Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Alberta, Alberta, Canada.
Arch Phys Med Rehabil. 2009 Dec;90(12):2062-5. doi: 10.1016/j.apmr.2009.07.022.
Burnham RS, Burnham TR. Effect of hand warming on electrodiagnostic testing results and diagnosis in patients with suspected carpal tunnel syndrome.
To evaluate the effects of hand warming on electrodiagnostic (EDX) parameters of carpal tunnel syndrome (CTS). Specifically, to evaluate the type and magnitude of change in EDX values; to determine whether warming can change the EDX diagnosis of CTS and, if so, to determine whether specific EDX tests are more vulnerable to the effects of warming.
Interventional before-after trial.
Community EDX laboratory.
Consecutive patients (N=33) referred for EDX evaluation of suspected CTS.
Each upper limb was tested at room temperature (average hand temperature, 31.9 degrees C) and retested after 20 minutes of heating pad warming (average hand temperature, 33.5 degrees C).
Median and ulnar nerve motor and sensory latency, conduction velocity, and amplitude.
Warming resulted in significantly faster transcarpal tunnel sensory and motor conduction (6%-10%), reduced median: ulnar sensory latency to digit 4 difference (23%), and reduced sensory nerve and compound motor action potential amplitude (10% and 13%, respectively). The changes resulted in 15% fewer limbs meeting the EDX conduction velocity criteria of CTS and 9% fewer by median: ulnar sensory latency to digit 4 difference. Waveform amplitudes became abnormally low after warming in 12% of limbs.
Hand warming using a heating pad for 20 minutes increases median nerve transcarpal tunnel conduction velocity and reduces amplitude. These phenomena introduce potential sources of diagnostic error, particularly in borderline cases. Generally, within hand, between nerve, and within nerve comparison techniques are less susceptible to the conduction velocity effects of warming.
Burnham RS，Burnham TR。手部加热对疑似腕管综合征患者电诊断测试结果和诊断的影响。
评估手部加热对手腕管综合征（CTS）电诊断（EDX）参数的影响。具体来说，评估 EDX 值的变化类型和幅度；确定加热是否可以改变 CTS 的 EDX 诊断，如果是，确定哪些特定的 EDX 测试更容易受到加热的影响。
干预前后试验。
社区 EDX 实验室。
连续的患者（N=33）因疑似 CTS 的 EDX 评估而转介。
每只上肢在室温下（平均手部温度 31.9°C）进行测试，然后在加热垫加热 20 分钟后进行复测（平均手部温度 33.5°C）。
正中神经和尺神经运动和感觉潜伏期、传导速度和幅度。
加热导致腕管内感觉和运动传导明显加快（6%-10%），正中神经：第四指感觉潜伏期差异减小（23%），感觉神经和复合运动动作电位幅度减小（分别为 10%和 13%）。这些变化导致符合 EDX 传导速度 CTS 标准的肢体减少了 15%，符合正中神经：第四指感觉潜伏期差异的标准减少了 9%。12%的肢体在加热后波形幅度变得异常低。
使用加热垫加热 20 分钟会增加正中神经腕管内的传导速度并降低幅度。这些现象可能会导致诊断错误，尤其是在边界病例中。一般来说，手部内、神经间和神经内比较技术受加热对传导速度影响的影响较小。
