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神经检查与神经传导检查
What nerve conduction studies and EMG are, why they are done for carpal tunnel and other nerve problems, what to expect, and how accurate they are.
这是什么¶
神经检查测量您的神经传导电信号的能力。检查神经功能的电学方法有两种,二者在实践中都已被证明有用 [1]。主要的检查称为神经传导检查。一个小型仪器向您的神经发送一个微小的脉冲,并记录信号传导的速度。如果神经受到挤压或损伤,信号就会变慢或减弱。
这些检查最常用于腕管综合征,即您腕部前方的神经受到压迫。对于这种疾病,它们被认为是术前评估中不可或缺的一部分 [2]。大多数医生在没有这一确认的情况下不会进行手术 [3]。这些检查也有助于诊断其他神经问题,例如肘部神经受压(肘管综合征)[4]。
您通常会在同一次就诊时接受第二项检查。在这项检查中,会将一根细针刺入几块肌肉。它检查肌肉对其神经支配的反应情况。这两项检查合称为电诊断检查,意思就是利用电来检查神经和肌肉的检查。
这些检查之所以有效,是因为神经传导信号就像电线传导电流一样。受挤压的神经就像一根被夹住的电缆,因此沿着它传导的信号会延迟或减弱。检查结果可以衡量神经受损的程度,这是反映疾病总体严重程度的最佳指标 [5]。这些检查的价值在于作出正确的诊断并判断其严重程度,而不是预测您术后的感受 [6]。
有一点值得了解:检查结果正常并不能排除腕管综合征,因为神经受到的挤压可能时有时无。
它有效吗?¶
坦白地说,这些检查在某些方面表现良好,在另一些方面则有局限。在检查腕管综合征时,它们是一种有用的补充手段,尤其是在常规检查结果正常的情况下 [7]。一项针对一种特殊神经检查的研究发现,它能在69%的病例中发现这种疾病,而且每一个阳性结果都是正确的。当这项检查与另一种测量感觉的方法结合使用时,它能发现84%的病例 [8]。
这些检查还有助于在手术前确认诊断。当您的体征和症状提示神经受到轻度至中度压迫、并且正在考虑手术时,额外的检查可以提高手术针对的是真实、可治疗问题的可能性 [9]。一项研究发现,仅凭症状被诊断的人数(73%)与经这些检查和超声检查确认的人数(51%)之间存在很大差距 [10]。这一差距正是检查之所以重要的原因:它能分辨出谁真正存在手术可以帮助解决的神经问题。
这些检查也有局限。不同机构所做检查的质量参差不齐,有些报告比其他报告更详细 [11]。解读检查结果的标准也需要更明确的界定,以确保诊断准确,并避免进行不必要的手术 [12]。而且,这些检查并不能告诉您一切。它们测量的是神经,而不是您的症状。
有些研究结果并不一致。类固醇注射后检查结果的变化在两年时并不显著 [13]。另一方面,对注射反应良好是预示手术效果的一个有用信号 [14]。检查中的一项指标称为远端运动潜伏期,意思就是信号到达肌肉所需的时间,它在预测您的术后情况方面有一定价值 [15]。
因此,这些检查作为诊断工具效果很好。但用它们来预测您的恢复情况则不太可靠。
风险有哪些?¶
神经检查是安全的,但您应该了解检查时会是什么样子。最常见的影响是检查过程中的不适。电脉冲的感觉像轻轻的敲击或一阵刺痛。如果将细针刺入肌肉,您会感到短暂的刺痛,之后该肌肉可能会酸痛一两天。针对无名指的这种检查很快,对您造成的负担极小 [16]。
电脉冲不会对您的皮肤或组织造成任何持久的影响。这些脉冲很微弱,它们穿过皮肤而不会损伤皮肤。如果您接受了针刺检查,针刺部位可能会有轻微压痛,也可能出现小块淤青。这些都会自行消退。
现有证据没有描述这些检查对身体其他部位的影响,也没有描述其罕见但严重的并发症。这一点值得坦白说明:本页所依据的研究报告的是这些检查的诊断和预测效果,而不是其危害,因此本页关于严重风险的信息有限。
有一种风险并非身体上的。不同机构对检查结果的解读可能不同,有些报告比其他报告更详细 [11]。如果报告列出了细微的异常却没有加以解释,就可能导致错误的结论 [17]。解读检查结果的标准也需要更明确的界定,以确保诊断准确,并避免进行不必要的手术 [12]。这是最主要的可能出错之处:问题不在于检查本身,而在于根据不完整或不清楚的报告作出的诊断。
如果您曾因腕管综合征接受过类固醇注射,那么注射后检查结果的变化在两年时并不显著 [13]。这意味着从较长期来看,注射似乎并不会改变检查所显示的结果,因此注射后再次检查仍应能较准确地反映您神经的情况。
请您的医生或为您做检查的人员向您解释检查报告。清楚地说明检查发现了什么以及这意味着什么,是一份好的检查结果的一部分。
这适合您吗?¶
如果您的症状提示腕管综合征,并且正在考虑手术,这些检查通常是治疗计划的一部分。大多数医生在没有这一确认的情况下不会进行手术 [3]。额外的检查可以提高手术针对的是真实、可治疗的神经问题的可能性 [9]。这一点很重要,因为这些检查能作出正确的诊断,并显示您的神经受到的压迫有多严重 [6]。
如果您的症状模糊不清或时有时无,这些检查的作用可能较小。在检查当天,神经受到的挤压可能检测不到。检查结果正常并不能排除腕管综合征。这些检查也无法预测您术后的感受,因此它们是一种诊断工具,而不是对您恢复情况的保证 [6]。
主要的替代方法是超声检查,它也可以检查神经是否受到压迫 [9]。您的医生可能会建议其中一项或两项都做。每种方法都有其优势,正确的选择取决于您的症状和体格检查结果。
这应该是您与医生共同作出的决定。请询问这项检查预计会显示什么,以及如果结果正常将会怎样。如果您对检查本身的风险有疑问,请阅读上文关于风险的部分。
核心要点¶
如果正在考虑为腕管综合征进行手术,这些检查值得一做。它们可以确认您的神经是否确实受到压迫,并显示其严重程度 [6]。额外的检查可以提高手术针对的是真实、可治疗问题的可能性 [9]。请抱着现实的期望去做检查:这些检查擅长诊断,但无法预测您术后的感受 [6]。最重要的一点提醒是,检查结果正常并不能排除腕管综合征,因为神经受到的挤压可能时有时无。在作出任何决定之前,请要求对方清楚地解释您的检查报告。
参考文献¶
[1] Sensory threshold and conductance testing in nerve injuries. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1986. DOI: 10.1016/0266-7681(86)90252-4
[2] Correlation of Clinical Signs with Nerve Conduction Tests in the Diagnosis of Carpal Tunnel Syndrome. Journal of Hand Surgery. 1994. DOI: 10.1016/0266-7681(94)90244-5
[3] Current Practice in the Use of Nerve Conduction Studies in Carpal Tunnel Syndrome by Surgeons in the Netherlands. Journal of Hand Surgery (European Volume). 2007. DOI: 10.1016/j.jhse.2007.09.007
[4] Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound — A Comparison to Electrophysiologic Studies. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.08.014
[5] Use of nerve conduction studies in carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231191685
[6] Electrical studies as a prognostic factor in the surgical treatment of carpal tunnel syndrome. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80384-4
[7] Provocative motor nerve conduction testing in presumptive carpal tunnel syndrome unconfirmed by traditional electrodiagnostic testing. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80045-7
[8] The utility of portable nerve conduction testing for patients with carpal tunnel syndrome: A prospective clinical study. The Journal of Hand Surgery. 1992. DOI: 10.1016/0363-5023(92)90117-8
[9] Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002751
[10] CORR Insights®: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002822
[11] Electrodiagnostic reports of median neuropathy at the wrist. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80089-0
[12] Electrodiagnostic testing and carpal tunnel release outcome. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(05)80209-6
[13] Nerve Conduction Studies after Treatment for Carpal Tunnel Syndrome. Journal of Hand Surgery. 1992. DOI: 10.1016/0266-7681(92)90191-4
[14] Diagnostic and therapeutic value of carpal tunnel injection. The Journal of Hand Surgery. 1984. DOI: 10.1016/s0363-5023(84)80065-9
[15] Carpal Tunnel Syndrome: Neurophysiological Results of Surgery Based on Preoperative Electrodiagnostic Testing. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80355-5
[16] Relative slowing of the median antidromic sensory nerve conduction velocity to the ring finger in screening for carpal tunnel syndrome. The Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsa.2004.04.026
[17] Electrodiagnostic testing in hand surgery. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80298-x
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview¶
- Nerve conduction studies serve as a measure of impaired nerve function and are the best available indicator of overall disease severity with some prognostic value for surgical outcome [1].
- Nerve conduction studies are considered an indispensable part of the pre-operative evaluation for carpal tunnel syndrome [2].
- Provocative nerve conduction testing is a useful and simple addition to the overall evaluation of patients with carpal tunnel syndrome, particularly those with otherwise normal findings on traditional electrodiagnostic studies [3].
- The selection of an appropriate electrical screening test for peripheral nerve injury depends on the prevalence and seriousness of the target disease and the relative consequences of over- and underdiagnosis [4].
- The absence of any real difference in nerve conduction time between a working group with symptoms and a group with diagnosed carpal tunnel syndrome indicates a high probability that many participants with symptoms would have had abnormal findings on standard electrodiagnostic tests [5].
- The value of preoperative nerve conduction studies lies in obtaining the correct diagnosis and determining the severity of the median nerve disease, not in predicting postoperative outcome [6].
- Electrodiagnostic criteria used in some referenced studies were inadequate and not the most sensitive available, potentially leading to the erroneous conclusion that electrodiagnostic studies offer no additional diagnostic power in carpal tunnel syndrome [7].
- The value of electrodiagnostic testing is not negated by findings that it does not predict postoperative outcome [8].
- When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as electrodiagnostic studies or ultrasound, to increase the probability of actual median neuropathy that can benefit from surgery [9].
- Clinical, electrodiagnostic, and physical examination criteria need better definition to avoid inaccurate diagnoses and unnecessary surgeries [10].
- Highly sensitive tests are required to assess or exclude the diagnosis in one quarter of cases of carpal tunnel syndrome [11].
- Nerve conduction studies were more sensitive than sensibility testing in confirming the diagnosis of carpal tunnel syndrome [13].
- The combination of nerve conduction studies and sensibility testing is more sensitive than either test alone in confirming the diagnosis of carpal tunnel syndrome [13].
- Given specific clinical criteria for establishing the diagnosis of carpal tunnel syndrome, electrodiagnostic testing does not appear to correlate with improved final symptomatic outcome after carpal tunnel release [20].
- Surgical intervention is advocated for patients with symptoms only, even when electrodiagnostic studies are normal, in the context of cubital tunnel syndrome [21].
- The majority of neurosurgeons and orthopaedic surgeons seldom operate without electrodiagnostic confirmation in line with the Dutch consensus guideline on this subject [29].
- When used together, Semmes-Weinstein monofilament mappings and sensory nerve conduction parameters present a clearer picture of the patient's sensory status than either test used alone [31].
- Receiver operating characteristic curves showed distal sensory latency measurement to be a superior diagnostic test for carpal tunnel syndrome, with 3.3 ms as optimal upper limit of normal, giving a sensitivity of 74% and a specificity of 87% [45].
How It Works¶
Diagnostic Utility and Role¶
- The clinical, electrodiagnostic, and physical examination criteria need better definition to avoid inaccurate diagnoses and unnecessary surgeries [10].
- Electrodiagnostic studies are used as part of a clinical evaluation process and are considered a reasonable way to practice medicine [12].
Sensitivity and Specificity¶
- Nerve conduction studies were more sensitive than sensibility testing in confirming the diagnosis of carpal tunnel syndrome, but the combination of the two studies is more sensitive than either test alone [13].
- The sensitivity of the neurometer test alone was 69% and specificity was 100%, increasing to 84% sensitivity when combined with quantitative sensibility testing [28].
- The relative slowing of the antidromic sensory conduction velocity of the median nerve to the ring finger is determined easily and efficiently and imposes minimal strain on the patient [34].
Prognostic Value and Outcomes¶
- Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve [22].
- Suprascapular nerve dysfunction, evidenced by reduced nerve amplitudes and supraspinatus muscle atrophy, significantly predicts poor functional outcomes following shoulder hemiarthroplasty, even when tuberosities are well healed [19].
- This strength recovers gradually as the median nerve heals, but never returns to normal, indicating that this test can be extrapolated to the reinnervation of the abductor pollicies brevis [23].
Technical Considerations and Reporting¶
- There is variability with respect to the thoroughness of electrodiagnostic studies and in the quality of information in the reports [16].
- Electrodiagnostic reports should specifically indicate abnormalities of latency and conduction and present a clear description of the probable pathophysiologic processes rather than just compiling slight abnormalities [26].
- The conduction velocity of the ulnar nerve after an anterior transposition is determined by both the position of the elbow and the location for the measurement of the skin distance [37].
Physiological Mechanisms and Intraoperative Findings¶
- When in situ nerve strain reached 8.1 ± 0.5%, the compound muscle action potential was not evoked [33].
- Intraoperative conduction latencies indicated a dramatic and immediate reduction in the conduction latency across the carpal canal in all but seven patients, two of whom had diabetes [36].
- Electrodiagnostic studies revealed an acute median nerve lesion at the wrist with motor and/or sensory conduction blocks in 20/30 women with pregnancy-related carpal tunnel syndrome [18].
Comparative Modalities¶
- Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies in detecting ulnar neuropathy at the elbow [14].
- The study confirms the high diagnostic value of the pre-operative antidromic sensory conduction velocity findings [25].
What the Evidence Shows¶
Diagnostic Role and Sensitivity¶
- The absence of any real difference in nerve conduction time between the working group with symptoms and the group with diagnosed carpal tunnel syndrome indicates a high probability that many participants with symptoms would have had abnormal findings on standard electrodiagnostic tests [5].
- There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%) [27].
- The authors argue that the electrodiagnostic criteria used in the referenced study were inadequate and not the most sensitive available, potentially leading to the erroneous conclusion that electrodiagnostic studies offer no additional diagnostic power in carpal tunnel syndrome [7].
- Carpal tunnel injection is a reasonably accurate diagnostic test, as a good response to injection is an excellent diagnostic and prognostic sign for surgical treatment [42].
Prognostic Value and Outcomes¶
- Upper arm motor nerve conduction velocity might be a useful predictor of poor surgical outcome in cubital tunnel syndrome [32].
- Distal motor latency is a simple test with a predictive value of the postoperative neurophysiological and clinical outcome of carpal tunnel syndrome [39].
- The changes in electrophysiological findings occurring spontaneously in carpal tunnel syndrome and after treatment by injection are not statistically significant at two years [38].
Clinical Application and Reporting¶
- The author continues to use electrodiagnostic studies as part of a clinical evaluation process and considers this a reasonable way to practice medicine [12].
- The author proposes that the clinical, electrodiagnostic, and physical examination criteria need better definition to avoid inaccurate diagnoses and unnecessary surgeries [10].
- The study confirms the high diagnostic value of the pre-operative antidromic sensory conduction velocity findings in carpal tunnel syndrome [25].
- Surgical intervention is advocated for patients with symptoms only, even when electrodiagnostic studies are normal, in cases of cubital tunnel syndrome [21].
- The incidence of abnormal conduction times was not reliably correlated with either age or duration of paralysis in the paraplegic hand [24].
- In primates, there is no significant difference in the conduction velocity of peripheral nerves repaired in adults and those repaired in early life [15].
- Although there are essential differences between Semmes-Weinstein monofilament mappings and sensory nerve conduction parameters, when used together they present a clearer picture of the patient's sensory status than either test used alone [31].
- The strength of the abductor pollicis brevis recovers gradually as the median nerve heals but never returns to normal, indicating that this test can be extrapolated to the reinnervation of the abductor pollicis brevis [23].
- Chitosan phonophoresis demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function for mild to moderate cubital tunnel syndrome [17].
- All patients had good clinical and electrophysiological recovery at 6 months following single-stage opponensplasty added at the time of release for severe carpal tunnel syndrome [41].
- Three weeks after the operation, 77% of the patients in the tourniquet group had denervation in other than thenar muscles [46].
Practical Considerations¶
Diagnostic Interpretation and Utility¶
- Nerve conduction studies serve as a measure of impaired nerve function and the best available indicator of overall disease severity, rather than a test that determines the diagnosis [1].
- The value of preoperative nerve conduction studies lies in obtaining the correct diagnosis and determining the severity of median nerve disease, not in predicting postoperative outcome [6].
- Electrodiagnostic testing does not appear to correlate with improved final symptomatic outcome after carpal tunnel release given specific clinical criteria for establishing the diagnosis [20].
- When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery [9].
- The authors argue that the electrodiagnostic criteria used in the referenced study were inadequate and not the most sensitive available, potentially leading to the erroneous conclusion that electrodiagnostic studies offer no additional diagnostic power in CTS [7].
- This does not negate the value of electrodiagnostic testing [8].
Testing Variations and Screening¶
- Provocative nerve conduction testing is a useful and simple addition to the overall evaluation of patients with CTS, particularly those with otherwise normal findings on traditional electrodiagnostic studies [3].
- The absence of any real difference in nerve conduction time between the working group with symptoms and the group with diagnosed CTS indicates a high probability that many of the participants with symptoms would have had abnormal findings on standard electrodiagnostic tests [5].
- There is a significant discrepancy between the practice recommended by the Danish Society of Neurophysiology of performing neurophysiological investigations in all cases of suspected CTS and what is actually done in most surgical departments [35].
Specific Clinical Scenarios¶
- Upper arm motor nerve conduction velocity (MNCV) might be a useful predictor of poor surgical outcome in cubital tunnel syndrome [32].
- Surgical intervention is advocated for patients with symptoms only, even when electrodiagnostic studies are normal, in cases of electrodiagnostic-negative cubital tunnel syndrome [21].
- SSN dysfunction, evidenced by reduced nerve amplitudes and supraspinatus muscle atrophy, significantly predicts poor functional outcomes following shoulder hemiarthroplasty, even when tuberosities are well healed [19].
- The incidence of abnormal conduction times in the paraplegic hand was not reliably correlated with either age or duration of paralysis [24].
- Intraoperative electrodiagnosis may offer limited value in neonatal brachial plexus palsy surgery, but there is insufficient evidence to reach robust conclusions [44].
- This underscores the need for surgeons to carefully evaluate suprascapular nerve integrity in cases of rotator cuff tear [40].
Methodological and Prognostic Notes¶
- Only studies with randomization, blinding, and sham injection or sham surgery can address subjective symptoms and satisfaction reliably and accurately [30].
Key Evidence¶
- [L5] Nerve conduction studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function, serving as the best available indicator of overall disease severity with some prognostic value for surgical outcome. [1] (10.1177/17531934231191685)
- [L3] We consider nerve conduction studies to be an indispensable part of the pre-operative evaluation. [2] (10.1016/0266-7681(94)90244-5)
- [L2] Provocative nerve conduction testing is a useful and simple addition to the overall evaluation of patients with CTS, particularly those with otherwise normal findings on traditional electrodiagnostic studies. [3] (10.1016/s0363-5023(97)80045-7)
- [L3] The selection of an appropriate electrical screening test for peripheral nerve injury, such as entrapment neuropathy, depends on the prevalence and seriousness of the target disease and the relative consequences of over- and underdiagnosis. [4] (10.1016/s0363-5023(96)80165-1)
- [L3] The absence of any real difference in nerve conduction time between the working group with symptoms and the group with diagnosed CTS indicates a high probability that many of the participants with symptoms would have had abnormal findings on standard electrodiagnostic tests. [5] (10.1016/0363-5023(92)90116-7)
- [L5] The value of preoperative nerve conduction studies lies in obtaining the correct diagnosis and determining the severity of the median nerve disease, not in predicting postoperative outcome. [6] (10.1016/s0363-5023(96)80384-4)
- [L5] The authors argue that the electrodiagnostic criteria used in the referenced study were inadequate and not the most sensitive available, potentially leading to the erroneous conclusion that electrodiagnostic studies offer no additional diagnostic power in CTS. [7] (10.1067/jhsu.2000.jjhsu00025a1le01)
- [L5] This does not negate the value of electrodiagnostic testing. [8] (10.1016/s0363-5023(96)80222-x)
- [L3] When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery. [9] (10.1097/corr.0000000000002751)
- [L5] The author proposes that the clinical, electrodiagnostic, and physical examination criteria need better definition to avoid inaccurate diagnoses and unnecessary surgeries. [10] (10.1016/s0363-5023(05)80209-6)
- [L3] Highly sensitive tests are required to assess or exclude the diagnosis in one quarter of cases of carpal tunnel syndrome. [11] (10.1016/0266-7681(94)90245-3)
- [L5] The author continues to use electrodiagnostic studies as part of a clinical evaluation process and considers this a reasonable way to practice medicine. [12] (10.1016/s0363-5023(96)80380-7)
- [L4] The results indicate that nerve conduction studies were more sensitive than sensibility testing in confirming the diagnosis of carpal tunnel syndrome, but the combination of the two studies is more sensitive than either test alone. [13] (10.1016/s0363-5023(82)80176-7)
- [L4] Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies in detecting ulnar neuropathy at the elbow. [14] (10.1016/j.jhsa.2023.08.014)
- [L3] The study demonstrates that in primates there is no significant difference in the conduction velocity of peripheral nerves repaired in adults and those repaired in early life. [15] (10.1016/s0363-5023(83)80199-3)
- [L4] There is variability with respect to the thoroughness of electrodiagnostic studies and in the quality of information in the reports. [16] (10.1016/s0363-5023(98)80089-0)
- [L1] This approach demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function. [17] (10.1016/j.jht.2024.02.006)
- [L4] Electrodiagnostic studies revealed an acute median nerve lesion at the wrist with motor and/or sensory conduction blocks in 20/30 women. [18] (10.1016/s0266-7681(98)80232-5)
- [L3] SSN dysfunction, evidenced by reduced nerve amplitudes and supraspinatus muscle atrophy, significantly predicts poor functional outcomes following SHA, even when tuberosities are well healed. [19] (10.1016/j.jse.2025.07.001)
- [L3] Given specific clinical criteria for establishing the diagnosis of carpal tunnel syndrome, electrodiagnostic testing does not appear to correlate with improved final symptomatic outcome after carpal tunnel release. [20] (10.1016/s0363-5023(96)80164-x)
- [L2] We advocate surgical intervention for patients with symptoms only, even when electrodiagnostic studies are normal. [21] (10.1053/jhsu.2001.26327)
- [L2] Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. [22] (10.1016/j.jhsa.2022.10.008)
- [L5] This strength recovers gradually as the median nerve heals, but never returns to normal, indicating that this test can be extrapolated to the reinnervation of the abductor pollicies brevis. [23] (10.1016/s0266-7681(03)00022-6)
- [L4] The incidence of abnormal conduction times was not reliably correlated with either age or duration of paralysis. [24] (10.1016/s0363-5023(88)80132-1)
- [L4] The study confirms the high diagnostic value of the pre-operative antidromic sensory conduction velocity findings. [25] (10.1016/0266-7681(88)90161-1)
- [L5] EDX reports should specifically indicate abnormalities of latency and conduction and present a clear description of the probable pathophysiologic processes rather than just compiling slight abnormalities. [26] (10.1016/s0363-5023(96)80298-x)
- [L5] There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%), calling into question whether clinicians can confidently diagnose patients with mild-to-moderate CTS. [27] (10.1097/corr.0000000000002822)
- [L3] The sensitivity of the neurometer test alone was 69% and specificity was 100%, increasing to 84% sensitivity when combined with quantitative sensibility testing. [28] (10.1016/0363-5023(92)90117-8)
- [L4] The majority of neurosurgeons and orthopaedic surgeons seldom operate without electrodiagnostic confirmation in line with the Dutch consensus guideline on this subject. [29] (10.1016/j.jhse.2007.09.007)
- [L4] Although there are essential differences in these two tests, when used together they present a clearer picture of the patient's sensory status than either test used alone. [31] (10.1016/s0894-1130(87)80010-8)
- [L3] Upper arm motor nerve conduction velocity (MNCV) might be a useful predictor of poor surgical outcome. [32] (10.1177/17585732241293360)
- [Paper] The results showed that when the in situ nerve strain reached 8.1 ± 0.5%, the compound muscle action potential was not evoked. [33] (10.1016/s0736-0266(02)00080-3)
- [L3] The relative slowing of the antidromic sensory conduction velocity of the median nerve to the ring finger is determined easily and efficiently and imposes minimal strain on the patient. [34] (10.1016/j.jhsa.2004.04.026)
- [L4] There is a significant discrepancy between the practice recommended by the Danish Society of Neurophysiology of performing neurophysiological investigations (NI) in all cases of suspected CTS and what is actually done in most surgical departments. [35] (10.1016/s0266-7681(97)80443-3)
- [L4] The results of intraoperative conduction latencies indicated a dramatic and immediate reduction in the conduction latency across the carpal canal in all but seven patients, two of whom had diabetes. [36] (10.1016/s0363-5023(78)80119-1)
- [L4] The conduction velocity of the ulnar nerve after an anterior transposition is determined by both the position of the elbow and the location for the measurement of the skin distance. [37] (10.1016/s0363-5023(87)80051-5)
- [L3] The changes in electrophysiological findings occurring spontaneously in carpal tunnel syndrome and after treatment by injection are not statistically significant at two years. [38] (10.1016/0266-7681(92)90191-4)
- [L3] DML is a simple test with a predictive value of the postoperative neurophysiological and clinical outcome of carpal tunnel syndrome. [39] (10.1016/s0266-7681(97)80355-5)
- [L5] This underscores the need for surgeons to carefully evaluate suprascapular nerve integrity in such cases. [40] (10.1186/s12891-025-09195-6)
- [L3] All patients had good clinical and electrophysiological recovery at 6 months. [41] (10.1177/1558944716660555fx)
- [L4] Results suggest that carpal tunnel injection is also a reasonably accurate diagnostic test, as a good response to injection is an excellent diagnostic and prognostic sign for surgical treatment. [42] (10.1016/s0363-5023(84)80065-9)
- [L4] Intraoperative electrodiagnosis may offer limited value in neonatal brachial plexus palsy surgery, but there is insufficient evidence to reach robust conclusions. [44] (10.1177/17531934261478357)
- [L3] Receiver operating characteristic curves showed distal sensory latency measurement to be a superior diagnostic test, with 3.3 ms as optimal upper limit of normal, giving a sensitivity of 74% and a specificity of 87%. [45] (10.1016/s0363-5023(96)80020-7)
- [L1] Three weeks after the operation 77% of the patients in the tourniquet group had denervation in other than thenar muscles. [46] (10.1016/s0363-5023(89)80011-5)
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