Ring finger sensorial conduction studies in grading carpal tunnel syndrome: Part II.

BACKGROUND

Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS.

OBJECTIVES

To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings).

MATERIAL AND METHODS

The patients with bilateral moderate grade of CTS in whom one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings.

RESULTS

A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 ± 0.49 msec versus 3.44 ± 0.39 msec; p< 0.001), sensory conduction velocity (SCV) was slower (33.7 ± 4.3 m/sec versus 40.2 ± 3.0 m/sec; p< 0.001), SNAP amplitude was smaller (10.3 ± 3.3 μV versus 19.1 ± 7.7 μV; p< 0.001), distal motor latency was longer (5.69 ± 0.60 msec versus 4.63 ± 0.32 msec; p< 0.001), and minimum F wave latency was longer (29.3 ± 1.7 msec versus 26.8 ± 1.4 msec; p< 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients.

CONCLUSION

Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not.