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164 41 3 CTS CTS Key Words : carpal tunnel syndrome, nerve conduction study, sensory nerve action potential CTS CTS 10 1 2 CTS 1 3 4 CTS 1 Tinel Phalen Tinel CTS 1 Phalen Phalen Phalen Phalen 2 1/3 : 1 2 All-median hand 4 5 CTS 1 5 CTS 3 CTS 4 Guyon CTS Guyon 5 CTS Guyon

2013. Guyon CTS median neuropathy at the wrist CTS median neuropathy at the wrist CTS CTS PMP22 HNPP CTS 1 APB CMAP 2 CMAP 165 CMAP CMAP CTS CTS 6 F CTS F F 2 CTS 1 2 3 CTS 1 2 3 1

166 41 3 1 4 2 3 CTS 4 4 4 4 SNAP 1 SNAP SNAP 0.5 ms SNAP bactrian sign SNAP, SNAP Onset latency 3 1 peak latency 5 2 8 cm 0.4 ms 6 1 1 4 3 median SNAP radial SNAP 0.5

2013. 167 1 8 9 Pooled sensitivity AAEM A 85 B 4 85 C 74 D 71 E 69 F 1 65 G 65 H 63 I terminal latency index TLI 62 J 2 1 56 4 ms 4 SNAP CTS 7 / 2L IO CMAP 4 2 CMAP 10 cm 0.5 ms CTS CMAP SNAP SNAP CTS CMAP CTS 8 CTS Kimura CTS 7 2 cm 9 terminal index terminal index TI / TI CTS 10 CTS 1 8 9

168 41 3 gold standard CTS gold standard gold standard Guyon Guyon CTS CTS Guyon Yemisci CTS CTS 10 Mondelli CTS 11 CTS CTS Guyon CTS CTS Guyon 5 CTS 1 5 CTS Tinel 90 95 5 10 5 Likelihood Ratio /1 1 / 6 7 1 CTS 1 2 CTS CTS

2013. 169 7 6 2 CTS CTS 3 4 CTS 12 12 CTS 2 CTS 7 1 CTS F CTS 2 CTS 2 CTS 13 1 CTS 3 1 CTS 4 CTS

170 4 Guyon CTS CTS CTS CTS CTS CMAP SNAP 14 15 1 CTS 2 16 CTS double crush syndrome CTS CTS CTS APB 41 3 CTS CTS Wee CTS 17 APB CTS CTS 1 Bland JD: Carpal tunnel syndrome. BMJ 335: 343 346, 2007. 2 Werner R, Armstrong TJ, Bir C, et al: Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clinical Biomechanics 12: 44 51, 1997. 3 Caliandro P, La Torre G, Aprile I, et al: Distribution of paresthesias in Carpal Tunnel Syndrome reflects the degree of nerve damage at wrist. Clin Neurophysiol 117: 228 231, 2006. 4 Zanette G, Cacciatori C, Tamburin S: Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain 148: 227 236, 2010. 5 Ginanneschi F, Filippou G, Reale F, et al: Ultrasonographic and functional changes of the ulnar nerve at Guyon s canal after carpal tunnel release. Clin Neurophysiol 121: 208 213, 2010. 6 Chang MH, Lee YC, Hsieh PF: The role of forearm mixed nerve conduction study in the evaluation of proximal conduction slowing in carpal tunnel syndrome. Clin Neurophysiol 119: 2800 2803, 2008. 7 Kimura J: The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain 102: 619 635, 1979. 8 Jablecki CK, Andary MT, Floeter MK, et al: Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of

2013. the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 58: 1589 1592, 2002. 9 2007. http://www.jsnt.gr.jp/guideline/img/syukonkan.pdf 10 Yemisci OU, Yalbuzdag SA, Cosar SN, et al: Ulnar nerve conduction abnormalities in carpal tunnel syndrome. Muscle Nerve 44: 352 357, 2011. 11 Mondelli M, Ginanneschi F, Rossi A: Evidence of improvement in distal conduction of ulnar nerve sensory fibers after carpal tunnel release. Neurosurgery 65: 696 700; discussion 701, 2009. 12 Nodera H, Herrmann DN, Holloway RG, et al: A Bayesian argument against rigid cut-offs in electrodiagnosis of median 171 neuropathy at the wrist. Neurology 60: 458 464, 2003. 13 Dorfman LJ, Robinson LR: AAEM minimonograph #47: normative data in electrodiagnostic medicine. ff. Muscle Nerve 20: 4 14, 1997. 14 Werner RA, Andary M: Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 44: 597 607, 2011. 15 Robinson L, Kliot M: Stop using arbitrary grading schemes in carpal tunnel syndrome. Muscle Nerve 37: 804, 2008. 16 Gnatz SM, Conway RR: The role of needle electromyography in the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 22: 282 286, 1999. 17 Wee AS: Needle electromyography in carpal tunnel syndrome. Electromyogr Clin Neurophysiol 42: 253 256, 2002.