Andary Michael T, Parkhurst Drew B, Bernaiche Maurice R, Figueroa Jose S, Kumaraswamy Lata, Manzi Suzanne M, O'Connor Ryan A, Parrington Ingrid P, Sylvain Jim R
Michigan State University College of Osteopathic Medicine, Sparrow Hospital, McLaren Greater Lansing Hospital.
New England Sports, Orthopedics, Spine, and Rehabilitation.
Spartan Med Res J. 2021 Aug 30;6(2):25941. doi: 10.51894/001c.25941. eCollection 2021.
The diagnosis of carpal tunnel syndrome (CTS) with nerve conduction studies traditionally involves warming the hand to avoid misleading prolongation of distal latency (DL). Comparing the median nerve DL to the ulnar and radial nerves using the combined sensory index (CSI) has been reported to improve the accuracy of CTS diagnosis. During this study, the authors examined the effect of hand temperature on the CSI and diagnosis of CTS.
The authors conducted a prospective, controlled, cohort study with 20 asymptomatic control patients and 21 symptomatic patients with confirmed CTS. Symptomatic patients underwent nerve conduction studies with the CSI calculated under both cold and warm conditions.
Control subjects with warm hands had an average CSI of 0.0 milliseconds (ms), and -0.3ms with cold hands. CTS subjects with warm hands had an average CSI of 3.2ms, and 3.7ms with cold hands. Although hand temperature was shown to slow sample latencies, differences calculated with the CSI did not misclassify any of the 41 sample subjects.
During this study, cold temperature did not result in misclassification of either control patients or CTS patients when CSI was diagnostically used. Based on these results, peak latency comparisons in cold hands can be considered as diagnostically reliable as under standard hand temperature ranges for the diagnosis of CTS, with caution warranted in borderline cases. This diagnostic technique can save time for the patient, physician, and care team without compromising quality of care. Future larger sample blinded studies at multiple electrodiagnostic sites are indicated.
传统上，通过神经传导研究诊断腕管综合征（CTS）时，需要对手部进行加温，以避免远端潜伏期（DL）出现误导性延长。据报道，使用联合感觉指数（CSI）将正中神经DL与尺神经和桡神经进行比较，可提高CTS诊断的准确性。在本研究中，作者研究了手部温度对CSI及CTS诊断的影响。
作者进行了一项前瞻性、对照队列研究，纳入20名无症状对照患者和21名确诊为CTS的有症状患者。有症状的患者接受神经传导研究，并在冷、暖两种条件下计算CSI。
手部温暖的对照受试者平均CSI为0.0毫秒（ms），手部寒冷时为-0.3ms。手部温暖的CTS受试者平均CSI为3.2ms，手部寒冷时为3.7ms。尽管手部温度显示会使样本潜伏期延长，但用CSI计算的差异并未将41名样本受试者中的任何一人误诊。
在本研究中，当使用CSI进行诊断时，寒冷温度并未导致对照患者或CTS患者被误诊。基于这些结果，对于CTS的诊断，寒冷手部的峰值潜伏期比较可被认为与标准手部温度范围下一样具有诊断可靠性，但在临界病例中需谨慎。这种诊断技术可为患者、医生和护理团队节省时间，而不影响护理质量。未来需要在多个电诊断部位进行更大样本的盲法研究。
