59 Case of the Issue No. 9 carpal tunnel syndrome: CTS CTS CTS CTS nerve conduction study; NCS needle electromyography; nemg NCS carpal tunnel syndrome: CTS 1 CTS 4 CTS 45 65 1 3 2 CTS CTS 1999 American Association of Electro diagnostic medicine AAEM American Academy of Neurology American Academy of Physical Medicine and Rehabilitation CTS NCS 3, 4 1 5 2007 CTS 6 CTS 1 CTS 2 2 CTS 6 CTS NCS motor nerve conduction study sensory nerve conduction study MCS SCS F
60 45 1 1 AAEM2002 CTS CTS 1 standard a 13 14 cm b 2 guideline 3 option 2 2 5 27 MCS SCS CTS 70 7 NCS 1 NCS 14 CTS / compound muscle action potential: CMAP 0.7 15 / CMAP 1.2 16 CMAP abductor policis brevis muscle: APB CMAP current spread 17 CTS 6 APB C8 Th1 ex. first dorsal interosseous: FDI C6 7 1 41 2 Tinel Phalen NCS 2 MCS SCS 2 CTS CTS
2017. 61 1 8 27 S1 S2 med ulnar rad CMAP compound muscle action potential SNAP sensory nerve action potential MNAP mixed nerve action potential S1 S2 27 NCS AAEM SCS standard CTS 18 8 12, 19 2 2 MCS
62 45 1 2 1 NCS nemg ms m/s F ms 14.5 3.8 22.8 14.1 7.3 63 13.8 1.8 14.4 2.5 13.2 7.1 66 36.4 2.7 51 29.5 2.4 59 LICS 2 3.6 LICS 1 2.8 D4CS 2.7 D4CS 2.2 potential CMAP 2 premotor potential 27 CMAP AAEM option 8 CMAP premotor potential SNAP 20 23 CMAP premotor 2 70 3 17.5 kg 8 kg Tinel Phalen NCS 3 2 CMAP nemg APB FDI 1 2 NCS CMAP SNAP CTS 2 24 APB CMAP CTS CMAP 25 CTS 105 APB CMAP 7 CMAP 26 CTS
2017. 63 3 2 NCS nemg ms m/s F ms NER NER NER 14.7 2.5 14.6 6.8 64 NER 30.0 2.5 59 D4CS NER D4CS 2.2 D1CS NER D1CS 1.6 PMCS NER PMCS 1.2 LICS 2 7.8 LICS 1 2.7 NER: no evoked response 1 CTS 4th finger method 26 CTS CTS CTS CTS 27 1 Atroshi I, Gummesson C, Johnsson R, et al: Precalence of carpal tunnel syndrome in a general population. JAMA 14: 153 158, 1999. 2 McCartan B, Ashby E, Taylor EJ, et al: Carpal tunnel syndrome. Br J Hosp Med (Lond) 73: 199 202, 2012. 3 American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation: Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 16: 1390 1391, 1993. 4 American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation: Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 25: 918 922, 2002. 5 Brain and Nerve 59: 1229 1238, 2007. 6 25: 65 84, 2008. 7 uncommon nerve conduction study NCS 38: 406 415, 2012. 8
64 40: 67 73, 2012. 9 Preston DC, Logigian EL: Lumbrical and interossei recording in carpal tunnel syndrome. Muscle Nerve 15: 1253 1257, 1992. 10 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 58: 131 138, 1979. 11 Robinson LR, Micklesen PJ, Wang L: Strategies for analyzing nerve conduction date: superiority of a summary index over single tests. Muscle Nerve 21: 1166 1171, 1998. 12 Uncini A, Di Muzio A, Awad J, et al: Sensitivity of three median-to-ulnar compara tive tests in diagnosis of mild carpal tunnel syndrome. Muscle Nerve 16: 1366 1373, 1993. 13 Carrol GJ: Comparison of median and radial nerve sensory latencies in the electrophysiological diagnosis of carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 68: 101 106, 1987. 14 Oh SJ: Clinical Electromyography: Nerve Conduction Studies. 2nd ed, Lippincott Williams & Wilkins, Philadelphia 1993. 15 Knack Pitfalls pp 80 85, 2007. 16 Lesser EA, Venkatesh S, Preston DC, el al: Stimulation distal to the lesion in patients with carpal tunnel syndrome. Muscle Nerve 18: 503 507, 1995. 17 J Clin Rehabil 13: 186 189, 2004. 45 1 18 Werner RA, Andary M: Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 44: 597 607, 2011. 19 Jackson DA, Clifford JC: Electrodiagnosis of mild carpal tunnel syndrome. Arch Phys Med Rehabil 70 3 : 199 204, 1989. 20 Takahashi N, Takahashi O, Ogawa S, et al: What is the origin of the premotor potential recorded from the second lumbrical? Muscle Nerve 34: 779 781, 2006. 21 Masakado Y, Abe L, Kawakami M, et al: The origin of the premotor potential recorded from the second lumbrical. Electromyogr Clin Neurophysiol 48: 9 11, 2008. 22 Masakado Y, Kodama M, Takahashi O, et al: The origin of the premotor potential recorded from the second lumbrical muscle in normal man. Clin Neurophysiol 122: 2089 2092, 2011. 23 Kodama M, Sasao Y, Tochikura M, et al: Premotor potential study in carpal tunnel syndrome. Muscle Nerve 46: 879 884, 2012. 24 Logigian EL, Busis NA, Berger AR, et al: Lumbrical sparing in carpal tunnel syndrome: anatomic, physiologic, and diagnostic implications. Neurology 37: 1499 1505, 1987. 25 Boonyapist K, Katirji B, Shapiro BE, et al: Lumbrical and interossei recording in sever carpal tunnel syndrome. Muscle Nerve 25: 102 105, 2002. 26 Kodama M, Tochikura M, Sasao Y, et al: What is the most sensitive test for diagnosing carpal tunnel syndrome? Tokai J Exp Clin Med 39: 172 177, 2014. 27 1. 41: 41 46, 2013. Carpal tunnel syndrome YOSHIHISA MASAKADO, MICHI TOCHIKURA, MITSUHIKO KODAMA Department of Rehabilitation Medicine, Tokai University School of Medicine Key Words carpal tunnel syndrome, nerve conduction study, lumb-interossei method, 4th finger method, sensitivity