Padua L, Lo MM, Padua R, Gregori B, Tonali P. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci.18(3):145-150

Istituto di Neurologia, Università Cattolica Sacro Cuore, Roma, Italy.
The Italian Journal of Neurological Sciences 07/1997; 18(3):145-50. DOI: 10.1007/BF02048482
Source: PubMed


Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Six hundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT-absence of thenar motor responses), severe CTS (SEV-absence of sensory response and abnormal distal motor latency-DML), moderate CTS (MOD-abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD-abnormal digit wrist conduction and normal DML), minimal CTS (MIN-exclusive abnormal segmental and/or comparative study), and negative CTS (NEG-normal findings at all tests). Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60-80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.

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    • "Congenital predisposition is the commonest cause of CTS in which carpal tunnel is simply narrower in some people than in others especially middle aged people. Other factors which contribute in its causation are stressful work, injury, trauma, endocrine disorders, joint deformities, fluid retention, and the development of any space occupying lesions in the tunnel.7-9 "
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    ABSTRACT: Objectives: The aim of this study was to review the clinical characteristics and demography of Carpel Tunnel Syndrome (CTS) cases presented to a university hospital. Methodology: A retrospective study was done for 336 consecutive patients (290 females and 46 males), referred with a clinical diagnosis of CTS to the Neuro-diagnostic laboratory at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2007 and December 2010. All subjects had clinical evaluation and standardized nerve conduction studies (672 hands) performed by the same examiner. Results: Carpal tunnel syndrome was confirmed in 640 hands (95.23%) with female predominance (86.3%). The mean age was 52.4 in females and 54.4 years in males with overall highest occurrence among the age group 45- < 55 years. Bilateral CTS was confirmed in the majority of the patients, i.e., 304(90.5%), and remaining were unilateral. Among unilateral pattern, 22 (68.8%) had right CTS and others had left CTS. Most of the patients were treated conservatively 85.4% while the rest had surgical decompression 14.6%. Conclusion: Overall predominant age group was 45-<55 years with female dominancy. Majority of subjects had bilateral CTS as well as conservative treatment was frequent.
    Full-text · Article · Mar 2013 · Pakistan Journal of Medical Sciences Online
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    • "The electrophysiological classification [5], in agreement with the AAEM guidelines, follows the neurophysiological progression of CTS severity and includes the following classes: Negative CTS: Normal findings on all tests (including comparative and segmental studies) Minimal CTS: Abnormal findings only on comparative or segmental tests Mild CTS: SCV slowed in the finger-wrist tract with normal DML Moderate CTS: SCV slowed in the finger-wrist tract with increased DML Severe CTS: Absence of sensory response in the finger-wrist tract with increased DML Extreme CTS: Absence of thenar motor response DIAGNOSIS: OTHER NEUROPHYSIOLOGIC EVALUATIONS There are several types of clinical neurophysiologic evaluations of the median nerve across the wrist. These include vibrometry threshold testing, current perception testing, symptom questionnaire (hand diagrams), and other quantitative sensory testing (Semmes-Weinstein monofilament testing, tactile sensation and two-point discrimination. "
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    ABSTRACT: Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging.
    Full-text · Article · Feb 2012 · The Open Orthopaedics Journal
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