King J C, Dumitru D, Wertsch J J
Department of Rehabilitation Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA.
Muscle Nerve. 2001 Nov;24(11):1489-95. doi: 10.1002/mus.1173.
Antidromic sensory nerve action potential testing is well characterized and commonly used to assess the sensory component of the upper limb median and ulnar nerves. The final terminal segments of these nerves are the proper digital nerves. Ring recording electrodes are commonly used to detect the proper digital nerves' antidromic responses. Attempts to record the separate contributions of individual digital nerves along the lateral aspects of each finger, using small surface electrodes, is shown to be unreliable for determining the integrity of a single terminal digital branch. We found between 50% to 77% of the stimulated terminal branch's response amplitude when recorded at electrodes positioned over the nonstimulated branch located 180 degrees from the activated terminal branch. Detecting a single terminal nerve response was achieved by using the fourth digit and the second digit with one of the second digit's branches neurophysiologically blocked by local anesthetic. The volume-conducted response from the opposite side of the finger resulted in this relatively large recorded response, which remains within the range of reference values precluding the simple use of antidromic techniques to assess injury to a single proper digital nerve. Techniques are proposed to avoid such pitfalls and to assess most accurately the desired response.
逆行感觉神经动作电位检测具有良好的特征，常用于评估上肢正中神经和尺神经的感觉成分。这些神经的终末段是指固有神经。环形记录电极常用于检测指固有神经的逆行反应。使用小表面电极试图记录沿每个手指外侧的各个指神经的单独贡献，结果表明对于确定单个终末指支的完整性是不可靠的。当在位于与激活的终末支相距180度的未刺激支上方的电极处记录时，我们发现刺激的终末支反应幅度的50%至77%。通过使用第四指和第二指，并在神经生理学上用局部麻醉剂阻断第二指的一个分支来实现检测单个终末神经反应。来自手指对侧的容积传导反应导致了这种相对较大的记录反应，该反应仍在参考值范围内，这使得不能简单地使用逆行技术来评估单个指固有神经的损伤。本文提出了避免此类陷阱并最准确地评估所需反应的技术。
