Department of Neurology, School of Medicine, University of Patras, Patras, Greece.
Department of Neurology, School of Medicine, University of Patras, Patras, Greece.
J Electromyogr Kinesiol. 2020 Apr;51:102410. doi: 10.1016/j.jelekin.2020.102410. Epub 2020 Mar 2.
To define the skin temperature at which diseased nerves are better differentiated from the healthy. Motor and sensory conduction of median and ulnar nerve were evaluated in 52 patients with carpal tunnel syndrome (CTS) and 52 matched healthy controls at environmental skin temperature (mean 32-33 °C), after warming by an average of 2 °C and cooling to approximately 6 °C below baseline. In the hot condition, group comparisons for the median nerve showed a similar rate of distal motor latency (DML) reduction and sensory conduction velocity (SCV) increase in CTS and controls. With cold, the rate of change was smaller for the patients: DML mean increase was 5% /°C (7% for controls) and SCV mean decrease was 2.5%/°C (3.2% for controls). Individual patients' analysis revealed fewer abnormal median DML and SCV values at hot or at cold, compared to environmental temperature. It is concluded that conduction adjustments for low hand temperatures based on healthy measurements resulted in overcorrection and therefore underdiagnosis of CTS. Alternatively, at excessive hand warming the convergence of patient and healthy measurements also lead to underdiagnosis. Maintenance of skin temperature at 32-33 °C, corresponding to normal body temperature, is the optimum approach and should always be employed in clinical practice.
为了明确病变神经与健康神经的温度分界点。我们评估了 52 名腕管综合征（CTS）患者和 52 名匹配的健康对照者的正中神经和尺神经的运动和感觉传导，在环境皮肤温度（平均 32-33°C）下，通过平均升温 2°C 和冷却至比基线低约 6°C。在热环境下，与对照组相比，正中神经的组间比较显示 CTS 患者的远端运动潜伏期（DML）降低和感觉传导速度（SCV）增加的速度相似。在冷环境下，患者的变化速度较慢：DML 的平均增加值为 5%/°C（对照组为 7%），SCV 的平均降低值为 2.5%/°C（对照组为 3.2%）。与环境温度相比，个体患者的分析显示，在热或冷时，正中神经的 DML 和 SCV 值异常的情况更少。因此，根据健康测量结果对低手部温度进行的传导调整导致了过度矫正，从而导致 CTS 的诊断不足。或者，在手过度升温时，患者和健康测量值的收敛也会导致诊断不足。将皮肤温度维持在 32-33°C，对应于正常体温，是最佳方法，在临床实践中应始终采用。
