Download PDF
Klinische Neurophysiologie 2002; 33(1): 25-33
DOI: 10.1055/s-2002-23086
Originalia
© Georg Thieme Verlag Stuttgart · New York

Zur elektrophysiologischen Diagnostik des Karpaltunnelsyndroms: Eigene Untersuchungen bei 124 Kontrollpersonen und eine Literaturübersicht

Electrophysiological Diagnostics of the Carpal Tunnel Syndrome: Investigations in 124 Healthy Controls and a BibliographyF.  Behse1 , F.  Masuhr1
  • 1Neurologische Klinik der Charité, Medizinische Fakultät der Humboldt-Universität zu Berlin, Campus Virchow, Berlin
Further Information

Publication History

Publication Date:
25 March 2002 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Das Karpaltunnelsyndrom (KTS) ist das häufigste Engpasssyndrom eines peripheren Nerven und einer Behandlung gut zugänglich. Die elektrodiagnostischen Methoden erlauben eine sichere und frühzeitige Erkennung des KTS, ermöglichen Aussagen zum Schweregrad der Nervenläsion, dienen der postoperativen Verlaufskontrolle und ermöglichen eine differenzialdiagnostische Abgrenzung von anderen neurogenen Erkrankungen. Dabei haben sich die Messung der distal-motorischen Latenz des N. medianus im Vergleich zu der im N. ulnaris, die Bestimmung der sensiblen Latenzen bzw. sensiblen Nervenleitgeschwindigkeit im distalen Abschnitt des N. medianus verglichen mit denen im N. ulnaris und N. radialis superficialis sowie die Messung der sensiblen Latenzen im Handgelenksbereich verglichen mit denen im Abschnitt Hohlhand-Finger, als diagnostisch sinnvoll und zuverlässig durchgesetzt. Durch eigene Untersuchungen bei 124 gesunden Probanden ermittelten wir Grenzwerte für die oben aufgezählten elektrophysiologischen Parameter, präsentieren anhand von ausgesuchten Fallbeispielen Sonderformen des KTS und geben eine zusammenfassende Literaturübersicht zum gegenwärtigen Stand der Elektrodiagnostik des Karpaltunnelsyndroms.

Abstract

The carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome and is well treatable. Electrophysiological tests allow an early and reliable recognition of a CTS, provide information on the severity of the nerve lesion, are useful for follow-up investigations after surgical treatment and play an important role in the differentiation from other neurogenic diseases. Among various tests which have been proposed for the electrophysiological assessment of a CTS, the following ones have been found to be useful and reliable: a comparison of the distal motor latencies of the median and ulnar nerve, a median-ulnar and median-radial comparison with respect to the sensory nerve latencies and sensory nerve conduction velocities, and the assessment of differences of sensory latencies between the wrist-palm and the palm-digit segments of the median nerve. In the present article. We demonstrate normal values for the above mentioned electrophysiological tests which were determined by studying the hands of 124 healthy volunteers. We also give clinical and electrophysiological examples for unusual forms of a CTS and present a literature review of the electrodiagnostics of the carpal tunnel syndrome.

Key words

Carpal tunnel syndrome - Electrodiagnosis - Nerve conduction studies

Literatur

  • 1 Richter H P. Karpaltunnelsyndrom. In: Tackmann W, Richter HP, Stöhr M (Hrsg) Kompressionssyndrome peripherer Nerven. Berlin; Springer-Verlag 1989: 163-260
    Google Scholar
  • 2 Clarke S J. AAEM Minimonograph # 26. The electrodiagnosis of carpal tunnel syndrome.  Muscle Nerve. 1997;  20 1477-1486
    CrossrefPubMedGoogle Scholar
  • 3 Skie M, Zeiss J, Ebraheim N A, Jackson W T. Carpal tunnel changes and median nerve compression during wrist flexion and extension seen by magnetic resonance imaging.  J Hand Surgery (Am). 1990;  15 934-939
    PubMedGoogle Scholar
  • 4 Horch R E, Allmann K H, Lauenberger J, Langer M, Stark G B. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel.  Neurosurgery. 1997;  41 76-82
    CrossrefPubMedGoogle Scholar
  • 5 Lee D, van Holsbeeck M T, Janevski P K, Ganos D L, Ditmars D M, Darian V B. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography.  Radiol Clin North Am. 1999;  37 859-872
    CrossrefPubMedGoogle Scholar
  • 6 Simpson J A. Electrical signs in the diagnosis of carpal tunnel and related syndromes.  J Neurol Neurosurg Psychiatry. 1956;  19 275-280
    PubMedGoogle Scholar
  • 7 Thomas P K. Motor nerve conduction in the carpal tunnel syndrome.  Neurology. 1960;  10 1045-1050
    PubMedGoogle Scholar
  • 8 Gilliat R W, Sears T A. Sensory nerve action potentials in patients with peripheral nerve lesions.  J Neurol Neurosurg Psychiatry. 1958;  21 109-118
    PubMedGoogle Scholar
  • 9 Kaeser H E. Diagnostische Probleme beim Karpaltunnel.  Dtsch Z Nervenheilk. 1963;  185 453-470
    PubMedGoogle Scholar
  • 10 Kemble F. Electrodiagnosis of the carpal tunnel syndrome.  J Neurol Neurosurg Psychiatry. 1968;  31 23-27
    PubMedGoogle Scholar
  • 11 Buchthal F, Rosenfalck A. Sensory conduction from digit to palm and from palm to wrist in the carpal tunnel syndrome.  J Neurol Neurosurg Psychiatry. 1971;  34 243-252
    PubMedGoogle Scholar
  • 12 Loong S C, Seah C S. Comparison of median and ulnar sensory nerve action potentials in the diagnosis of the carpal tunnel syndrome.  J Neurol Neurosurg Psychiatry. 1971;  34 750-754
    PubMedGoogle Scholar
  • 13 Melvin J L, Schuchmann J A, Lanese R R. Diagnostic specificity of motor and sensory nerve conduction variables in the carpal tunnel syndrome.  Arch Phys Med Rehabil. 1973;  54 69-74
    PubMedGoogle Scholar
  • 14 Felsenthal G, Spindler H. Palmar conduction time of median and ulnar nerves of normal subjects and patients with carpal tunnel syndrome.  Am J Phys Med. 1979;  58 131-138
    PubMedGoogle Scholar
  • 15 Smith J. Radial nerve conduction in patients with carpal tunnel syndrome.  Appl Neurophysiol. 1981;  44 363-367
    PubMedGoogle Scholar
  • 16 Tackmann W, Kaeser H E, Magun H G. Comparison of orthodromic and antidromic sensory nerve conduction velocity measurements in the carpal tunnel syndrome.  J Neurol. 1981;  224 257-266
    PubMedGoogle Scholar
  • 17 Goddard D H, Barnes C G, Berry H, Evans S. Measurement of nerve conduction - a comparison of orthodromic and antidromic methods.  Rheumatology. 1983;  2 169-174
    PubMedGoogle Scholar
  • 18 Buchthal F, Rosenfalck A, Trojaborg W. Electrophysiological findings in entrapment of the median nerve at wrist and elbow.  J Neurol Neurosurg Psychiatry. 1974;  37 340-360
    CrossrefPubMedGoogle Scholar
  • 19 Kimura J. The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve.  Brain. 1979;  102 619-635
    CrossrefPubMedGoogle Scholar
  • 20 Kimura J, Ayyar D R. The carpal tunnel syndrome: electrophysiological aspects of 639 symptomatic extremities.  EMG Clin Neurophysiol. 1985;  25 151-164
    PubMedGoogle Scholar
  • 21 Johnson E W, Sipski M, Lammertse T. Median and radial sensory latencies to digit I: normal values and usefulness in carpal tunnel syndrome.  Arch Phys Med Rehabil. 1987;  68 140-141
    PubMedGoogle Scholar
  • 22 White J C, Hansen S R, Johnson R K. A comparison of EMG procedures in the carpal tunnel syndrome with clinical-EMG correlations.  Muscle Nerve. 1988;  11 1177-1182
    PubMedGoogle Scholar
  • 23 Jackson D, Clifford J C. Electrodiagnosis of mild carpal tunnel syndrome.  Arch Phys Med Rehabil. 1989;  70 199-204
    PubMedGoogle Scholar
  • 24 Uncini A, Lange D J, Solomon M, Soliren B, Meer J, Lovelace R E. Ring finger testing in carpal tunnel syndrome: a comparative study of diagnostic utility.  Muscle Nerve. 1989;  12 735-741
    PubMedGoogle Scholar
  • 25 Gunnarsson L G, Amilon A, Hellstrand P, Leissner P, Philipson L. The diagnosis of carpal tunnel syndrome. Sensitivity and specificity of some clinical and electrophysiological tests.  J Hand Surg. 1997;  22B 34-37
    PubMedGoogle Scholar
  • 26 Wiederholt W C. Median nerve conduction velocity in sensory fibers through carpal tunnel.  Arch Phys Med Rehabil. 1970;  51 328-330
    PubMedGoogle Scholar
  • 27 Roth G. Vitesse de conduction motorice du nerf median dans le canal carpien.  Annales de Médicine Physique. 1970;  13 117-132
    PubMedGoogle Scholar
  • 28 Kimura J. A method for determining median nerve conduction velocity across the carpal tunnel.  J Neurol Sci. 1978;  38 1-10
    CrossrefPubMedGoogle Scholar
  • 29 Wongsam P E, Johnson E W, Weinermann J D. Carpal tunnel syndrome: use of palmar stimulation of sensory fibers.  Arch Phys Med Rehabil. 1983;  64 16-19
    PubMedGoogle Scholar
  • 30 Eklund G. A new electrodiagnostic procedure for measuring sensory nerve conduction across the carpal tunnel.  Upsala J Med Sci. 1975;  80 63-64
    PubMedGoogle Scholar
  • 31 Daube J. Percutaneous palmar median nerve stimulation for carpal tunnel syndrome.  Electroencephalogr Clin Neurophysiol. 1977;  43 139-140
    PubMedGoogle Scholar
  • 32 Seror P. Le test centimétrique: test diagnostique de certitude du syndrome du canal carpien très frustre?.  Ann Chir Main. 1989;  8 254-264
    PubMedGoogle Scholar
  • 33 Seror P. Sensitivity of the various test for the diagnosis of carpal tunnel syndrome.  J Hand Surg (Brit). 1994;  19B 725-728
    PubMedGoogle Scholar
  • 34 Seror P. Orthodromic inching test in mild carpal tunnel syndrome.  Muscle Nerve. 1998;  21 1206-1208
    PubMedGoogle Scholar
  • 35 Johnson E W, Kuklar R D, Wongsam P E, Piedmont A. Sensory latencies to the ring finger: normal values and relation to carpal tunnel syndrome.  Arch Phys Med Rehabil. 1981;  62 206-208
    PubMedGoogle Scholar
  • 36 Valls J, Llamas J M. Orthodromic study of the sensory fibers innervating the fourth finger.  Muscle Nerve. 1988;  11 546-552
    PubMedGoogle Scholar
  • 37 Uncini A, di Muzio A, Awad J, Manenteg G, Tafuro M, Gambi D. Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome.  Muscle Nerve. 1993;  16 1366-1373
    CrossrefPubMedGoogle Scholar
  • 38 Charles N, Vial C, Chauplannaz G, Bady B. Clinical validation of antidromic stimulation of the ring finger in early electrodiagnosis of mild carpal tunnel syndrome.  Electroencephalogr Clin Neurophysiol. 1990;  76 142-147
    CrossrefPubMedGoogle Scholar
  • 39 Lauritzen M, Liguori R, Trojaborg W. Orthodromic sensory conduction along the ring finger in normal subjects and in patients with carpal tunnel syndrome.  EEG Clin Neurophysiol. 1991;  81 18-23
    PubMedGoogle Scholar
  • 40 Preston D C, Logigian E L. Lumbrical and interossei recording in carpal tunnel syndrome.  Muscle Nerve. 1992;  15 1253-1257
    PubMedGoogle Scholar
  • 41 Preston D C, Ross M H, Kothari M J, Plotkin G M, Venkatesch S, Logigian E L. The median-ulnar latency difference studies are comparable in mild carpal tunnel syndrome.  Muscle Nerve. 1994;  17 1469-1471
    PubMedGoogle Scholar
  • 42 Löscher W N, Auer-Grumbach M, Trinka E, Ladurner G, Hartung H P. Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands.  J Neurol. 2000;  247 530-534
    PubMedGoogle Scholar
  • 43 Vogt T, Seddigh S, Hundemer H, Thomalske C, Köhler J, Hopf H C. Motorische Medianus-Ulnaris-Latenzdifferenz in der Diagnostik des Karpaltunnelsyndroms.  Z EEG-EMG. 1995;  26 141-145
    PubMedGoogle Scholar
  • 44 Vogt T, Mika A, Thömke F, Hopf H C. Evaluation of carpal tunnel syndrome in patients with polyneuropathy.  Muscle Nerve. 1997;  20 153-157
    PubMedGoogle Scholar
  • 45 Muellbacher W, Mamoli B, Zifko U, Grishold W. Lumbrical and interossei recording in carpal tunnel syndrome.  Muscle Nerve. 1994;  17 359-360
    PubMedGoogle Scholar
  • 46 Rempel D, Evanoff B, Amadio P C, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg M, Hales T, Katz J N, Pransky G. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.  Am J Public Health. 1998;  88 1447-1451
    CrossrefPubMedGoogle Scholar
  • 47 Szabo R M, Slater R R, Farver T B, Stantan D B, Sharman W K. The value of diagnostic testing in carpal tunnel syndrome.  J Hand Surg. 1999;  24A 704-714
    PubMedGoogle Scholar
  • 48 Rosenbaum R. Carpal tunnel syndrome and the myth of El Dorado.  Muscle Nerve. 1999;  22 1165-1167
    PubMedGoogle Scholar
  • 49 Gnatz S M, Conway R R. The role of needle electromyography in the evaluation of patients with carpal tunnel syndrome.  Muscle Nerve. 1999;  22 282-286
    PubMedGoogle Scholar
  • 50 Horst-Meyer A. Verlaufsbeobachtung des Karpal-Tunnel-Syndroms bei Diabetikern. Berlin; Med Diss Humboldt-Universität zu Berlin 2002
    Google Scholar
  • 51 Christensen J EJ, Peter P J, Nielsen V K, Mai J. Prevalence of carpal tunnel syndrome among individuals with Down syndrome.  Am J Ment Ret. 1998;  102 547-551
    PubMedGoogle Scholar
  • 52 Stoll C, Maitrot D. Autosomal dominant carpal tunnel syndrome.  Clin Genet. 1998;  54 345-348
    CrossrefPubMedGoogle Scholar
  • 53 Phalen G S. The carpal tunnel syndrome. Clinical evaluation of 598 hands.  Clin Orthop. 1972;  83 29-40
    PubMedGoogle Scholar
  • 54 Stevens J C, Beard C M, O'Fallon W M, Kurland L T. Conditions associated with carpal tunnel syndrome.  Mayo Clin Proc. 1992;  67 541-548
    CrossrefPubMedGoogle Scholar
  • 55 Voitk A K, Mueller J C, Farlinger D E, Johnston R U. Carpal tunnel syndrome in pregnancy.  Can Med Assoc J. 1983;  128 277-281
    PubMedGoogle Scholar
  • 56 al-Quattan M M, Manktelow R T, Bowen C V. Pregnancy-induced carpal tunnel syndrome requiring surgical release longer than 2 years after delivery.  Obstet Gynecol. 1994;  84 249-251
    PubMedGoogle Scholar
  • 57 Stahl S, Blumenfeld Z, Yarnitsky D. Carpal tunnel syndrome in pregnancy: indications for early surgery.  J Neurol Sci. 1996;  136 182-184
    CrossrefPubMedGoogle Scholar
  • 58 Assmus H, Hashemi B. Die operative Behandlung des Karpaltunnelsyndroms in der Schwangerschaft. Ein Erfahrungsbericht anhand von 314 Fällen.  Nervenarzt. 2000;  71 470-473
    CrossrefPubMedGoogle Scholar
  • 59 Adamson J E, Srouji S J, Horton C E, Mladick R A. The acute carpal tunnel syndrome.  Plast Reconstr Surg. 1971;  47 332-336
    PubMedGoogle Scholar
  • 60 Gordon C, Bowyer B L, Johnson E W. Electrodiagnostic characteristics of acute carpal tunnel syndrome.  Arch Phys Med Rehabil. 1987;  68 545-548
    PubMedGoogle Scholar
  • 61 Cruz Martinez A, Arpa J. Carpal tunnel syndrome in childhood: study of 6 cases.  Electroencephalogr Clin Neurophysiol. 1998;  109 304-308
    CrossrefPubMedGoogle Scholar
  • 62 Johnson R K, Shrewsbury M M. Anatomical course of the thenar branch of the median nerve - usually in a seperate tunnel through the transverse carpal ligament.  J Bone Joint Surg (Am). 1970;  52 269-273
    PubMedGoogle Scholar
  • 63 Nathan P A, Keniston R C, Meadows K D, Lockwood R S. Predictive value of nerve conduction measurements at the carpal tunnel.  Muscle Nerve. 1993;  16 1377-1382
    PubMedGoogle Scholar
  • 64 Salerno D F, Franzblau A, Werner R A, Bromberg M B, Armstrong T J, Albers J W. Median and ulnar nerve conduction studies among workers: normative values.  Muscle Nerve. 1998;  21 999-1005
    CrossrefPubMedGoogle Scholar
  • 65 Werner R A, Franzblau A, Albers J W, Armstrong T J. Median mononeuropathy among active workers: are there differences between symptomatic and asymptomatic workers?.  Am J Ind Med. 1998;  33 374-378
    CrossrefPubMedGoogle Scholar

PD Dr. Friedrich Behse

Neurologische Abteilung · Universitätsklinikum Rudolf Virchow

Augustenburger Platz 1

13353 Berlin

Email: Florian.Masuhr@charite.de

      >