Neurophysiological classification of carpal tunnel syndrome: Clinical and prognostic value
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文摘
Following the AAEM guidelines, we performed a prospective clinical-neuro-physiological study in 600 hands with carpal tunnel syndrome (CTS) (mean age = 51.4 yr., female/male ratio = 5.5, right/left ratio = 1.8). A postoperative follow-up was also performed in 58 hands. Aim of this study was the development and evaluation of a classification of CTS based only on neurophysiological findings, to standardise the neurophysiological approach to this mononeuropathy. Sensory median nerve conduction velocity (SNCV) first and third digit-wrist and wrist-thenar distal motor latency (DML) were always performed; in “negative” hands, more sensitive tests (segmental-comparative) were performed. CTS Hands were divided in six groups: Extreme (absence of motor and sensory responses), Severe (absence of sensory response and abnormal DML), Moderate (abnormal SNCV and DML), Mild (abnormal SNCV only), Minimal (abnormal segmental-comparative tests only), Negative (normal findings at all tests). This classification does not depend on the techniques used as it is based on “non-numerical” neurophysiological “cut-offs”; thus it can be used in all EMG laboratories. It appears reliable and can be useful for clinical-prognostic assessment: age of patients and clinical data appeared related to neurophysiological picture and significant differences of parameters not used for classification (as palm-wrist SNCV) were observed between groups. The classification may be also useful in discovering “atypical” cases (i.e. Severe-Extreme CTS in young patient) which could suggest to further investigate for systemic illness. Moreover, the postoperative follow-up showed a prognostic value of this classification: Minimal-Moderate cases presented a high incidence of complete postoperative neurophysiological recovery, while more advanced cases presented a partial postoperative recovery only.