Pasutharnchat Nath, Amornvit Jakkrit, Taychargumpoo Chamaiporn, Santananukarn Manasawan
Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Clin Neurophysiol Pract. 2020 Mar 20;5:79-82. doi: 10.1016/j.cnp.2020.03.001. eCollection 2020.
Median and ulnar motor nerve conduction study recording from median-innervated 2nd lumbrical and ulnar-innervated 1st palmar and 2nd dorsal interossei is designated in electrodiagnostic evaluation of carpal tunnel syndrome. In this technique, both responses are recorded by the same surface recording electrode placing over their shared motor point in mid-palm. To the best of our knowledge, this technique has never been utilized in demonstration of Martin-Gruber anastomosis.
By applying this technique to the conventional CMAP comparison method, the authors accordingly demonstrated Martin-Gruber anastomosis in four cases. Three presented with focal mononeuropathies of the upper limbs, including a severe carpal tunnel syndrome, a mild to moderate carpal tunnel syndrome, and an ulnar neuropathy. One was a normal individual.
This report described a new electrophysiological pattern of MGA. Adding the mid-palm recording to conventional CMAP comparison method provides a broader view in terms of innervation of MGA. This technique is not complicated and can be added to the electrophysiological investigation for complete studying of the innervated muscles in MGA.
在腕管综合征的电诊断评估中，通过记录正中神经支配的第2蚓状肌以及尺神经支配的第1掌侧骨间肌和第2背侧骨间肌的运动神经传导，来进行正中神经和尺神经运动神经传导研究。在这项技术中，两个反应均通过置于手掌中部共同运动点上方的同一表面记录电极进行记录。据我们所知，这项技术从未用于证明马丁-格鲁伯吻合（Martin-Gruber anastomosis，MGA）。
通过将这项技术应用于传统的复合肌肉动作电位（CMAP）比较方法，作者相应地在4例患者中证明了马丁-格鲁伯吻合。其中3例表现为上肢局灶性单神经病，包括1例严重腕管综合征、1例轻至中度腕管综合征和1例尺神经病变。1例为正常人。
本报告描述了一种新的马丁-格鲁伯吻合的电生理模式。在传统的CMAP比较方法中增加手掌中部记录，在马丁-格鲁伯吻合的神经支配方面提供了更广阔的视野。这项技术并不复杂，可以添加到电生理检查中，以便对马丁-格鲁伯吻合中受支配肌肉进行全面研究。
