, which raised overall sensitivity to 91 %. Specificities were 89 % and 82 %, positive predictive values 93 % and 89 %, negative predictive values 73 % and 79 % for 4th i nger sensory comparison study and CSI, respectively.Conclusions: Study demonstrated that most CTS are coni rmed by 4th i nger sensory comparison study. Additional two comparison studies are needed only rarely, and confirm CTS in about 0,75 of remaining hands.
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