AAEM PRACTICE TOPIC IN ELECTRODIAGNOSTIC MEDICINE

American Association of Electrodiagnostic Medicine

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2002 American Association of Electrodiagnostic Medicine Muscle Nerve 25: 918922, 2002

PRACTICE PARAMETER FOR ELECTRODIAGNOSTIC STUDIES IN CARPAL TUNNEL SYNDROME: SUMMARY STATEMENT*
AMERICAN ASSOCIATION OF ELECTRODIAGNOSTIC MEDICINE, AMERICAN ACADEMY OF NEUROLOGY, and AMERICAN ACADEMY OF PHYSICAL MEDICINE AND REHABILITATION

Carpal tunnel syndrome (CTS) is a common clinical problem and frequently requires surgical therapy. The results of electrodiagnostic (EDX) studies have been found to be highly sensitive and specific for the
* Approved by the American Association of Electrodiagnostic Medicine: J anuary 2002, original document approved April 1993. Approved by the American Academy of Neurology February 2002, : original document endorsed, February 1993. Endorsed by the American Academy of Phy sical Medicine and Rehabilitation: February2002, original document endorsed, March 1993. Reviewed and revised in 2001 by the American Association of Electrodiagnostic Medicine ( AAEM) CTS Task Force: Charles K J ableck MD, Chair;Michael T.Andary MD, MS;Mary Kay Floeter i, , MD, PhD;Robert G.Miller, MD;Caroline A.Quartly MD, FRCP( ; , C) Michael J Vennix MD;J . , ohn R.W ilson, MD.American Academy of Neurology ( AAN)Quality Standards Subcommittee:Gary M.Frank lin, MD, Cochair; Catherine A. Zahn, MD, FRCP( , MHSc, CoC) chair; Milton Alter, MD, PhD;Stephen Ashwal, MD;Rose M.Dotson, MD; Richard M.Dubinsk , MD;J y acqueline French, MD;Gary H.Friday , MD;Michael Glantz MD;Gary S.Gronseth, MD;Deborah Hirtz MD; , , J ames Stevens, MD;David J Thurman, MD, MPH;W illiam W einer, . MD. American Academy of Phy sical Medicine and Rehabilitation ( AAPM&R) Practice Guidelines Committee: J ohn C. Cianca, MD; Gerard E. Francisco, MD; Thomas L. Hedge, J , MD; Deanna M. r. J anora, MD; Aj Kumar, MD; Gerard A, Malanga, MD; J M. ay ay Mey thaler, MD, J Frank J Salvi, MD;Richard D.Zorowitz MD. D; . , Authors had nothing to disclose. Original document developed in 1993 by the AAEM Quality Assurance Committee: Charles K. J ableck MD, Chair; Michael T. i, Andary MD, MS;Richard D.Ball, MD, PhD;Michael Cherington, MD; , Morris A Fisher, MD;Lawrence H.Phillips I MD;Yuen T.So, MD, I , PhD; J ohn W . Tulloch, MD; Margaret A. Turk MD; David O. , W iechers, MD, MS;Asa J W ilbourn, MD;Dennis E.W ilk . ins, MD; Faren H. W illiams, MD; Roy G. Ysla, MD. American Academy of Neurology ( AAN) Quality Standards Subcommittee: J ay H. Rosenberg MD, Chair;Milton Alter, MD, PhD;J asper R.Daube, MD; Gary Frank lin, MD, MPH; Benj amin M. Frishberg, MD; Michael K. Greenberg, MD; Douglas J Lansk MD; George Paulson, MD; . a, Richard A. Pearl, MD; Cathy A. Sila, MD. American Academy of Phy sical Medicine and Rehabilitation ( AAPM&R)Practice Parameters Committee:Carl V.Granger, MD, Chair;J A.DeLisa, MD;My oel ron M. LaBan, MD; J ames S. Lieberman, MD; Mark A. Tomsk MD; i, Margaret A.Turk MD. , Key wor ds: carpal tunnel sy ndrome; electromy ography literature ; review; nerve conduction study reference values; sensitivity ; ; specificity Cor espondence t American Association of Electrodiagnostic r o: Medicine;email:aaem@ aaem. net 2002 American Association of Electrodiagnostic Medicine. Published byW ileyPeridodicals, I nc. Published online 7 May 2002 in W iley I nterScience

( www. interscience.wileycom) DOI 1002/ . . 10. mus. 10185

diagnosis of CTS. This document defines the standards, guidelines, and options for EDX studies of CTS based on a critical review of the literature published in 19931 and recently updated by a review of the literature through the year 2000.2 The reader is referred to the updated review2 for a detailed discussion of the literature and the EDX techniques for the assessment of CTS which are summariz here. Both reviews addressed the ed following k clinical questions: ey 1. I patients clinically suspected of having CTS, n what are the best EDX studies to confirm the diagnosis? 2. How can future clinical research studies be improved to evaluate the usefulness of laboratory studies, including EDX studies, to confirm the diagnosis of CTS?
DESCRIPTION OF THE REVIEW PROCESS

The source of the articles for the first CTS Literature Review1 published in 1993 was a Medline search for literature in English from January 1, 1986, through May 1991. The Medical Subj Headings (MeSH) searched ect were (1) wrist inj uries or wrist j oint, (2) nerve compression syndrome, and (3) carpal tunnel syndrome. The search identified 488 articles. Based on a review of the abstracts, 81 articles describing EDX studies were chosen for review. An additional 78 reports were identified from the bibliographies of the 81 articles, and AAEM consultants recommended 6 others for a total of 165 articles. Of the 165 articles reviewed, 20 were classified as back ground references. The source of the articles for the second CTS Literature Review2 was a Medline search for literature in English through December 2000. The MeSH searched

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were (1) carpal tunnel syndrome and diagnosis or (2) carpal tunnel syndrome and neural conduction. The search generated 497 article titles with abstracts published since 1990. Based on a review of the abstracts, the AAEM CTS TaskForce chose 92 articles for review. An additional 5 articles were identified from the bibliographies of the articles, and 16 from AAEM members who have current research interests in CTS, for a total of 113 articles. Of the 113 articles reviewed, 24 were classified as back ground references.
DESCRIPTION OF THE REVIEW ERS

I 1997, the AAEM President appointed Dr. n Charles K. Jableck to Chair the AAEM CTS Task i Force. The Chair selected the members of the AAEM CTS Task Force from the AAEM membership with the assistance of the AAEM staff and the AAEM President to include neurologists (Floeter, Jableck Wilson) and physiatrists i, (Andary, Quartly, Vennix in both academic ) (Andary, Floeter, Quartly, Vennix and clinical ) practice (Jableck Wilson) with interests in the use i, of EDX studies in CTS. The AAEM CTS Task Force included three members who authored the first CTS Literature Review published in 1993 (Jableck Andary, Wilson). I 1999, the AAEM i, n President appointed Dr. Robert G. Miller to the AAEM CTS Task Force to provide an interface and full collaboration with the AAN Quality Standards Subcommittee in the development of the second CTS Literature Review and the Summary Statement.
LITERATURE INCLUSION CRITERIA

procedure under evaluation. 3. EDX procedure described in sufficient detail to permit replication of the procedure. 4. Limb temperature monitored (measured continuously) during nerve conduction procedures and minimum (or range) of limb temperatures reported for both CTS patients and the reference population. 5. Reference values for the EDX test obtained either: a) with concomitant studies of a reference population, or b) with previous studies of a reference population in the same laboratory. 6. Criteria for abnormal findings clearly stated and, if the measurement is a quantitative one, the abnormal value is defined in statistically computed terms, e.g., range and mean 2 standard deviations, from data derived from the reference population.
REVIEW OF ELECTRODIAGNOSTIC STUDIES

A total of 22 of the 278 articles reviewed met all 6 AAEM CTS LI There were nine additional C. articles (eight using surface electrodes and one using needle electrodes) that studied median motor and sensory nerve conduction across the carpal tunnel (amplitude, latency, and velocity) in normal subj ects only and otherwise fulfilled the AAEM CTS LI C. The first and second CTS Literature Reviews1,2 provide convincing, scientific evidence that median sensory and motor NCSs: 1. are valid and reproducible clinical laboratory studies; and 2. confirm a clinical diagnosis of CTS with a high degree of sensitivity (> 85%) and specificity (95%). Table 1 provides a summary of pooled sensitivities and specificities from studies that met all six AAEM CTS LI for EDX techniques used to C diagnose CTS. I these studies, hand temperatures n were monitored continuously and the maj ority of the studies maintained the hand temperature at 32 or greater. Details of techniques and the C specific studies pooled are provided in the second CTS Literature review.2
DEFINITION OF PRACTICE RECOMMENDATION STRENGTHS

I the fall of 1991, the AAEM Quality Assurance n Committee adopted six literature inclusion criteria (LI of scientific methodology to evaluate CTS C) literature describing EDX procedures. The AAEM CTS Task Force used the same six AAEM CTS LI when reviewing the literature. The first two C criteria apply to all studies of diagnostic tests and deal with the quality of evidence and reducing bias; remaining four criteria deal with technical the and analytic issues that are critical to the use of nerve conduction studies (NCSs) to document nerve pathology. All of these criteria are important for a study to determine whether or not a NCS is useful to diagnose CTS. The sixLI used were as C follows: 1. Prospective study design. 2. Diagnosis of CTS in patient population based on clinical criteria independent of the EDX

The strength of a recommendation or conclusion is

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based on the quality and consistency of supporting evidence. The following rating system is used: Practice standards: generally accepted principles for patient management that reflects a high degree of clinical certainty. Practice guidelines: recommendations for patient management that reflect moderate clinical certainty. Practice options: other strategies for patient management for which the clinical utility is uncertain.

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Tabl 1.Comparison of pooled sensitivities and specificities of EDX techniques to diagnose CTS. e
Technique A B C D E F G H I J K Median sensory and mix nerve conduction: wrist and palm segment ed compared to forearm or digit segment Comparison of median and ulnar sensory conduction between wrist and ring finger Median sensoryand mix nerve conduction between wrist and palm ed Comparison of median and ulnar mix nerve conduction between wrist ed and palm Median motor nerve conduction between wrist and palm Comparison of median and radial sensory conduction between wrist and thumb Median sensorynerve conduction between wrist and digit Median motor nerve distal latency Median motor nerve terminal latencyindex Comparison of median motor nerve distal latency ( second lumbrical)to the ulnar motor nerve distal latency( second interossei) Sy mpathetic sk response in Pooled sensitivity * 0. 85 ( 83, 0. 0. 88) 0. 85 ( 80, 0. 0. 90) 0. 74 ( 71, 0. 0. 76) 0. 71 ( 65, 0. 0. 77) 0. 69 ( 64, 0. 0. 74) 0. 65 ( 60, 0. 0. 71) 0. 65 ( 63, 0. 0. 67) 0. 63 ( 61, 0. 0. 65) 0. 62 ( 54, 0. 0. 70) 0. 56 ( 46, 0. 0. 66) 0. 04 ( 00, 0. 0. 08) Pooled specificity * 0. 98 ( 94, 1. 0. 00) 0. 97 ( 91, 0. 0. 99) 0. 97 ( 95, 0. 0. 99) 0. 97 ( 91, 0. 0. 99) 0. 98 ( 93, 0. 0. 99) 0. 99 ( 96, 1. 0. 00) 0. 98 ( 97, 0. 0. 99) 0. 98 ( 96, 0. 0. 99) 0. 94 ( 87, 0. 0. 97) 0. 98 ( 90, 1. 0. 00) 0. 52 ( 44, 0. 0. 61)

* For each EDX technique to summariz results across studies, sensitivities were pooled from individual studies by calculating a weighted average.I e n calculating the weighted average, studies enrolling more patients received more weight than studies enrolling fewer patients. Specificities were similarly pooled by calculating the weighted average.The data in the parentheses below the sensitivity and specificity values represent the lower and upper 95% confidence limits of the weighted average, respectively Data analy courtesy of Dr.Gary Gronseth.There was heterogeneity between . sis some of the studies ( 95% confidence intervals of the sensitivities and specificities do not overlap) This disparity may be related to differences in the . case definition of CTS, the use of different cutpoints to define an abnormal value, and differences in the average severity of the CTS patients in the different studies.Results based on a single study .

RECOMMENDATIONS REGARDING EDX STUDIES TO CONFIRM A CLINICAL DIAGNOSIS OF CTS

The recommendations below are identical to those made and endorsed in 1993 by the American Academy of Neurology,3 the American Academy of Physical Medicine and Rehabilitation,4 and the American Association of Electrodiagnostic Medicine5 with the clarification of recommendation 1 and 2a and the addition of 2c based on new evidence reviewed in the second CTS Literature Review.2 I patients suspected of CTS, the following EDX n studies are recommended (See Table I for sensitivity and specificity of Techniques AK): 1. Perform a median sensory NCS across the wrist with a conduction distance of 13 cm to 14 cm (Technique G). I the result is f abnormal, comparison of the result of the median sensory NCS to the result of a sensory NCS of one other adj acent sensory nerve in

the symptomatic limb ( tandard) S . 2. I the initial median sensory NCS across the f wrist has a conduction distance greater than 8 cm and the result is normal, one of the following additional studies is recommended: a. comparison of median sensory or mix ed nerve conduction across the wrist over a short (7 cm to 8 cm) conduction distance (Technique C) with ulnar sensory nerve conduction across the wrist over the same short (7 cm to 8 cm) conduction distance (Technique D) ( tandard) or S , b. comparison of median sensory conduction across the wrist with radial or ulnar sensory conduction across the wrist in the same limb (Techniques B and F) ( tandard) or S , c. comparison of median sensory or mix ed nerve conduction through the carpal tunnel to sensory or mix NCSs of ed prox imal (forearm) or distal (digit)

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segments of the median nerve in the same limb (Technique A) ( tandard) S . 3. Motor NCS of the median nerve recording from the thenar muscle (Technique H) and of one other nerve in the symptomatic limb to include measurement of distal latency ( Guideline) . 4. Supplementary NCS: comparison of the median motor nerve distal latency (second lumbrical) to the ulnar motor nerve distal latency (second interossei) (Technique J); median motor terminal latency index (Technique I median motor nerve conduction ); between wrist and palm (Technique E); median motor nerve compound muscle action potential (CMAP) wrist-to-palm amplitude ratio to detect conduction block median ; sensory nerve action potential (SNAP) wristto-palm amplitude ratio to detect conduction block short segment (1 cm) incremental ; median sensory nerve conduction across the carpal tunnel ( Option) . 5. Needle electromyography (EMG) of a sample of muscles innervated by the C5 to T1 spinal roots, including a thenar muscle innervated by the median nerve of the symptomatic limb ( Option) . Based on the second AAEM CTS Literature Review,2 the following EDX studies are not recommended to confirm a clinical diagnosis of CTS either because the EDX studies recommended above have greater sensitivity and specificity or the test is best described as investigational at this time. 1. Low sensitivity and specificity compared to other EDX studies:multiple median F-wave parameters, median motor nerve residual latency, and sympathetic sk in response (Technique K). 2. I nvestigational studies: evaluation of the effect on median NCS of limb ischemia, dynamic hand ex ercises, and brief or sustained wrist positioning.
RECOMMENDATIONS STUDIES IN CTS FOR FUTURE RESEARCH

2.

Clinical diagnosis of CTS independent of EDX studies. For ex ample, a diagnosis of probable CTS as defined in the second CTS Literature Review2 which is based on a consensus recommendation by Rempel and colleagues.6 3. A uniform protocol for data collection and measurement with the physicians performing and interpreting the EDX studies under investigation blinded to the clinical diagnosis of all the human subj ects (normal, CTS, disease control) in the study at least until the data collection and measurements are completed. The AAEM recommends that future clinical research studies of the usefulness of EDX studies to confirm the diagnosis of CTS meet four additional methodological study criteria: 1. Description of EDX technique sufficient to permit replication of the study. 2. Monitor limb temperature continuously during the EDX study. 3. Normal values for EDX technique obtained with concomitant studies or with previous studies in the same laboratory. 4. Criteria of EDX abnormality obtained from normal population and defined in statistical terms.

The first and second AAEM CTS Literature C. Reviews1,2 used six CTS LI The second CTS Literature Review2 recommends (1) the addition of criterion 3, and (2) that future AAEM CTS Literature Reviews use all seven CTS LI to C review reports of the usefulness of EDX studies in the evaluation of CTS patients. The second AAEM CTS Literature Re-view2 also provides a set of specific criteria to mak a clinical diagnosis of e CTS based on ex pert opinion. Both the first and second AAEM CTS Literature Reviews recommend that outcome studies should be performed to assess the harms, benefits, and costs of performing NCSs and needle EMG in patients with symptoms suggestive of CTS. The AAEM CTS Task Force has addressed future research principles over future research topics (ex cept for outcome studies) because the Task Force concluded that future research studies need to meet these principles (1) to provide reliable and

The AAEM recommends that future clinical research studies of the usefulness of EDX studies to confirm the diagnosis of CTS meet three clinical study criteria:
1.

Prospective study.

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reproducible data to evaluate the usefulness of EDX studies to confirm the clinical diagnosis of CTS, and (2) to permit comparison of the relative utility of different EDX studies for that purpose.
DISCLAIMER

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This report is provided as an educational service of the AAEM, AAN, and AAPM&R. I is based on t an assessment of the current scientific and clinical information. I is not intended to include all t possible methods of care of a particular clinical problem, or all legitimate criteria for choosing to use a specific procedure. Neither is it intended to ex clude any reasonable alternative methodologies. The AAEM recogniz that specific patient care es decisions are the prerogative of the patient and his/her physician and are based on all of the circumstances involved.
REFERENCES 1. Jableck CK, Andary MT, So YT, Wilk DE, Williams FH. i ins Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 1993; 13921414. 16:

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Jableck CK, Andary MT, Floeter MK, Miller RG, Quartly i CA, Vennix MJ, Wilson JR. Second literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 2002;Published online 1 June 2002 in Wiley I nterScience (www.interscience.wiley.com). DOI 10.1002/ mus.10215. American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement). Neurol 1993; 24042405. [ 43: See correction, Neurol 1994; 304.] 44: American Academy of Physical Medicine and Rehabilitation, American Association of Electrodiagnostic Medicine, and American Academy of Neurology. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome summary statement). Arch Phys Med Rehab 1994; 124125. 75: 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 1993; 13901391. 16: Rempel D, Evanoff B, Amadio PC, de Krom M, Frank G, lin Franz blau A, Gray R, Gerr F, Hagberg M, Hales T, KatzJN, Pransk G. Consensus criteria for the classification of carpal y tunnel syndrome in epidemiologic studies. Am J Public Health 1998; 14471451. 88:

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ABSTRACT: Th first AAEM Carpal Tunnel Syndrome (CTS) Literature Review ( e 1993 evaluated th ) e sensitivity and sp ecificity of nerve conduction studies ( NCSs) and needle electromy ograp y ( h EMG) to confirm a clinical diagnoses of ( CTS)b ased up a critical review of 16 articles from th literature th on 5 e rough May 1991.Th new rep includes all of th information from th first review and 113 additional articles is ort e e from th literature th e rough Decemb 2000.Th auth concluded th median sensoryand motor NCSs er e ors at are valid and rep roducib clinical lab le oratory studies th confirm th clinical diagnoses of CTS with a h at e igh degree of sensitivity ( 85 ) and sp > % ecificity ( 95 ) and th th clinical p > % at e ractice recommendations p lish in 1993 remain valid. ub ed Needle EMG studies were not as sensitive or sp ecific as NCSs to diagnose CTS alth ough th are useful to document ax ey onal nerve p ology I future research studies to evaluate ath .n th usefulness of NCSs and needle EMGs to diagnose CTS, th auth recommend th ( th p y e e ors at 1) e h sician p erforming and interp reting th NCS and needle EMGs b b e e linded to th diagnosis of th subects ( e e j normal, CTS p atient, or disease control)to avoid ob server b and ( th clinical diagnosis of CTS b made ias 2) e e according to a new set of consensus clinical diagnostic criteria p resented in th rep to p is ort rovide a more uniform p ulation of CTS p op atients.

SECOND AAEM LITERATURE REVIEW OF THE USEFULNESS OF NERVE CONDUCTION STUDIES AND NEEDLE ELECTROMYOGRAPHY FOR THE EVALUATION OF PATIENTS W ITH CARPAL TUNNEL SYNDROME
Chare K.J e k MD, Mi hae T.Andar , MD, MS, Mar Kay Fl t r MD, PhD, Robe tG.Mie , MD, ls abl c i c l y y oe e , r lr l Car i A. ol ne Quarl, MD, FRCP( Mi hae J Ve x MD, J ty C) c l . nni , ohn R. i on, MD W l s I NTRODUCTI ON Carpal tunnel syndrome (CTS) is a common clinical problem and a frequent diagnosis of patients referred for evaluation in electrodiagnostic medicine (EDX) laboratories. I Rochester, MN, the prevalence of CTS was n estimated at 88 per 100,000 in 1961 to 1965 and at 125 per n 100,000 in 1976 to 1980.245 I 1988, there were 51 cases per 100,000 in Santa Clara County, California, of which 47% were workrelated.186 Most physicians agree that the accuracy of the diagnoses and the care and management of patients with symptoms and signs of CTS are improved by the performance of EDX studies which increases the lik elihood of the correct diagnosis of CTS.20,29,55,56,95,139,205 Those physicians believe that a definite diagnosis of CTS cannot be based solely on subj ective complaints (e.g., pain, paresthesia), subj ective findings, (e.g., Tinels sign, Phalens sign, sensory deficit) and voluntary effort (e.g., weak ness) because there are other ________________________ ________________________
This review was developed for the AAEM by the CTS TaskForce the members of which are listed as the authors of this review. The 1993 document was developed by the members of the AAEM Quality Assurance Committee: Chair Charles K. Jableck MD;Members: i, Michael T. Andary, MD, MS;Yuen T. So, MD, PhD;Dennis E. Wilk MD; Faren H. Williams, MD. ins, and Key W ords: carpal tunnel syndrome diagnosis neural conduction electromyography literature review reference values sensitivity specificity Address correspondence to CK. Jableck , j i; ableck post.harvard.edu i@ To purchase the document contact AAEM; aaem@ aaem.net.

common disorders (e.g., cervical radiculopathy, tendonitis) which have similar signs and symptoms or that may coex ist with CTS. I addition, there is a high incidence (20% or n greater) of Tinels sign and Phalens sign in normal subj 227,230,246 The accuracy of the diagnosis of CTS is ects. important because the diagnosis often leads to surgical release of the carpal ligament in patients whose symptoms are refractory to non-operative therapy. I the symptoms are f not due to CTS, then the patient is unlik to benefit from ely surgery. The sensitivity and specificity of nerve conduction studies (NCSs) and needle electromyography (EMG) for the diagnosis of CTS were evaluated by a critical review of the S medical literature published in 1993.109 The 1993 CT Lteratu Revew109 provided the evidence base for the i re i Prac c Parametersf Elec i nos cS desi CT 7 tie or trodag ti tu i n S which was endorsed by the American Association of Electrodiagnostic Medicine (AAEM), the American Academy of Neurology (AAN), and the American Academy of Physical Medicine and Rehabilitation (AAPMR). Furthermore, the recommendation that future clinical research studies should meet the 6 AAEM CTS literature classification criteria (hereafter referred to as the literature inclusion criteria [ C] published in 1993 has LI ) been described as a goal of several subsequent studies of EDX tests in CTS.59,75,91,140,188,189,221,237,254 I the 1993 report, it was recommended that the report be n reviewed and updated periodically. The AAEM formed a

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Prac c Parameter: Carpal T nnel S nd tie u y rome second CTS Task Force in 2000 to update the 1993 report and to provide a single reference for EDX studies in CTS by including the information from the 1993 publication along with the additional information from a systematic review of articles published in English through December 2000. Based on a systematic review of the literature, this document addresses the following k clinical questions: ey 1. I patients clinically suspected of having CTS, what n are the best EDX studies to confirm the diagnosis? 2. What improvements can be made to future clinical research studies to evaluate the usefulness of laboratory studies, including EDX studies, to confirm the diagnosis of CTS? AAEM CTSLI TERATURE I NCLUS ON CRI I TERI A I the fall of 1991, the AAEM Quality Assurance (QA) n Committee adopted 6 criteria of scientific methodology to evaluate CTS literature describing EDX procedures. The AAEM CTS Task Force used the same 6 AAEM CTS LI to update this report. The first 2 criteria apply C to all studies of diagnostic tests and deal with the quality of evidence and reducing bias;the remaining 4 criteria deal with technical and analytic issues that are critical to the use of NCS to document nerve pathology. All of these criteria are important for a study to determine whether or not an NCS is useful to diagnose CTS. 1. Pros tie s d d in. A prospective study pec v tu y esg design permits uniform collection and analysis of data. Di nossof Si pati popu on bas on ag i CT n ent lati ed c nial c teri i epend li c ri a nd ent of th EDX e proc u u er ev ati Use of clinical ed re nd alu on. criteria for the diagnosis of CTS permits identification of a defined population in which to test the sensitivity of the EDX procedure to confirm the diagnosis of CTS. The clinical criteria include a history of nocturnal and activity-related pain and paresthesia in the affected hand, reproduction of the paresthesia with maneuvers that stress the median nerve in the carpal tunnel (Phalens sign/wrist flex ion, reverse Phalens sign/wrist ex tension, Tinels sign/percussion of the wrist, carpal tunnel compression test), sensory deficit limited to the distribution of the median nerve passing through the carpal tunnel, and weak ness and/or atrophy limited to the median innervated muscles in the thenar eminence.1,12,244 EDX proc u d c bed i s f cent d l to ed re es ri n uf i i etai permi repliati of th proc u Specific t c on e ed re. 5. details of the EDX procedure are necessary (1) to verify the results and (2) to use the procedure in other clinical laboratories. 4. L mb temperatu i re moni tored ( meas red u c nu s ) d ri onti ou ly u ng nerv e c u ti ond c on proc u ed res and mi mu ( rang of li ni m or e) mb temperatu reportedf bothCT pati and res or S ents th ref e erenc popu on. The speed of sensory e lati and motor nerve conduction is temperature dependent. The use of temperature correction factors to adj nerve conduction velocity (CV) ust measurements made in cool limbs of CTS patients to a reference temperature is controversial and not recommended.10,14,18 Ref erenc v es f th EDX tes obtai e alu or e t ned ei er th a. wi c omi th onc tant s des of a ref tu i erenc e popu on, lati or b. wi prevou s des of a ref th i s tu i erenc e popu on i th s lati n e ame laboratory . The results of the EDX procedure in a reference population are necessary to determine the specificity of the results of the EDX procedure in CTS patients. Cri a f abnormal f i s c teri or i ng learly s nd tated and i th meas rement i a q anti v one, ,f e u s u tatie th abnormal v e i d i e alu s ef ned i s s c n tatitially c ompu ted terms e.. rang and mean 2 , g, e s ard d i ons f d d v f th tand evati , rom ata eried rom e ref erenc popu on.Use of standard statistical e lati terms permits computation of the sensitivity and specificity of the EDX procedure and comparison of the procedure to other EDX and non-EDX tests for CTS.

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Description of e Rev Process th iew The 6 AAEM CTS LI were listed on a review sheet C followed by yes or no answers to be circled by the reviewer to indicate whether or not an article fulfilled each criterion;each article was reviewed independently by 2 reviewers and the results were discussed until a consensus was reached if there was a difference in scoring. The articles were then rank by the number of ed criteria met. Table 1 lists those articles meeting 4, 5, or 6 of the AAEM CTS LI C. EDX studies of only normal subj ects could meet a max imum of 5 of the 6 AAEM CTS LI because these C studies do not contain CTS patients (criterion 2).

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 Literature Classif le . ication of EDX S tudies.

Normal S jects and Patients W ithCTS ub
6 of 6 Literature Inclusion Criteria Met S rf e Elec es u ac trod 130 Kimura Scelsa and colleagues221 140 Sener223 Kuntz er Simovic and colleagues237 Nathan and colleagues181 182 Uncini and colleagues254 Nathan and colleagues 188 Werner and colleagues262 Padua and colleagues Padua and colleagues189 Rosecrance and colleagues213 5of 6 Literature Inclusion Criteria Met Andary and colleagues Felsenthal and Spindler71 Fitzand colleagues74 Hansson and Nilsson97 I maok and colleagues106 a Kimura128 Kothari and colleagues135 Lesser and colleagues144
9

Carroll Casey and LeQuesne39 Cioni and colleagues47 Clifford and I sraels48 57 DeLean * Di Guglielmo and colleagues59 Jack and Clifford110 son

38

S bd u ermal Elec es trod Buchthal and colleagues31 30 Buchthal and Rosenfalck Tack mann and colleagues248

Chang and colleagues44 Charles and colleagues45 Eisen and colleagues64 Felsenthal69 Felsenthal70 Fisher and Hoffen73 Gilliatt and colleagues84 Gunnarsson and colleagues91 Joynt117 Kabiraj colleagues119 and Kemble125

S rf e Elec es u ac trod 145 Preston and colleagues200 Lew and colleagues 146 Robinson and colleagues211 Logigian and colleagues 148 Sander and colleagues220 Loong and Seah 158 Seror228 Marin and colleagues 167 Shafshakand El-Hinawy231 Melvin and colleagues 168 Troj aborg and colleagues253 Merchurt and colleagues 174 Verghese and colleagues259 Monga and colleagues Wang and colleagues260 Palliyath and Holden190 4of 6 Literature Inclusion Criteria Met S rf e Elec es u ac trod Kiernan and colleagues126 Rosen214 127 Kim Rosenberg215 131 Kimura and Ayyar Rossi and colleagues216 137 Kraft Seror224 157 Macleod Seror226 159 Marinacci Seror229 166 Melvin and colleagues Sheean and colleagues233 171 Mills Tack mann and Lehman249 Monga and Laidlow173 Pease and colleagues192 Pease and colleagues194 Uncini and colleagues255 Valls-Soland colleagues257

S bd u ermal Elec es trod Lauritz and colleagues143 en Pease and colleagues193 Smith239 Thomas252

S bd u ermal Elec es trod Plaj 199 al 202 Preswick

Normal S jects Only ub

5of 6 Literature Inclusion Criteria Met (ri a met: ,,,,; ri on 2relatesto CT pati only c teri 13456 c teri S ents ) Buschbacher32 Buschbacher33 Buschbacher34 S rf e Elec es u ac trod Buschbacher35 Buschbacher36 Di Benedetto and colleagues58 Stetson and colleagues242 Wiederholt265 S bd u ermal Elec es trod Nielsen185

*Surface electrodes for motor studies, subdermal needle electrodes for sensory studies.

The source of the articles reviewed in the 1993 report was a Medline search for literature in English from January 1, 1986, through May 1991. The Medical Subj Headings ect (MeSH) searched were (1) wrist inj uries or wrist j oint, (2) nerve compression syndrome, and (3) CTS. The search

generated 488 article titles with abstracts. Two AAEM 1991

to 1993 QA Committee members reviewed the abstracts. Of

the 488 articles, 81 reports referred to electrodiagnosis and other laboratory studies to evaluate CTS; these were

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Prac c Parameter:Carpal T nnel S nd tie u y rome reviewed. The bibliographies of the 81 reports were ex amined and an additional 78 reports published prior to 1986 were identified and reviewed. The AAEM QA Committee members and 12 additional AAEM members, who have current research interests in CTS, were contacted to provide bibliographies of EDX studies in CTS. Six additional references were identified from these AAEM consultants. Of the total of 165 (81+ 6) articles reviewed, 78+ 20 were classified as back ground references. The source of the articles for this second report was a Medline search for literature in English through December 2000. The MeSH searched were CTS and diagnosis or carpal tunnel and neural conduction. The search generated 497 article titles with abstracts published since 1990. Based on a review of the abstracts, the AAEM CTS Task Force chose 92 articles for review. An additional 5 articles were identified from the bibliographies of the articles and 16 from AAEM members who have current research interests in CTS. Of the total of 113 (92+ 16) articles reviewed, 24 5+ were classified as back ground references. At the start of the second review process, the AAEM CTS LI for limb temperature monitoring during an NCS was C clarified: the published paper must report the limb temperature was measured continuously during the NCS. To S be certain that all of the papers reported in the second CT Lteratu Revew met this criterion, the papers reviewed for i re i the first CT Lteratu Revew were re-ex S i re i amined. As a result of the re-ex amination, there was no change in the classification of papers that previously met 6 of 6 AAEM CTS LI several papers that previously met 5/6 C; (9),50,113,125,157,161,162,171,202,204 4/6 (6),15,112,222,243,264,271 3/6 (4),62 ,88,114,134 and 1/6(1)111 were reclassified as not meeting the AAEM CTS LI for limb temperature monitoring. C DES CRI ON OF DATA PRES PTI ENTATI ON Tables were constructed to display the data from the articles that met all 6 AAEM CTS LI unless the studies used C subdermal (needle) stimulating and/or recording electrodes for the NCS or the studies were considered to be investigational. Abstracts of articles that met 4, 5, or 6 AAEM CTS LI or had historical interest are included in C the references. The tables describing the results of NCSs with surface recording and stimulating electrodes were to include the following information: 1. Author: a. Publication date. 2. Control subj ects: a. Number of control hands (number of control subj ects). b. Mean (range) age of control subj ects. 3. CTS Patients: a. Number of CTS hands (number of CTS patients). b. Mean (range) age of CTS patients. Test parameters: a. Conduction distance in centimeters. b. Stimulation site. c. Recording site. Range or minimum hand temperature. Mean standard deviation of test results in normal hands. Criteria for abnormal value, e.g., mean 2 standard deviations. Abnormal value. Specificity of the test defined as the percentage of normal hands with normal test results (calculated or actual). Sensitivity of the test defined as the percentage of CTS hands with abnormal test results.

4.

5. 6. 7. 8. 9.

10.

I an article chosen for a table did not contain all the data f required for the table, the author(s) of the article were contacted to provide the missing information and the data was added to the table with a notation of the source as being written communication. REVI ER OBS EW ERVATI ONS Although the amplitudes of median sensory nerve action potentials (SNAPs) are frequently reduced in CTS,30,68,70, 131,148,199,243 this is not always the case.3,110,117,118,167 Furthermore, damage to the median nerve fibers in the brachial plex or prox us imal portions of the median nerve can produce changes in the amplitude of median nerve responses in the hand similar to changes caused by damage to the median nerve fibers in the carpal tunnel.266 On the other hand, focal slowing or block of nerve conduction across the carpal tunnel has localiz ing pathologic significance.82,83 For this reason, the 1991 to 1993 AAEM QA Committee agreed to focus on the results of EDX techniques to measure the speed of median nerve conduction across the carpal tunnel in CTS rather than the results of techniques to measure the amplitude of median sensory and motor responses. Since 1991, additional articles have been published which support that decision.26,32,33 This current report is more inclusive and contains new tables with data on median sensory and motor nerve amplitude changes in CTS patients from the 1991 to 2000 literature search to permit the reader to verify the conclusions of the AAEM CTS TaskForce. While reviewing the articles, it became clear that the selection criteria for the clinical diagnosis of CTS was not always described in sufficient detail to determine whether the patient group was representative of the CTS population. I 1989, Jack n son and Clifford110 demonstrated that the incidence of EDX abnormalities increased according to the severity of the median nerve compression as determined by the clinical history of persistent sensory symptoms and the

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Prac c Parameter:Carpal T nnel S nd tie u y rome clinical findings of thenar muscle weak ness and atrophy. Thus, selection of more advanced cases would increase the yield of EDX abnormalities. A report by Buchthal and colleagues31 in 1974 illustrated this point because they reported a 91% incidence of abnormal findings on the needle EMG ex amination of the abductor pollicis brevis (APB) muscle in CTS patients. Subsequent studies of needle EMG findings in CTS243 and the consensus of members of the 1991 to 1993 AAEM QA Committee and the AAEM CTS TaskForce was that the incidence of abnormal needle EMG findings in the thenar muscles of CTS patients is much less than were reported by Buchthal and colleagues31 whose studies were conducted at a national clinical research center. To balance the authority of a publication meeting the 6 AAEM CTS LI in a controlled academic setting with the C reality of clinical ex perience, the 1991 to 1993 QA Committee decided to report data in tables only if the max imum incidence of any EDX abnormality in all the CTS patients in the study was less than 90%. I over 90% of the f patients with a clinical diagnosis of CTS demonstrate a test abnormality, the results suggest that the patient population was heavily screened and, therefore, biased with patients with advanced CTS. For this reason, the studies of Casey and LeQuesne39 and Cioni and colleagues,47 which met the 6 literature classification criteria, were not included in the table data of the 1993 publication. This convention was eliminated from the current review. Data from all studies that met 6 AAEM CTS LI are displayed in tables C regardless of how high or low the sensitivity and specificity of the test results so readers can draw their own conclusions. The AAEM CTS Task Force identified 2 possible sources of investigator bias in the CTS literature: selection bias and observer bias. Selection bias might increase the incidence of EDX test abnormalities due to inclusion of CTS patients with more severe CTS than usually encountered in a clinical practice. To address prospectively the issue of selection bias in CTS research studies as described above, the AAEM CTS Task Force developed a set of criteria for the clinical diagnosis of CTS to provide a more uniform population of CTS patients for use in future research studies of the usefulness of EDX studies to diagnose CTS (see Table 2). Observer bias might increase the incidence of EDX test abnormalities due to the desire of the researcher to document the usefulness of the EDX test. To address prospectively the issue of observer bias, Sack and ett colleagues217 have recommended that clinical research studies of diagnostic tests be performed with the physician performing and interpreting the diagnostic tests blinded to the diagnosis of the subj At the recommendation of the ect. AAN, the AAEM recently endorsed that principle and recommends that physicians performing and interpreting the EDX test as part of a clinical research study be blinded to the clinical classification of the research subj (normal, ects CTS, disease control). REVI OF EDX S EW TUDI ES The identification of the clinical manifestations and operative treatment for symptoms due to compression of the median nerve in the carpal tunnel are generally credited to Phalen198 although there were earlier reports of successful surgical treatment of median nerve compression in the carpal tunnel.23,37,270,273 I 1953, Kremer published the n salient clinical feature of CTS.138 I 1949, Dawson and Scott54 reported the reproducible n recording of nerve action potentials with surface electrodes in arms of healthy human subj after electric stimulation ects of the nerves and suggested that the technique may be useful in detecting nerve damage. I 1956, Simpson238 reported the n observation that the median motor distal latency was prolonged across the carpal tunnel in CTS and this was confirmed by other investigators:Thomas252 in 1960 and n Lambert141 in 1962. I 1956, Dawson53 described a technique for measuring median sensory nerve conduction across the carpal tunnel. I 1958, Gilliatt and Sears85 n demonstrated slow median sensory nerve conduction across the carpal tunnel in patients with CTS. Casey and LeQuesne39 confirmed the finding of Buchthal and 30 that the median nerve conduction Rosenfalck abnormalities in CTS were focal and localiz to the ed segment of the median nerve in the carpal tunnel. Brown28 confirmed the localiz ation of the median nerve conduction abnormalities in CTS patients to be under the carpal ligament with intraoperative NCSs. Other studies have verified these reports and median sensory and motor NCSs have become the mainstay for the laboratory evaluation of CTS.243 Over the past 40 years, clinical research efforts have refined the techniques of median sensory and motor NCSs across the carpal tunnel to mak the tests more sensitive and e specific for the detection of compression of the median nerve in the carpal tunnel.110,181 To mak the NCSs more e sensitive, investigators have developed techniques to ex clude the normal segment of the median nerve distal to the flex retinaculum of the carpal tunnel,30,52,59,65,104,143,265 or compared the speed of median nerve conduction to the speed of ulnar or radial nerve conduction from the same hand,31,200,216,220,233,253 performed sequential short segment (1 cm) sensory and motor NCSs,106,132,224 ,226 and compared the median nerve conduction across the carpal tunnel to median nerve conduction in the forearm or digit.131,188,189,236,237

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Prac c Parameter: Carpal T nnel S nd tie u y rome Tab 2 Clinical Diagnostic Criteria f CTSResearch le . or . To assist in the research evaluation of EDX studies to confirm the clinical diagnosis of CTS, the following criteria are provided to mak a clinical diagnosis of CTS. The criteria are based on symptoms alone;the findings on the physical ex e amination are not necessary for the clinical diagnosis of CTS.205 The findings on the physical ex amination should be used with the medical history to diagnose (1) alternative causes of the sensory symptoms in the hand(s) and (2) concomitant disorders that may confound the laboratory diagnosis of CTS. This document incorporates criteria originally proposed by the AAN Quality Standards Subcommittee in 1993.1 Note that the first inclusion criterion is based on the presence of numbness and tingling, not pain, because numbness and tingling are more specific for nerve inj whereas pain is commonly found in soft-tissue inj ury uries and musculosk eletal disorders in addition to CTS.272 The terms numbness and tingling were chosen over the term paresthesia because the terms numbness and tingling are generally understood by patients and the term paresthesia is foreign to most patients.

I NCLUS ON CRI I TERI A

1. Sensory symptoms (numbness and/or tingling) in at least 2 of digits 1, 2, 3, and 4 for at least 1 month.205,244 The sensory symptoms may be intermittent or constant, but if constant, there must have been a period of time during which the symptoms were intermittent. The numbness and tingling may be accompanied by pain, but pain alone is not sufficient to meet this first inclusion criteria. 2. Sensory symptoms (numbness and/or tingling) aggravated by at least 1 of the following:sleep, sustained hand or arm positioning, or repetitive actions of the hand. 3. Sensory symptoms (numbness and/or tingling) mitigated by at least 1 of the following:changes in hand posture, shak the ing hand, or use of a wrist splint. 4. I pain is present, the wrist, hand, and finger pain is greater than elbow, shoulder, or neckpain if there is pain in any or all of f those locations. EXCLUS ON CRI I TERI A 1. Sensory symptoms ex clusive or predominantly in the D5 (little finger) (ulnar neuropathy). 2. Neckpain or shoulder pain preceded the paresthesia in the digits (cervical radiculopathy and/or brachial plex opathy). 3. Numbness and/or tingling in the feet which preceded or accompanied the sensory symptoms in the hands (polyneuropathy). 4. Findings on the problem focused history and physical ex amination which indicate an ex planation for the sensory symptoms which is more probable than CTS, for ex ample, digital neuropathy, median nerve pathology prox imal to the carpal tunnel, ulnar neuropathy, radial neuropathy, brachial plex opathy, cervical radiculopathy, spinal cord, brainstem or brain pathology, or a polyneuropathy. CERTAI NTY DI AGNOS SOFCTSFOR RES I EARCH S TUDI ES I is recommended that clinical research studies use a combination of clinical and EDX findings to define the highest level of t certainty (def inite) of the diagnosis of carpal tunnel syndrome, while clinical criteria alone are used to define prob le and ab possib CTS as follows: le Def inite CTS Patients (1) satisfy all inclusion and ex : clusion criteria, and (2) have nerve conduction abnormalities consistent with pathology ex clusive to the median nerve and localiz in the carpal tunnel segment of the median nerve. ed Prob le CTS Patients satisfy all clinical inclusion and ex ab : clusion criteria. US OFCLI CAL DI E NI AGNOS C CRI TI TERI FOR CTSRES A EARCH 1. Iis recommended that clinical studies of CTS include patients who meet the criteria for the diagnosis of prob le CTS based on t ab clinical findings alone as test subj for studies to evaluate the usefulness of EDX studies to confirm the clinical diagnosis of ects CTS. The use of a uniform set of diagnostic criteria will permit clinical research studies to focus on a well-defined CTS patient population and will simplify comparison of different EDX techniques as well as EDX data from different clinical laboratories. 2. I is ack t nowleged that a diagnosis of CTS based solely on clinical criteria alone has limited sensitivity and specificity (Rempel205). Therefore, for clinical research purposes, a diagnosis of definite CTS requires the demonstration of abnormalities of median nerve conduction in the carpal tunnel segment of the median nerve in addition to meeting the clinical inclusion and ex clusion criteria. These diagnostic criteria for CTS are proposed for clinical research studies to provide a uniform population of CTS patients with a gold standard diagnosis and representing a broad spectrum of disease. 3. I is ack t nowledged that there are CTS patients who meet only the criteria for probable and possible CTS but who still may deserve appropriate clinical treatment of their condition. Furthermore, there are CTS patients with concomitant polyneuropathy, ulnar neuropathy, and cervical radiculopathy who might be ex cluded from clinical research studies of CTS based on the ex clusion criteria but who may still deserve appropriate clinical treatment of their condition.

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Prac c Parameter: Carpal T nnel S nd tie u y rome To evaluate the specificity of NCSs for the diagnosis of CTS, investigators have used clinical criteria for the diagnosis of CTS independent of EDX findings, performed prospective studies, and included concomitant evaluation of normal control subj 110 The results of these clinical ects. research efforts have found rapid application in the clinical laboratory. Physicians in several specialties, including neurology, physical medicine and rehabilitation, orthopaedics, neurosurgery, plastic surgery, rheumatology, and occupational medicine have concluded that NCSs and needle EMG are of value for the laboratory diagnosis of n CTS.77,80,110,121,243 I a multidiscipline consensus forum, Rempel and colleagues205 concluded that NCSs, combined with the clinical history and clinical findings, provide a better basis for the diagnosis of CTS than the clinical history and clinical finding alone. Several investigators have studied the relationship between the abnormalities on NCSs and the duration and severity of symptoms and signs of CTS. Patients with weak ness and/or sensory deficits frequently have low amplitude motor and/or sensory potentials, respectively.85,251 Although the incidence of abnormalities of median sensory and motor conduction is greater when the duration of the symptoms of CTS is longer, there are definite ex ceptions.251 Furthermore, in 76 1963, Fullerton demonstrated that the susceptibility of median motor nerve conduction across the wrist to ischemia correlated with the frequency and severity of intermittent attack of pain and paresthesias in the affected hand; s slowing of motor nerve conduction (prolonged distal latency) did not correlate with pain and paresthesias. Fullerton76 suggested that there were 2 mechanisms responsible for the symptoms and signs of CTS:(1) a rapidly reversible change in the nerve fibers associated with ischemic attack and (2) a slowly developing structural s, change in the nerve fibers resulting from pressure on the nerve under the flex retinaculum. I 1980, Gilliatt82 or n reviewed additional evidence to support Fullertons hypothesis which provides an ex planation for the prompt relief of some symptoms of CTS with surgical decompression of the carpal tunnel. Motor and sensory NCSs can be performed in the clinical laboratory setting with surface stimulating and recording electrodes.85,141,252 The technical factors that influence the results of these studies have been identified to include the following:amplifier gain and filter settings;electrode siz e, shape, and material; distance between stimulating and recording electrodes; distance between recording electrodes; and limb temperature. Pathologic conditions which cause nerve damage also alter the results of NCSs by slowing or block nerve conduction. NCSs provide a unique and ing reliable method for assessing directly the integrity of sensory and motor nerve fibers.82,83 Needle EMG is performed by inserting a sterile needle electrode through the sk into the belly of a muscle and in evaluating the spontaneous and voluntary electrical activity in the muscle. The technical factors that influence the results of these studies have been identified and include amplifier gain and filter settings and electrode siz shape, and e, material. After inj of a nerve to a muscle, abnormal ury electrical activity can be recorded in the muscle, which serves to provide obj ective evidence of motor nerve inj ury. NCSs and needle EMG are complementary but distinctly different EDX techniques although they are often performed sequentially for the evaluation of clinical problems. Because the use of NCSs and needle EMG requires (1) the formulation of a differential diagnosis based on the clinical history and physical ex amination, (2) interpretation of the data during the ex amination, and (3) a change in the direction of the ex amination during the study based upon that interpretation integrated with clinical information, NCSs and EMG are the practice of medicine and should be performed by a physician qualified by education, training, and ex perience.6 RES ULTS The article review process was designed to ensure that all of the articles cited used comparable scientific methods to evaluate the proposed EDX study. Some variation is to be ex pected in the results even with identical techniques because the percentage of abnormal values depends on several factors including (1) the number of and selection process for the normal subj ects, (2) the number of and selection process for the CTS patientsfew articles described in detail the clinical criteria for the diagnosis of CTS or the severity of the CTS in the patients entered in the study, and (3) the numeric value chosen as the upper limit of normal for the NCS. A total of 22 of the 320 articles and abstracts reviewed met all 6 AAEM CTS LI (see Table 1) and 16 of these 22 C articles were selected as the source of the data displayed in Tables 3 through 22.38,39,47,57,59,110,130,140,181,182,188,189,221,223,237 ,254 The 16 articles selected for the tables: met all 6 CTS (1) LI (2) used surface recording electrodes for NCSs, (3) used C, a technique that evaluated median nerve conduction with the wrist in a neutral position and the hand in a rested state, and (4) reported median nerve conduction abnormalities in a total of 1812 CTS patients and a total of 678 normal subj The data from the remaining 6 articles are discussed ects. in the tex but were not used as a source of Table t data30,31,48,213,248,262 because:(1) 3 investigators30,31,248 used subdermal needle electrodes for stimulating and/or recording electrodes for all of the NCSs (1 used needle recording electrodes for the median sensory NCS and surface electrodes for the median motor NCS29), and needle electrodes are not generally used for NCS,239 and (2) 3 additional articles48,213,262 reported the effect of wrist positioning and/or hand movements on median NCS and these studies are best viewed as investigational techniques

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Prac c Parameter:Carpal T nnel S nd tie u y rome since there is conflicting information on their usefulness to diagnose CTS. There were 9 additional articles listed in Table 1 (8 using surface electrodes and 1 using needle electrodes) that studied median motor and sensory nerve conduction across the carpal tunnel (amplitude, latency, and velocity) in normal subj only and otherwise fulfilled the AAEM ects CTS LI The 9 articles are referenced in the tex that C. t accompanies the appropriate numbered tables. The 8 articles that used surface electrodes provide measurements of median nerve conduction in a total of 425 normal subj ects. M edian M otor Nerv Conduction S e tudies Medan Motor Nerv Dital L i e s atenc . Table 3 presents the y results of 6 studies of median motor conduction over a 6 to 8 cm length of the median nerve passing through the carpal tunnel that met all 6 AAEM CTS LI the median motor C; distal latency is prolonged in 44% to 74% of CTS patients. The more recent studies in Table 3 reported sensitivities of 44% to 55% with specificities of 97% to 99%. The abnormal value (4.0 ms) chosen for the median motor distal latency in the report by Padua188,189 was almost identical to the abnormal value reported in an independent study of 105 control subj by Stetson.242 However, the ects criteria for an abnormal value in the report by Kuntz 140 er (> ms) was closer to the abnormal value (> ms) 4.5 4.7 reported in a larger independent study of 249 control subj by Buschbacher.34 ects There were 21 studies of the median motor distal latency in CTS that met 4 or 5 of the 6 AAEM CTS LI with the C following incidence of prolonged median motor distal latency measurements in CTS: Rosen214 (1993), 20%; Macleod157 (1987), 29%;Mills171 (1985), 33%;Kothari135 (1995), 33%; Gunnarsson91 (1997), 37%; White and colleagues264 (1988), 46%;Preston and Logigian200 (1992), 54%;Seror228 (1994), 55%, Kimura and Ayyar83 (1985), 202 56%; aborg and colleagues253 (1996), 60%; Troj Preswick 252 (1963), 62%;Thomas (1960), 63%;Bhala and Thoppil15 (1981), 67%; Merchut and colleagues168 (1990), 68%; 74 Kemble125 (1968), 69%;Marinacci159 (1964), 69%;Fitz 233 (1995), 78%; (1990), 72%; Sheean and colleagues Melvin and colleagues167 (1973), 79%; Schwartz and Monga and colleagues174 (1985), colleagues222 (1980), 80%; 81%. I nterestingly, the median motor conduction may be slightly slowed in the forearm segment above the carpal tunnel in CTS when the median motor distal latency is prolonged.131,194,252 The cause of the slowing of median motor conduction in the forearm of CTS patients is not clear. Chang43,44 provided evidence that the slowing is due to retrograde degeneration of median motor nerve fibers in the forearm segment of the median nerve. However, Wilson268 provided evidence that the measured slowing is due to the blockof conduction of the faster conducting fibers at the wrist. Medan Motor Nerv Cond c on between Writ andPalm. i e u ti s Table 4 presents the results of 2 studies that met 6 AAEM CTS LI and calculated the median motor CV over a short C conduction distance (5 cm to 6 cm) between the wrist and palm stimulation sites.59,130 Compared to the studies in Table 3 of median distal motor latency, the calculated median motor CV across the carpal tunnel was a more sensitive test for CTS. Medan Motor Nerv Compou Mu c Ac on Potenti i e nd s le ti al Ampli d Table 5 presents the results of a study of tu e. median motor nerve compound muscle action potential (CMAP) amplitude changes in CTS by Kuntz 140 that er met all 6 AAEM CTS LI The study demonstrated that C. measurements of median motor distal latency is more often abnormal in CTS patients than the measurement of median motor CMAP amplitude, 47% versus 15% (compare Table 3 and Table 5). The criterion of SD] abnormality (mean 2 standard deviation [ ) chosen 140 5 by Kuntz er (1994) of the CMAP < mV lies between ects the mean 2 SD of 2 studies of normal subj that met 5 of the 6 AAEM CTS LI the mean SD for the thenar C: CMAP was 10.2 3.6 mV, mean 2 SD = 3.0 mV (Buschbacher34) and 12.5 3.1 mV, mean 2 SD = 6.3 mV (Stetson242 ) Medan Motor Nerv Writ to Palm CMAP Ampli d i e s tu e Rati The ratio of the amplitude of the median motor o. CMAP recorded over the APB with (1) stimulation of the median nerve at the wrist and (2) stimulation in the palm mak it possible to identify median motor nerve es conduction blockacross the carpal tunnel. The technique is technically difficult because it is necessary to tak steps to e avoid simultaneous stimulation of the ulnar nerve in the palm which, if undetected, results in a factitious increase in the APB CMAP with palm stimulation compared to the APB CMAP with wrist stimulation (Di Guglielmo59). Pease193 and Gordon89 evaluated this technique for the diagnosis of CTS and the results were inconclusive. Table 6 presents the results of the study by Di Guglielmo59 that met all 6 AAEM CTS LI the incidence of motor C; conduction blockwas low (7%) with the criteria of a greater than 30% reduction in CMAP amplitude with less than a 15% increase in the duration of the prox imal CMAP, criteria which tak into account temporal dispersion and e phase cancellation. Lesser and colleagues,144 in a study that met 5 of the 6 AAEM CTS LI reported that a higher C, incidence of abnormalities (39% of CTS patients showed evidence of motor conduction block across the carpal tunnel) but did not provide data on temporal dispersion and phase cancellation which would give the appearance of conduction block(Di Guglielmo).59

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Tab 3 M edian M otor Nerv Distal Latency in CTS le . e .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: ub s M ean ( range) Numb of er CTS Hands ( patients) CTSS jects ub Age: M ean ( range) Tech ue: niq Conduction Distance S timulation S ite Recording S ite M inimum Hand Temperature M edian M otor Distal Latency S D Criteria f or Ab normal Value Ab normal Value S pecif of icity Ab normal Value S ensitiv of ity Ab normal Value DeLean57 1988 80 (43) 33 (20 to 73) 253 (150) 47 (20 to 84) 6 cm to 8 cm Wrist APB 32 C 3.2 0.4 ms Mean + 2 SD > ms 4.2 99% (estimate) 60% Jack and son Clifford110 1989 38 (38) Kimura130 1979 122 (61) 43 (15 to 60) 172 (105) 48 (20 to 78) Anatomical landmark s 3 cm prox imal to wrist crease APB 34 C 3.60 0.36 ms Mean +2 SD > ms 4.4 97.5% (estimate) 61% Padua and colleagues188 1996 40 (36) Padua and colleagues189 1997* Kuntz 140 er 1994 70 (70) Cioni and colleagues47 1989 56 (54) 38 (18 to 68) 375 (370) 46 (20 to 72) 6 cm

42 (21 to 69) 131 (123) 53 (21 to 85)

44 (19 to 79) 50 (43) 45 (23 to 80) 500 (379) 51 (20 to 88)

43 (25 to 70) 100 (100) 51 (26 to 85) Anatomical landmark s Distal wrist crease APB 32 C 3.66 0.38 ms Mean +2 SD > ms 4.5 98.6% (actual) 55% 47%

8 cm

6 cm to 8 cm

Wrist APB 31 C 3.18 0.27 ms Mean +2 SD > 3.71 ms 95% (actual) 74%

Wrist APB 31 C 3.2 0.4 ms Mean +2 SD 3.2 0.4 ms 97.5% (estimate) 44%

Wrist APB 33 C 3.3 0.5 ms Mean +2 SD > ms 4.3 97.5% (estimate) 80%

The median nerve motor conduction studies cited in Table 3 were performed by fastening surface recording electrodes over the thenar eminence (G1 or E1) and thumb (G2 or E2) and supramax imal stimulation of the median nerve with surface electrodes above the wrist crease. With these anatomic landmark the conduction distance is usually 6 to 8 cm in normal adults. The time (latency) from the stimulus artifact to the initial s, negative deflection of the compound muscle action potential (CMAP) was measured in ms and recorded as the median motor distal latency (MDL). Slowing of median motor nerve conduction in the carpal tunnel with nerve inj will result in prolongation of the median MDL. Because ury cooling of the nerve fibers and increasing the conduction distance also result in prolongation of the median nerve MDL, it is important that the limb temperature and the conduction distance be controlled. *1997 Padua and colleagues paper189 cites reference population studies performed in the same laboratory in 1996.188 For each reference subj only one hand was tested; each CTS patient, only the most symptomatic hand was tested. ect, for Written communication. Written communication: SD of the normal value was misprinted in the 1996 paper, Table 1 (page 50), 3.2 0.8 ms, and should have been 0.4 the ms. The abnormal value (4.0 ms) was published correctly. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome S =Standard Deviation D

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Tab 4 M edian M otor Nerv Conduction Between le . e W rist and Palm in CTS .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject ub s Age: M ean ( range) Numb of er CTS Hands ( patients) CTSS jects Age: ub M ean ( range) Tech ue niq Prox imal S timulation S ite Distal S timulation S ite Recording S ite M inimum Hand Temperature M edian M otor CV S D Criteria f Ab or normal Value Ab normal Value S pecif of icity Ab normal Value S ensitiv of ity Ab normal Value Kimura130 1979 122 (61) 43 (15 to 60) 172 (105) 48 (20 to 78) Anatomical landmark s Wrist crease Palm APB 34 C 49.0 5.7 Mean 2 SD < m/s 38 97.5% (estimate) 84%
59

Tab 5 M edian M otor Nerv CM AP Amplitude in le . e CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSh ands ( patients) Normal S ject Age: M ean ub s ( range) S timulation S ite Recording S ite M inimum Hand Temperature Normal CM AP amplitude S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Kuntz 140 er 1994 70 (70)* 43 (25 to 70) 100 (100)* 51 (26 to 85) Wrist APB 32 C 7.8 1.4 mV Mean 2 SD < mV 5 100% (actual) 15%

Di Guglielmo and colleagues59 1997 88 (69) 40 (20 to 86) 294 (198) 46 (13 to 84) Anatomical landmark s 1-2 cm prox imal to wrist crease 3 cm distal to wrist crease APB 32 C 46.7 5.8 Mean 2 SD < m/s 35 97.5% (estimate) 23% (61%)*

*I the Di Guglielmo and colleagues paper, measurement of median n motor conduction in the carpal tunnel segment was performed only in 146 CTS hands with normal median sensory conduction from wrist to D2 (SCV > m/s) and normal median motor distal latency (< ms). 45 4.2 Therefore, the percentage (33/146 =23%) of abnormal median motor conduction across the carpal tunnel segment was reported for a subset of all the CTS hands. From the data in the paper, the max imum possible percentage of abnormal median motor conduction in the carpal tunnel segment for all the CTS hands was calculated to be 61%. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome CV =Conduction Velocity S =Standard Deviation APB =Abductor Pollicis Brevis D S =Sensory Conduction Velocity CV

*For each reference subj only 1 hand was tested; each CTS patient, ect, for only the most symptomatic hand was tested. S pecif icity equals the percentage of reference subj hands with normal ects results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal ity results calculated from the test data on the CTS population. APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome CM AP =Compound Muscle Action Potential S =Standard Deviation D

Medan Motor S ort-eg i h s ment I remental S des nc tu i . Kimura128,130 performed short-segment incremental stimulation of the median nerve across the carpal tunnel at 1-cm intervals and noted that, unlik the median sensory e nerve fibers (see below), the median motor nerve fibers are difficult to activate sequentially in steps of 1 cm because of the recurrent course of the motor branch of the median nerve to the thenar muscle and the prox imity of the stimulating electrodes to the thenar muscle. The technique can be time consuming because it is often difficult to eliminate the stimulus artifact from the

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Prac c Parameter: Carpal T nnel S nd tie u y rome been widely accepted for evaluation of patients with CTS. Marti Gru Anas n- ber tomoss The Martin-Gruber anastomosis i. describes the anomalous communication in the forearm of nerve fibers from the median nerve to the ulnar nerve, and its presence may affect the results of median motor NCSs in CTS. Stimulation of the median nerve at the elbow ordinarily results in the selective activation of median innervated intrinsic hand muscles. I the presence of a n Martin-Gruber anomaly, however, ulnar and median innervated hand muscles are simultaneously activated by stimulation of the median nerve at the elbow.93,107,129,141 The Martin-Gruber anomaly does not affect the measurement of the median motor distal latency with stimulation of the median nerve at the wrist.243 I the median nerve conduction f in the carpal tunnel is sufficiently slower than the ulnar nerve conduction at the wrist, then stimulation of the median nerve at the elbow in the presence of the Martin-Gruber median to ulnar anastomosis in the forearm may result in 2 temporally separate CMAPs recorded over the thenar muscle, the normal ulnar response and delayed median response.92,93,129 More often the occurrence of CTS in a patient with an underlying Martin-Gruber anastomosis results in (1) a change in the waveform of the thenar muscle action potential with prox imal median nerve stimulation (initial positive deflection and increased amplitude) compared to distal median nerve stimulation (initial negative deflection)93 and (2) an erroneously fast median nerve forearm CV measurement.129,267 Gutmann92,93 suggested that the presence of an initial positive deflection of the CMAP recorded over the thenar muscle with stimulation of the median nerve at the elbow which was not present with stimulation of the median nerve at the wrist was evidence of median nerve pathology at the wrist. However, more prox imal median nerve pathology in the forearm could result in the same phenomenon. Comparion of s Medan Nerv Cond c on to P i s Dital i e u ti roxmal Medan Nerv Cond c on.I i e u ti nvestigators have recommended formulae (residual latency [ and terminal latency index RL] [ ] to permit comparison of distal median nerve TLI) conduction through the carpal tunnel to more prox imal median nerve conduction through the forearm with the goal of eliminating intersubj variability of motor nerve ect conduction and thereby improving the diagnostic usefulness of motor NCSs to diagnose CTS.137,232 Medan Motor Nerv RL Kraft and Halvorson137 proposed i e . the concept and formula for RL measurements. The RL is equal to the difference between the measured distal latency and the predicted distal latency, the latter computed as the quotient of the distal conduction distance and the prox imal CV of the same nerve. Kuntz 140 in a report that met 6 er, AAEM CTS LI confirmed that the measurements of C, median motor RL is more often abnormal in CTS patients than the measurement of median motor distal latency, 64%

Tab 6 M edian M otor Nerv CM AP W rist to le . e Palm Amplitude Ratio in CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( jects) sub CTSS jects Age: M ean ub ( range) Tech ue: Conduction niq Distance W rist S timulation S ite Palm S timulation S ite Recording S ite M inimum Temperature Amplitude ( wrist) S D Amplitude ( palm) S D W rist to palm amplitude ratio S D Ab normal Value Criteria f Ab or normal Value S pecif of normal icity Ab Value S ensitiv of normal ity Ab Value *Written communication. Di Guglielmo and colleagues59 1997 88 (69) 40 (20 to 86) 294 (198) 46 (13 to 84) Anatomical landmark s 1 cm to 2 cm prox imal to wrist crease 3 cm distal to wrist crease APB 32 C 10.2 2.9 mV 10.5 2.9 mV 0.9 0.1 < 0.7 Lowest value of range of normal values* 100% (actual) 7%

S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. ABP =Abductor Pollicis Brevis CM AP =Compound Muscle Action Potential CTS=Carpal Tunnel Syndrome S =Standard D Deviation

recording.128,130,243 I addition, it is difficult to choose a limit n for normal results that provide both sensitivity and specificity. For ex ample,although White and colleagues264 in 1988 reported a very high test sensitivity (89% in mild CTS), the same authors reported a very high incidence (72%) of abnormalities in asymptomatic hands, which suggests that this test has an unacceptable high rate of false positive results. For these reasons, the technique of segmental (1 cm) median motor nerve stimulation has not

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Prac c Parameter:Carpal T nnel S nd tie u y rome versus 47%, but with lower specificity, 89% versus 99% (Table 7 and Table 3). The latter results suggest that if the criteria for an abnormal RL were adj usted for comparable specificity, that the increased incidence of abnormalities would fall. Evidence to support this conclusion is found in the study by Troj aborg,253 which met 5 of the 6 AAEM CTS 253 LI Troj C. aborg noted a lower incidence of abnormal RL values (48%) compared to abnormal distal latency values (60%) in CTS patients with comparable specificity and that the RL was normal in CTS patients with normal median motor distal latencies. The interested reader is also referred to studies of median motor nerve RL previously reviewed in the 1993 AAEM CT Lteratu Revew.66,116,137,204 S i re i Medan Nerv T nal L i e ermi atenc I ex Simovic and y nd . Weinberg236,237 provide a summary of the reported studies on the usefulness of the median motor TLI diagnose CTS. to I 1979, Shahani described the potential usefulness of the n TLI ratio to diagnose CTS. I 1988, Lissens reported similar n findings in the Dutch literature. The TLIis calculated from the conventional median motor NCS measurements that adj the median motor distal latency for the terminal usts motor conduction distance and the prox imal median motor nerve CV. The TLI is calculated as follows: terminal . conduction distance / [ imal CV distal latency] The prox ratio decreases as the conduction time increases across the carpal tunnel. Table 8 presents the results of 2 studies of the TLI met 6 that AAEM CTS LI The study by Simovic and Weinberg237 C. concluded that 81.5% of CTS patients demonstrate a TLI less than 0.34. However, Donahue and colleagues60 noted that the presence of the Martin-Gruber anastomosis in CTS patients could create an artificially high median motor forearm CV measurement. The study by Kuntz 140 noted er that 10% of the control group and 7% of the CTS group showed a median-to-ulnar crossover. Kuntz 140 ex er cluded those normal subj and CTS patients from his analysis of ects the value of the TLIto identify CTS and noted that only 50% of the CTS group showed a TLIless than 0.34 with a specificity of 91%. Simovic and Weinberg237 provided a summary of the published normative data on 242 hands and noted that only 6 had a TLIunder 0.34 to yield a specificity of 97.5%. These interesting findings need to be confirmed in other laboratories to determine the usefulness of the TLIto diagnose CTS. Comparion ofMedan Motor Nerv Cond c on to Ulnar s i e u ti Motor Nerv Cond c on i th S e u ti n e ame Lmb.There are 3 i different published methods to confirm the diagnosis of CTS by calculating the difference between the median and ulnar nerve distal motor latencies:the median-thenar to ulnar-hypothenar latency difference (THLD),167 the medianthenar to ulnar-thenar latency difference (TTLD),220 and the median-lumbrical to ulnar-interossei latency difference (LI 146 These studies approach the sensitivity of median LD).
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Tab 7 M edian M otor Nerv RL in CTS le . e .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb CTSh er ands ( patients) CTSS ject Age ub Tech ue: Conduction niq Distance S timulation S ite Recording S ite M inimum Hand Temperature Normal RL S D Criteria f Ab or normal Value Ab normal Values S pecif of normal icity Ab Value S ensitiv of normal ity Ab Value Kuntz 140 er 1994 70 (70)* 43 (25 to 70) 100 (100)* 51 (26 to 85) Anatomical landmark s Distal wrist crease APB 32 C 1.96 0.32 ms Mean +2 SD > ms 2.6 88.5% (actual) 64%

*For each reference subj only 1 hand was tested: each CTS ect, for patient, only the most symptomatic hand was tested. S pecif equals the percentage of reference subj hands with icity ects normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome RL =Residual Latency S =Standard Deviation D

sensory NCSs in the diagnosis of CTS and may also be useful in localiz median nerve pathology to the wrist (1) when the ing median sensory response is absent and (2) when CTS occurs in the presence of a polyneuropathy. 220,253 Medan- h i T enar to Ulnar- poth Hy enar L atenc Dierenc y f f e. The THLD method is straightforward and calculates the difference (THLD) between (1) the distal latency of the CMAP recorded over the APB with median nerve stimulation at the wrist (thenar latency) and (2) the distal latency of the CMAP recorded over the abductor digiti minimi (ADM) with ulnar nerve stimulation at the wrist (hypothenar latency).167,220 There are no studies of this method that meet all 6 AAEM CTS LI I a study that met C. n 5 of the 6 AAEM CTS LI Sander220 noted the sensitivity C,

Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 8 M edian M otor Nerv Terminal Latency I le . e ndexin CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ( ub s range) Numb of er CTSHands ( patients) CTSS jects Age: M ean ( ub range) Tech ue niq S timulation S ite S timulation S ite Recording S ite M inimum Hand Temperature Terminal Latency I ndex S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Simovic and colleages237 1999 38 (19) 40 (25 to 68) 54 (54) 50 (18 to 86) Motor conduction study Wrist Elbow APB 32 C 0.43 0.045 Mean 2 SD < 0.34 97.5% (estimate) 82% Kuntz 140 er 1994 63 (63)* 45 (32 to 72)* 93 (93)* 50 (35 to 85)* Motor conduction study Wrist Elbow APB 32 C 0.427 0.043 Mean 2 SD < 0.34 91.4% (actual) 50%

*For each reference subj only 1 hand was tested; each CTS patient, only the most symptomatic hand was tested. Terminal latency index ect, for data from 7 (10%) of 70 normal subj and 7 (7%) of the 100 CTS subj were ex ects ects cluded because of the presence of a median to ulnar crossover in the forearm and median nerve conduction velocity calculations may not be accurate in those cases. The crossover was identified by a compound muscle action potential with an initial negative (upgoing) deflection recorded over the abductor digiti minimi (gain 200 V/div) with median nerve stimulation at the elbow. The mean and range of the ages of the remaining 63 normal subj and 93 CTS patients were provided ects by the author by written communication. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome S =Standard Deviation D

of the THLD study approached the sensitivity of median mix nerve palmar studies for the diagnosis of CTS ed because 85% of CTS patients with abnormal median mix ed nerve palmar studies showed abnormal THLD. I a study n that met 4 of the 6 AAEM CTS LI Rosen214 also noted C, that median mix nerve palmar conduction studies (100%) ed were much more sensitive than THLD studies (36%). Medan- h i T enar to Ulnar- h T enar L atenc Dierenc The y f f e. TTLD method was unusual because the CMAP is recorded over the thenar eminence (active electrode over the APB) with sequential stimulation at the wrist of first the median and then the ulnar nerves and one calculates the difference (TTLD) between the distal latency with median and ulnar

nerve stimulation. The CMAP recorded over the thenar eminence with ulnar nerve stimulation at the wrist begin with an initial positive deflection because the CMAP was in part volume conducted from the hypothenar muscles (Sander220). There are no studies of this method that meet all 6 AAEM CTS LI I a study that met 5 of the 6 AAEM C. n CTS LI Sander220 noted the sensitivity of the TTLD study C, approached the sensitivity of median mix nerve palmar ed studies because 95% of CTS patients with abnormal median mix nerve palmar studies showed abnormal TTLD. ed Medan- u c to Ulnar-nteroseiL i L mbrial I s atenc Dierenc y f f e. The LI method is also unusual because the CMAP is LD recorded over the distal medial palm (active electrode

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Prac c Parameter:Carpal T nnel S nd tie u y rome placed slightly lateral to the midpoint of the third metacarpal) with stimulation at the wrist for both the median and ulnar nerves. The median nerve CMAP is recorded from the second lumbrical and the ulnar nerve CMAP is recorded from the dorsal interosseus deep to the second lumbrical in the palm with the same set of recording n electrodes.200 I contrast to the TTLD methodology described above, both CMAPs have an initial negative deflection. I a study that met all 6 AAEM CTS LI Uncini254 n C, demonstrated that the LI identified a small number of LD additional CTS patients with normal median motor distal latency values (Table 9). Because Uncini254 did not simultaneously evaluate median mix nerve palmar ed conduction studies in CTS patients, his results are not inconsistent with the results of Sander220 which showed the median mix nerve palmar conduction studies to be more ed sensitive than the THLD and TTLD studies to identify CTS patients. There were 4 studies of the LI in CTS that met 4 or 5 of LD the 6 AAEM CTS LI with the following incidence of C abnormal LI LD measurements in CTS: Sheean and aborg253 (1996), 84%; colleagues233 (1995), 73%; Troj 200 Preston and Logigian (1992), 95%; and Resende207 (2000), 100%. Sheean and colleagues233 noted that the computation of the LI was identical in sensitivity to LD computation of the difference in median and ulnar mix ed nerve palmar CV to confirm the diagnosis of CTS; 48 of in 66 hands with suspected CTS, 48 (72%) showed abnormalities with each test and there was a close correlation between the 2 tests. Medan F- e L i Wav atenc S des Table 10 presents the y tu i . results of a study of 7 different F-wave parameters in CTS. The study by Kuntz 140 met 6 AAEM CTS LI and er C demonstrated that none of the F-wave parameters achieved the specificity and sensitivity for the diagnosis of CTS of direct measurements of distal median motor conduction across the carpal tunnel segment of the median nerve. Sander and colleagues,220 in a study that met 5 of the 6 AAEM CTS LI evaluated the calculated difference C, (FWLD:F-wave latency difference) between the minimum median F-wave latency recorded from the APB and the minimum ulnar F-wave latency recorded from the ADM to identify CTS patients. I the Sander and colleagues220 study, n the sensitivity of the FWLD to identify CTS was less than (1) comparison of median and ulnar distal motor latencies across the carpal tunnel and (2) comparison of median and ulnar mix nerve latencies across the carpal tunnel. ed C, Macleod,157 in a study that met 4 of the 6 AAEM CTS LI noted that there was a high percentage of repeater F waves in CTS, which are identical recurring F waves with the same latency, configuration, and amplitude. However, abnormalities of median F-wave parameters can be caused by pathology not only in the carpal tunnel segment of the
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Tab 9 Comparison of e M edian M otor Nerv le . th e Distal Latency (nd Lumb 2 rical) th Ulnar M otor to e Nerv Distal Latency (nterossei) CTS e I in .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ub s ( range) Tech ue: Conduction niq Distance S timulation S ( ite median) S timulation S ( ite ulnar) Recording S ite M inimum Hand Temperature Diference M edianf Ulnar Uncini and colleagues254 1993 72 (47) 45 (18 to 78) 95 (70) 49 (26 to 78) Anatomical landmark s Wrist crease Wrist crease Palm* 32 C 0.10 0.19 ms Mean +2 SD > ms 0.5 97.5% (estimate) 10% (56%)

Onset Latency S D
Criteria f Ab or normal Value Ab normal Value Diference in f M edian and Ulnar Latency S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab

*Lateral to midpoint 3rd metacarpal bone I the Uncini and colleagues paper,254 comparison of median motor n conduction (lumbrical) and ulnar motor conduction (interossei) was done only in the CTS patients with (1) normal median sensory conduction from D2 to wrist (SCV > ms) and (2) normal median 45 motor conduction from wrist to APB (MDL < ms) so that the 4.3 percentage (10%) of abnormal comparison studies of median/ulnar motor conduction was reported for a subset of the CTS patient population; from the data in the paper, the max imum possible percentage of abnormal comparison studies of median/ulnar motor conduction for the whole CTS patient population was calculated to be 56%. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal ity results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome S =Standard Deviation D APB =Abductor Pollicis Brevis M DL =Motor Distal Latency S = CV Sensory Conduction Velocity

Prac c Parameter: Carpal T nnel S nd tie u y rome median nerve, but also by pathology along the length of the median motor nerve fibers to the APB from the spinal cord to the wrist. For all these reasons, measurements of F-wave latencies and other F-wave parameters are not recommended for the diagnosis of CTS. C, Buschbacher,35 in a study that met 5 of the 6 AAEM LI reported the results of F-wave parameter in 195 reference subj Fisher73 (1997) used CTS as a model for analyz ects. ing the effects of focal nerve inj on F-wave parameters. ury M edian S ensory NCS s Medan S ory Nerv Cond c on f i ens e u ti rom Dii to Writ. gt s Table 11 presents the results of 6 studies of median sensory NCSs of a 13 to 14 cm length of the median nerve with the prox imal portion passing through the carpal tunnel (digitwrist studies). These 6 studies that met all 6 AAEM CTS LI determined that between 40% and 74% of patients with C CTS demonstrate either a prolonged median sensory peak latency or the median SNAP was absent. I a 1972 study n that met the 6 AAEM CTS LI Casey and LeQuesne39 C, reported a 94% incidence of abnormal median digit-wrist sensory conduction: 15 out of 16 CTS patient studies abnormal with 9 out of 16 absent SNAP and 6 out of 16 reduced CV. There are 4 studies listed in Table 1 that provide median sensory nerve conduction data in normal subj which ects support the choice of abnormal values in the 6 studies in Table 11 for median sensory peak latency, median sensory onset latency, and median sensory CV (calculated from the onset latency and conduction distance).34,58,110,242 There were 19 other median sensory NCSs of the peak latency, onset latency, and CV with conduction between the wrist and a digit (conduction distance of 13 to 14 cm) that met 4 or 5 of the AAEM CTS LI with the following C incidence of abnormal findings (absent response, prolonged peakor onset latency, or reduced CV) in patients with CTS: Andary and colleagues9 (1996), 27%; Kothari and colleagues135 (1995), D2 42% and D3 54%;White and colleagues264 (1988), 44%, if a response could be elicited; Rosen214 (1993), 48%;Mills171 (1985), 53%;Sheean and colleagues233 (1995), 55%;Stevens243 (1987), 64%; Seror228 (1994), peak latency 61%, CV 66%; Preston and Logigian200 (1992), 67%; Felsenthal71 (1979), 70%; Troj aborg253 (1996), D2 70% and D3 72%;Gunnarsson91 (1997), 77%; Melvin and colleagues167 (1973), 79%; Marinacci159 (1964), 83%;Monga and colleagues174 (1985), 86%; Kimura and Ayyar131 (1985), 92%; Kemble125 (1968), 199 93%; Plaj (1971), 98%; Merchut and colleagues168 a (1990), 100%. While most authors used the indexfinger (Digit 2 or D2) for stimulation or recording, some prefer to use the middle finger (Digit 3 or D3) instead of the indexfinger to evaluate median sensory conduction in CTS.31,117,118,173,181,192,271 The studies that evaluated median digit-wrist sensory conduction with several digits noted abnormalities in CTS patients more often with evaluation of the middle finger compared to the indexfinger, and evaluation of the thumb and sometimes the ring finger studies were more often abnormal than both the indexand middle finger studies.135,188,189,253 There are 2 studies of median sensory conduction from digit to wrist in normal subj that met 5 of the 6 AAEM CTS ects LI Stetson242 (1994) D2 onset latency (3.0 0.2 ms) and C: D2 sensory CV (SCV) (60.2 4.9 m/s);Buschbacher36 onset (D2 = 2.6 0.3 ms, D3 = 2.7 0.3 ms) and peak(D2 and D3 = 3.4 0.3 ms) latencies, the Buschbacher36 data presents mean + 2 SD values higher than most of the reference values in the 7 studies in Table 11. Medan S ory Cond c on f th Palm to th Writ. i ens u ti rom e e s Table 12 presents the results of 7 studies of median sensory and/or mix NCSs of an 8-cm length of the median nerve ed passing through the carpal tunnel. These 7 studies that met all 6 AAEM CTS LI determined that between 67% and C 84% of patients with CTS demonstrate a prolonged median peak latency, onset latency, or CV with a conduction distance of 8 cm. I Table 1, there are 4 studies of median sensory and/or n mix nerve conduction between the wrist and palm in ed normal subj Using a technique to study the conduction ects. of the wrist-palm median nerve segment similar to Kimura,130 Di Benedetto and colleagues58 reported a difference in peaklatency in healthy subj of less than 2.2 ects ms, and a difference in onset latency in healthy subj of ects less than 1.8 ms, the latter value almost identical to the finding of Kimura130 in Table 12. Cruz Martinez and colleagues50 calculated the CV in palm-to-wrist segments of the median nerve from the onset latency in 47 normal subj ects, aged 21 to 77 Under the age of 50, the median sensory CV was 55 5 m/s, and over the age of 50, the median sensory CV was 51 5 m/s. Stetson242 in a study of 105 normal subj noted an onset latency of 1.8 0.2 ms. ects Buschbacher33 in a study of 248 normal subj reported an ects onset latency of 1.6 0.2 ms and a peaklatency of 2.1 0.2 ms. There were 15 additional studies that report median mix ed nerve conduction over a 7 cm to 8 cm distance across the carpal tunnel that met 4 or 5 of the 6 AAEM CTS LI with C the following incidence of abnormal findings in patients with CTS:Kimura121 (1978), 45%;Andary and colleagues9 (1996), 57%;White and colleagues264 (1988), 65%, a study that ignored cases with absent responses;Mills171 (1985), 67%;Robinson and colleagues211 (1998) 70%;Sheean and colleagues233 (1995), 73%;Seror228 (1994), 76%;Preston and Logigian200 (1992), 82%; Stevens243 (1987), 87%; Monga and colleagues174 (1985), 88%; Felsenthal and Spindler71 (1979), 100%; Wongsam271 (1983), 100%;

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .M edian M otor Nerv F- av S le 0 e W e tudies in CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: ub s M ean ( range) Numb of er CTSHands ( patients) CTSS jects Age: ub M ean ( range) S timulation S ite Recording S ite M inimum Hand Temperature F- av Parameter W e Normal S D Criteria f Ab or normal Value Ab normal Value S pecif of normal icity Ab Value S ensitiv of normal ity Ab Value Persistence 92.8 9.2% Mean 2 SD < 70% 91% (actual) 35% Chronodispersion 1.42 0.37 ms Mean +2 SD > ms 2.2 80% (actual) 69% Minimal latency 27.6 2.1 ms Formula +2 SD SD =1.4 86% (actual) 16% Kuntz 140 er 1994 70 (70)* 43 (25 to 70) 100 (100)* 51 (26 to 85) Wrist APB 32 C Minimal ulnarmedian F-wave latency difference 0.59 0.91 ms Mean +2 SD 72.4 90% (actual) 48% Mean duration 10.67 1.62 ms Mean +2 SD > ms 14 10% (actual) 2% Mean amplitude 0.297 0.124 mV Mean +2 SD > 0.545 mV 10% (actual) 2% Mean amplitude ratio 2.97 1.21 Mean +2 SD > 5.39 70% (actual) 15%

*For each reference subj only 1 hand was tested; each CTS patient, only the most symptomatic hand was tested. ect, for Mean F-wave amplitude as a percentage of the median CMAP. Formula: minimum F-wave latency (ms) equals 0.12 height (cm) +6.8. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity CTS=Carpal Tunnel Syndrome S =Standard Deviation APB =Abductor Pollicis Brevis CM AP =Compound Muscle Action Potential D

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .M edian S le 1 ensory Nerv Conduction Between W rist and Digit in CTS e .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ( ub s range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ( ub s range) Tech ue: Conduction Distance niq S timulation S ite Recording S ite M inimum Hand Temperature M edian S ensory PeakLatency S D M edian S ensory Onset Latency S D M edian S ensory Conduction Velocity ( calculated f onset latency*) S rom D Criteria f Ab or normal Value Casey and LeQuesne39 1972 75 (75) 51 (30 to 70) 16 (16) 56 (35 to 70) Anatomical landmark s Middle finger (D3) Wrist 35 C Not reported Not reported 54.8 7.3 m/s Mean - 2 SD Kimura130 1979 122 (61) 43 (15 to 50) 172 (105) 48 (20 to 78) Anatomical landmark s 3 cm prox imal to wrist crease I ndexfinger (D2) 34 C Not reported 2.82 0.28 ms Not reported Mean +2 SD Sensory latency Onset > ms 3.4 97.5% (estimate) Carroll38 1987 100 (50) 47 (16 to 82) 161 (101) 45 (22 to 82) 13 cm I ndexfinger (D2) Wrist 30 C 2.68 0.16 ms age 16 to 39 2.91 0.24 ms age 40 to 59 3.03 0.23 ms age 60 to 82 Not reported Not reported Mean +2 SD Sensory peaklatency > ms age 16 to 39 3.0 > ms age 40 to 59 3.4 > ms age 60 to 82 3.5 100% (actual) Jack and son Clifford110 1989 38 (38) 42 (21 to 69) 131 (123) 53 (21 to 85) 14 cm Wrist I ndexfinger (D2) 31 C 3.16 0.16 ms 2.47 0.12 ms Not reported Mean +2 SD Sensory latency Peak> 3.48 ms Onset > 2.72 ms 97.5% (actual) Cioni and colleagues47 1989 56 (54) 38 (18 to 68) 375 (370) 46 (20 to 72) Anatomical landmark s I ndexfinger (D2) Wrist 30 C Not reported Not reported 58.4 4.1 m/s Mean 2 SD Kuntz 140 er 1994 70 (70) 43 (25 to 70) 100 (100) 51 (26 to 85) 14 cm Middle finger (D3) Wrist 32 C Not reported Not reported 49.6 2.8 m/s Mean 2 SD SNCV D3: 44 m/s < 100% (actual) Padua and colleagues188 1996 40 (36) 44 (19 to 79) 50 (43) 45 (23 to 80) 500 (379) 51 (20 to 88) Padua and colleagues189 1997* Scelsa and colleagues221 1998 30 (25) 42 (23 to 63) 67 (42) 50 (25 to 85) Anatomical landmark s I ndexfinger (D2) Wrist 32 C Not reported Not reported 58 5 m/s# Mean 2.5 SD SNCV D2: 46 m/s < 98% (actual)

Anatomical landmark s Middle finger (D3) Wrist 31 C Not reported Not reported D3: 53.8 5.1 m/s Mean 2 SD SNCV D3: 44 m/s < 97.5% (estimate)

Ab normal Value S pecif of normal Value icity Ab

< m/s 40 97.5% (estimate)

< m/s 50 97.5% (estimate)

43% 63% 49% 66% 80% (96%) 49% D3: 64% D3: 67% 40% S ensitiv of normal Value ity Ab The antidromic median nerve sensory conduction studies cited in Table 9 were performed by securing surface recording ring electrodes on the indexor middle finger and stimulating the median nerve in the wrist prox imal to the carpal tunnel. With these anatomic landmark the conduction distance is usually 13 to 14 cm in normal adults. The time (latency) from the stimulus artifact to the onset or peakof the negative deflection of the biphasic or triphasic waveform s, was measured in milliseconds and recorded as the median sensory peaklatency. Studies have shown that the orthodromic median nerve sensory conduction study can be performed by stimulating the digit and recording from the wrist and the latency measurements results are essentially identical though the amplitude of the sensory nerve action potential (SNAP) is less.147 Slowing of median nerve sensory conduction in the carpal tunnel with nerve inj will result in ury prolongation of the median sensory peaklatency and slowing of the conduction velocity. *1997 paper cites reference population studies performed in the same laboratory published in 1996. For each reference subj only 1 hand was tested; each CTS patient, only the most symptomatic hand was tested. Written communication. I the Cioni and colleagues paper,47 measurement of the median SNCV from digit to ect, for n wrist was done only in a CTS patients hand with normal median motor distal latency (4.3 ms) so that the percentage (80%) of abnormal median SNCV was reported for a subset of the CTS population; from the data in the paper, the calculated form the onset latency. max imum possible percentage of abnormal median SNCVs for the whole CTS population was calculated to be 96%. # Written communication: S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity CTS=Carpal Tunnel Syndrome S =Standard Deviation S D NCV =Sensory Nerve Conduction Velocity

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .M edian S le 2 ensory and M ix Nerv Conduction Between W rist and Palm in CTS ed e .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ( ub s range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ( ub s range) Tech ue: Conduction Distance niq S timulation S ite Recording S s) ite( M inimum Hand Temperature M edian S ensory Onset Latency S D M edian S ensory PeakLatency S D Diference M edian S f ensory Onset Latency S D M edian S ensory Conduction Velocity S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Jack and son Clifford110 1989 38 (38) 42 (21 to 69) 131 (123) 53 (21 to 85) 8 cm Palm Wrist 31 C 1.54 0.12 ms 2.03 0.12 ms Not reported Not reported Mean +2 SD Onset > 1.78 ms Peak> 2.27 ms 97% (actual) 69% Kimura130 1979 122 (61) 43 (15 to 50) 172 (105) 48 (20 to 78) 8 cm Wrist crease: 3 cm prox imal, 5 cm distal D2 34 C Not reported Not reported 1.41 0.18 ms Not reported Mean +2 SD Difference > ms 1.8 97.5% (estimate) 84% Scelsa and colleagues221 1998 30 (25) 42 (23 to 63) 67 (42) 50 (25 to 85) Anatomical landmark s Palm Wrist 32 C Not reported Not reported Not reported 58.5 5.2 m/s Mean 2.5 SD < m/s 46 98% (actual) 67% Kuntz 140 er 1994 70 (70) 43 (25 to 70) 100 (100) 51 (26 to 85) Anatomical land mark (6-8 cm) s Palm Wrist 32 C Not reported Not reported Not reported 54.2 3.1 m/s Mean 2 SD < m/s 48 97% (estimate) 83% Di Guglielmo and colleagues59 1997 88 (69) 40 (20 to 86) 294 (198) 46 (13 to 84) Anatomical landmark s Wrist crease: cm 1-2 prox imal, 3 cm distal D2 32 C Not reported Not reported Not reported 58.1 6.4 m/s Mean 2 SD < m/s 45 97.5% (estimate) 13% (56%)# Padua and colleagues188 1996 40 (36) 44 (19 to 79) 50 (43) 45 (23 to 80) Padua and colleagues189 1997*

500 (379) 51 (20 to 88)

Anatomical landmark s D3 Palm and wrist 31 C Not reported Not reported Not reported 58.3 6.4 m/s Mean 2 SD < m/s 45 97.5% (estimate) 76% 20% (81%)*

The nerve conduction studies of the carpal tunnel segment of the median nerve described in Table 8 were obtained in 3 different ways. (1) To study median mix nerve conduction, Jack and Clifford,110 ed son Kuntz 140 and Scelsa and colleagues,221 placed recording disc electrodes over the median nerve above the wrist and stimulated the median nerve in the palm between the 2nd and 3rd metacarpal heads with er, measurement of the conduction distance. Measurements of the time (ms) from the stimulus artifact to the onset and negative peakof the potential were recorded as the onset and peaklatencies, respectively. (2) imal to To study median sensory nerve conduction, Kimura130 and Di Guglielmo and colleagues59 placed recording ring electrodes on the indexfinger and stimulated the median nerve in 2 locations, 3 cm prox the wrist crease and 5 cm distal to the wrist crease. Measurements of the time (ms) from the stimulus artifact to the onset of the sensory nerve action potential or SNAP (onset latency) were made for each site and the difference calculated and (a) reported as the conduction time of the sensory fibers in the median nerve segment in the carpal tunnel or (b) used to calculate the sensory conduction velocity (SCV) of the carpal tunnel segment. (3) To study median nerve sensory conduction, Padua and colleagues188,189 placed stimulating ring electrodes on the middle finger and a bipolar bar electrodes on the palm and wrist. The palm wrist conduction velocity was calculated the (palm-wrist distance) / [ (digit-wrist onset latency) (digit palm onset latency)] . ects n *The 1997 Padua and colleagues paper189 references studies of normal subj published in the 1996 Padua and colleagues paper.188 I the 1997 Padua and colleagues paper,189 measurement of median sensory conduction in the carpal tunnel segment was done only in CTS patients with normal (1) median sensory conduction from D1 to wrist (SCV > m/s), (2) normal median sensory conduction from D3 to wrist 42 (SCV > m/s, and (3) and normal median motor distal latency (< ms) so that the percentage (20%) of abnormal median sensory conduction across the wrist was reported for a subset of the CTS population; 44 4 from the data in the paper, the max imum possible percentage of abnormal median sensory conduction in the carpal tunnel segment for the whole CTS patient population was calculated to be 81%. For each reference subj only 1 hand was tested; each CTS patient, only the most symptomatic hand was tested. Written communication. Calculated from onset latency (written communication). ect, for # I the Di Guglielmo and colleagues paper,59 measurement of median sensory conduction in the carpal tunnel segment was done only in CTS patients with normal median sensory conduction from wrist to D2 n (SCV > m/s) and normal median motor distal latency (< ms) so that the percentage (13%) of abnormal median sensory conduction across the wrist was reported for a subset of the CTS population; 45 4.2 from the data in the paper, the max imum possible percentage of abnormal median sensory conduction in the carpal tunnel segment for the whole CTS patient population was calculated to be 56%. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity CTS=Carpal Tunnel Syndrome S =Standard Deviation D

S 4 CT L teratu Revew 92 S i re i 2 0 Amerian Asocati of 02 c s i on Elec i nos cMedcne trodag ti ii

Prac c Parameter: Carpal T nnel S nd tie u y rome Rosen214 (1993), 100%;Rossi and colleagues216 (1994), 100%. I a study that met 4 of the 6 AAEM CTS LI Rossi n C, reported a variation on the orthodromic median and ulnar palmar conduction studies with a slightly longer conduction distance (about 10 cm) to enable selective stimulation of the palmar branches to the adj acent surfaces of the digits at the metacarpophalangeal j oints. Rossi216 concluded that stimulation of the palmar branch to the adj acent surfaces of the middle and ring fingers demonstrated a measurable abnormal response when the orthodromic median sensory response with stimulation of the fourth digit was absent and when the response with stimulation of the palmar branch of the median nerve to the adj acent surfaces of the indexand middle fingers was normal. Medan S i NAP Ampli d S des Kuntz 140 in a report tu e tu i . er, that met all 6 AAEM CTS LI confirmed that the C, measurements of median sensory conduction from digit to wrist is more often abnormal in CTS patients than the measurement of median SNAP amplitude, 49% versus 30% (Table 13). I a study that met 5 of the 6 AAEM n CTS LI Sander220 noted that median sensory conduction C, from digit to wrist is more abnormal in CTS than measurement of median SNAP amplitude, 64% versus 48%. I a study that met 4 of the 6 AAEM CTS LI n C, Sheean and colleagues233 (1995) also noted that median sensory conduction from digit to wrist is more often abnormal in CTS patients than measurement of median SNAP amplitude, 55% versus 41%. Two recent studies (Seror228 and Nesathurai184) and several earlier studies son (Cioni,47 Felsenthal,68,70 Jack and Clifford,110 Redmond and Rivner204 ) that compared the diagnostic sensitivity of median sensory conduction from digit to wrist to measurements of median SNAP amplitudes reached the same conclusion with the ex ception of Loong and Seah,148 who computed the ratio of the median SNAP amplitude to the ulnar SNAP amplitude in the same hand. Two studies of normal subj that met 5 of the 6 AAEM ects CTS LI noted values slightly greater than the values C reported by Kuntz 140 in Table 13 for normal subj for er ects the mean and SD of the median SNAP amplitude: 32.7 11.4 V by Stetson242 (1995) and 41 20 V by Buschbacher.33 Medan S ory Nerv Writ to Palm S i ens e s NAP Ampli d tu e Rati The ratio of the amplitude of the median SNAP o. recorded from a digit with (1) stimulation of the median nerve at the wrist and (2) stimulation in the palm mak it es possible to identify median sensory nerve conduction blockacross the carpal tunnel. Table 14 presents the results of a study by Di Guglielmo59 that met all 6 AAEM CTS LI the incidence of sensory C;
216

Tab 1 .M edian S le 3 NAP Amplitude in CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject ub s Age: M ean ( range) Numb CTSHands er ( patients) CTSS ject Age ub S timulation S ite Recording S ite M inimum Hand Temperature Normal S NAP Amplitude S D Criteria f or Ab normal Value Ab normal Values S pecif of icity Ab normal Value* S ensitiv of ity Ab normal Value Kuntz 140 er 1994 70 (70)* 43 (25 to 70) 100 (100)* 51 (26 to 85) Digit Wrist 32 C 12 2.5 V Mean 2 SD < V 7 100% (actual) 30%

*For each reference subj only 1 hand was tested; each CTS ect, for patient, only the most symptomatic hand was tested. Stimulation of the most symptomatic finger or third digit.

S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome S =Standard Deviation D S NAP =Sensory Nerve Action Potential

conduction block was low (13%) with the criteria of a greater than 50% reduction in SNAP amplitude. Lesser and colleagues,144 in a study that met 5 of the 6 AAEM CTS LI reported that 36% of CTS patients showed C, evidence of sensory conduction block across the carpal tunnel but did not provide data on temporal dispersion and phase cancellation which would give the appearance of conduction blockas did Di Guglielmo.59 I a study of 258 normal subj listed in Table 1, n ects Buschbacher36 noted up to a 50% to 55% increase in the

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .M edian S le 4 NAP W rist to Palm Amplitude Ratio in CTS .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( jects) sub CTSS ject Age: M ean ub s ( range) Tech ue: Conduction niq Distance W rist S timulation S ite Palm S timulation S ite Recording S ite M inimum Temperature Amplitude ( wrist) S D Amplitude ( palm) S D W rist to Palm Amplitude Ratio S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab *Written communication.
S pecif equals the percentage of reference subj hands with icity ects normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome S =Standard Deviation D S NAP =Sensory Nerve Action Potential

Di Guglielmo and colleagues59 1997 88 (69) 40 (20 to 86) 294 (198) 46 (13 to 84) Anatomical landmark s 1 cm to 2 cm prox imal to wrist crease 3 cm distal to wrist crease D2 32 C 42 19 V 45 21 V 0.8 0.2 Lowest value of range of normal values* < 0.5 100% (actual) 13%

Tab 1 .S ortle 5 h segment I ncremental M edian S ensory Nerv Conduction Across th Carpal e e Tunnel in CTS .
Auth or Year Numb er of Normal ( jects) sub Normal S ject Age: ub s ( range) Numb er of CTS ( patients) CTS S ject Age: ub s ( range) Tech ue: Conduction niq Distance S timulation S ite Hands M ean Hands M ean Nathan and colleagues181 1988 70 (38) 38 (16 to 69)* 54 (30) 43 (23 to 70)* 1-cm intervals 9 points Start 2 cm prox imal End 6 cm distal Middle finger 30 C 0.29 0.8 ms Calculated range of normal 0.1 to 0.3 ms > ms / > ms 0.4 0.5 81% / 97% (actual) 81% / 54%

Ref erenced to th W rist Crease e Recording S ite M inimum Hand Temperature M ax imum Diference b f etween Consecutiv S e egments S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab

SNAP amplitude between wrist and palm stimulation in normal subj ects, a finding similar to that reported by Di Guglielmo.59 Medan S ory S ort-eg i ens h s ment I remental S des nc tu i . Table 15 presents the results of sequential antidromic stimulation of the median sensory nerve at 1-cm intervals across the carpal tunnel recording from the middle finger
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The median sensory conduction study was performed by placing the recording ring electrodes on the middle finger and stimulating the median nerve at 9 points separated by 1-cm intervals beginning 2 cm prox imal to the wrist crease and ending 6 cm distal to the wrist crease. The time (ms) from the stimulus artifact to the peakof the SNAP was measured for each stimulation site and the difference between the peak latency for successive SNAPs calculated. Two years later, Nathan and colleagues,182 in a study that also met 6/6 AAEM CTS LI localiz the slowing of C, ed conduction most commonly to the an area 3 to 4 cm distal to the wrist crease. * Written communication. S pecif equals the percentage of reference subj hands with icity ects normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome S =Standard Deviation D S NAP =Sensory Nerve Action Potential

by Nathan and colleagues,181 a short-segment incremental stimulation technique (antidromic inching test or AI T) initially described by Kimura.130 Though time consuming, ed the landmark studies by Kimura128,130 localiz the

Prac c Parameter:Carpal T nnel S nd tie u y rome abnormality of median sensory conduction in most CTS patients to the distal edge of the carpal ligament, and this finding has been confirmed by Nathan and colleagues,182 White and colleagues,264 I maok and colleagues,106 and a 226 Seror. Because a frequency distribution of the segmental latency differences in the normal subj ects showed a sk ewed distribution of data, Nathan181 used a contingency table to evaluate the sensitivity and specificity of 2 different criteria of abnormality (0.4 ms and 0.5 ms). Although Nathan181 recommends use of the 0.4 ms criterion of abnormality, only the 0.5 ms criterion provides specificity (97%) comparable to the other tests presented in this review. I maok and colleagues106 in a study that met 5 of the 6 a AAEM CTS LI used a special linear grid of 9 surface C, electrodes at 15 mm intervals (a total of 8 neighboring pairs of electrodes) to record the median SNAP simultaneously across the wrist with stimulation of the median nerve at the elbow. With a criterion of deviation by 0.6 ms or more from a predicted peak latency value based on measurements of peak latencies recorded prox imal to the wrist crease, I maok 106 and colleagues a (1992) reported a specificity of 99% compared to normal subj (mean +3 SD) and a high test sensitivity (87% in ects mild CTS). Seror,226 in a study that met 4 of the 6 AAEM CTS LI C, used an orthodromic inching test (OI with stimulation T) of the third digit and measuring the peak latency of the SNAP recorded with a bipolar fix distance (22 mm) ed surface electrode moved centimeter by centimeter from a point 4 cm prox imal to the distal wrist crease to a point 6 cm distal to the distal wrist crease to provide 11 measurements; an abnormality was defined as a conduction delay greater than 0.36 ms based on control studies with a range of 0.20 to 0.34 ms. Seror226 concluded that most CTS patients can be diagnosed with other methods and that the more time consuming inching technique is needed to confirm the diagnosis in only about 5% of all CTS patients. Seror,224 in a study that met 4 of the 6 AAEM CTS LI C, concluded that the OI was superior to the AI because T T the OI was more sensitive than the AI the stimulation T T, site and intensity was unchanged during the study which ensures that the same nerve fibers are evaluated, and the stimulation intensity is less and better tolerated by the patient compared to AI T. Comparion ofCarpal T nnel S ment Medan Mied s u eg i x Nerv Cond c on to More Proxmal ( e u ti i Forearm)Mied x Nerv Cond c on or Dital ( e u ti s palm to dgt) Medan ii i S ory Nerv Cond c on. The possible usefulness of ens e u ti comparing CVs of different segments of the same nerve to demonstrate focal conduction slowing to minimiz e intersubj variability has been evaluated with median ect sensory and mix nerve conduction in CTS patients. The ed results of 2 studies that met all 6 AAEM CTS LI are C presented in Table 16. The first by Scelsa221 concluded that comparison of the median palm to index finger sensory CV to the median carpal tunnel mix nerve CV ed demonstrated a sensitivity to detect CTS (87%) that was significantly greater than the sensitivity (61%) of comparison of the median forearm CV to the median carpal tunnel CV with similar specificities (98% and 96%, respectively). The second by Kuntz 140 demonstrated an er intermediate sensitivity (69%) with similar specificity (99%) by comparison of the peak latency of the mix ed nerve median palm to wrist segment to the peak latency of the median sensory palm to D2 segment. There are also 2 studies that meet all 6 AAEM CTS LI by Padua and C colleagues188,189 that described the usefulness of a ratio of the orthodromic sensory CV for 2 segments of the median sensory nerve (D3 to palm/palm to wrist) to diagnose CTS with high sensitivity: 1996, 98% and 1997, 97%. I 1985, Kimura and Ayyar131 reported a 100% incidence n of abnormalities in CTS patients if the ratio of the median antidromic sensory CV across the wrist to the median sensory CV across the forearm was calculated. However, in a study that met 4 of the 6 AAEM CTS LI Rosen214 C, noted that the quotient of the median antidromic mix ed nerve CV in the carpal tunnel segment to the antidromic median sensory CV in the forearm segment (70%) was less sensitive than median mix nerve palm to wrist ed conduction (100%). Buschbacher,33 in a study of 258 normal subj listed in ects Table 1, noted that 50% of the wrist to digit median sensory peak latency is attributable to the wrist-palm segment, a finding that agrees well with the ratio of the peak latency for the 2 segments reported by Kuntz 140 er: 0.98 0.17 in Table 16. Comparion of Medan S ory Nerv Cond c on to s i ens e u ti Ulnar or Radal S oryNerv Cond c on i th S i ens e u ti n e ame Lmb. I theory, the biologic variation in speed of nerve i n conduction from person to person due to age and genetic differences can be controlled by comparison of the speed of nerve conduction in 1 nerve to another nerve in the same limb.69,243 This comparison principle underlies the basis for development of the sensory NCSs reported in Tables 17, 18, 19, and 20. Comparion of Medan and Ulnar S ory Nerv s i ens e Cond c on Between Writ and Dii Table 17 u ti s gt. presents the results of a study that met all 6 AAEM CTS LI by Kuntz 140 who determined the difference C er between the median and ulnar nerve peak latency measurements with orthodromic stimulation (14-cm conduction distance) in CTS patients and normal control subj ects and found the percentage of CTS patients with abnormal values was 61%. Stetson,242 in a

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .M edian S le 6 ensory and M ix Nerv Conduction in CTS ed e : W rist and Palm S egment Compared to Forearm or Digit S egment.
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ub s ( range) Tech ue: Conduction niq Distance S timulation S ite Recording S ite Scelsa and colleagues221 1998 30 (25) 42 (23 to 63) 67 (42) 50 (25 to 85) Anatomical landmark s Kuntz 140 er 1994 70 (70) 43 (25 to 70) 100 (100) 51 (26 to 85) Anatomical landmark s Padua and colleagues188 1996 40 (36) 44 (19 to 79) 50 (43) 45 (23 to 80) 500 (379) 51 (20 to 88) Padua and colleagues189 1997*

Anatomical landmark s

Carpal Tunnel S egment

Palm Wrist Palm Wrist Palm Wrist D3 Wrist

Oth S er egment
S timulation S ite Recording S ite M inimum Hand Temperature Diference Between M edian f S S of CV D CTSS egment and of er S Oth egment Ratio of Onset Latencies: Palm to W rist/ Palm to D2 Ratio of Conduction Velocities: D3to Palm/ Palm to W rist Criteria f Ab or normal Value Ab normal Value S pecif of normal Value* icity Ab S ensitiv of normal Value ity Ab
189

Palm D2 32 C 2.7 3.1 m/s Not reported Not reported Mean +2.5 SD > m/s 10 98% (actual) 87%

Elbow Wrist 32 C 5.7 4.3 m/s Not reported Not reported Mean +2.5 SD > m/s 16 96% (actual) 61%

Palm D2 32 C Not reported 0.98 0.17 Not reported Mean +2 SD > 1.32 99% (actual) 69%

D3 Palm 31 C Not reported Not reported 0.82 0.08 Mean +2 SD 1.0 97.5 % (estimate) 98%
188

87% (97%)*

*The 1997 Padua and colleagues paper references studies of normal subj published in the 1996 Padua and colleagues paper. The D3-palm segment SNCV ects was measured directly. The SNCV of the palm-wrist segment was computed from the palm-wrist distance (mm) divided by [ to wrist latency (ms) minus D3 to D3 palm latency (ms)]n the 1997 Padua and colleagues paper,189 measurement of the ratio of SNCV of the distal (D3 to palm) to prox I imal (palm to wrist) segments, defined as the distoprox ratios, was done only in CTS patients with normal (1) median sensory conduction from D1 to wrist (SCV > m/s), (2) normal median imo 42 sensory conduction from D3 to wrist (SCV > m/s, and (3) and normal median motor distal latency (< ms) so that the percentage (87%) of abnormal median 44 4 distoprox ratios was reported for a subset of the CTS population; imo from the data in the paper, the max imum possible percentage of abnormal distoprox ratios imo for the whole CTS patient population was calculated to be 97%. Calculated from onset latency (written communication). For each reference subj only 1 hand was tested; each CTS patient, only the most symptomatic hand was tested. ect, for S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity CTS=Carpal Tunnel Syndrome S =Standard Deviation S D NCV =Sensory Nerve Conduction Velocity S =Sensory Conduction Velocity CV

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 .Comparison of edian and Ulnar le 7 M S ensory Nerv Conduction Between e W rist and Digit in CTS .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ub s ( range) Tech ue: Conduction niq Distance S timulation S ite Recording S ite M inimum Hand Temperature Diference M edianf Ulnar PeakLatency S D Criteria f Ab or normal Value Ab normal Value Diference f in M edian and Ulnar Peak Latency S pecif of normal icity Ab Value S ensitiv of normal ity Ab Value Kuntz 140 er 1994 70 (70)* 43 (25 to 70) 100 (100)* 51 (26 to 85) 14 cm Median: Digit 3 Ulnar: Digit 5 Wrist 32 C 0.14 0.16 ms Mean +2 SD > 0.50 ms 100% (actual) 61%

study of 105 normal subj listed in Table 1, noted a ects value (mean + 2 SD = 0.5ms) identical to that reported by Kuntz 140 A study that met 5 of the 6 AAEM CTS LI er. C showed a slightly lower sensitivity for the same test in CTS patients: Andary9 (1996), 42%. Comparion ofMedan and Ulnar S ory( x )Nerv s i ens Mied e Cond c on between Writ andPalm.Table 18 presents the u ti s results of 2 studies that met all 6 AAEM CTS LI Both C. Jack son and Clifford110 and Uncini254 determined the difference between the median and ulnar nerve latency measurements with palmar stimulation (8 cm conduction distance to recording electrodes over the wrist) in CTS patients and normal subj Jack and Clifford110 found ects. son the percentage of CTS patients with abnormal values was 66% and Uncini254 reported abnormalities in 56% of CTS patients with normal median sensory conduction from D2 to wrist (SCV > m/s). Jack and Clifford110 and Uncini254 45 son reported values for the median-ulnar palmar latency difference for normal hands (96% < ms) and (97% < 0.4 0.4 ms), respectively, similar to the findings of 3 independent 0.5 studies of normal hands: Redmond and Rivner204 (92% < 0.5 ms) and ms), Stetson and colleagues242 (95% < Buschbacher36 (97% < ms). Sixstudies that met 4 or 5 of 0.5 the 6 AAEM CTS LI showed similar sensitivity of the C comparison study of median and ulnar mix NCSs ed between wrist and palm in CTS patients:Kim127 (1983), 57%; Mills171 (1985), 60%; Andary9 (1996), 61%; Robinson211 (1998) 70%;Sheean and colleagues233 (1995) 73%; Preston and Logigian200 (1994), 94%. and Comparion of Medan and Ulnar S ory Cond c on s i ens u ti between Writ and Ri Fi er. Table 19 presents the s ng ng results of 2 studies which compared the speed of sensory conduction in the branches of the median and ulnar nerves to the ring finger and found between 77% to 82% showed abnormalities. Stetson,242 in a study of normal hands, noted a similar mean and slightly greater standard deviation for the median-ulnar difference (0.1 0.25 ms) than the 2 studies in Table 19. Cioni and colleagues,47 in a study that met all 6 AAEM CTS LI found 100% of CTS patients showed C, abnormal median sensory conduction compared to ulnar sensory conduction in the ring finger. These findings are similar to the findings of 7 studies that met 4 or 5 of the 6 AAEM CTS LI Robinson and colleagures211 (1998), 74%; C en Uncini and colleagues255 (1989), 78%; Lauritz and colleagues143 (1991), 87%;Monga and Laidlow173 (1982), 93%; Seror228 (1994), 97%; Johnson and colleagues66 (1981), 100%; Charles and colleagues45 (1990), 100%.

* For each reference subj only 1 hand was tested and for each ect, CTS patient, the most symptomatic hand was tested. D3 or the most symptomatic digit was tested. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with ity abnormal results calculated from the test data on the CTS population. CTS=Carpal Tunnel Syndrome S =Standard Deviation D

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Prac c Parameter: Carpal T nnel S nd tie u y rome When performing the antidromic median and ulnar sensory conduction study from wrist to D4 (conduction distance of 14 cm), Laroy142 recommended simultaneous recording of SNAPs from another median (D3) and ulnar (D5) innervated digit to detect inadvertent co-stimulation of the median and ulnar nerves in the wrist. I the same study, n Laroy142 found no evidence of mononeural (median or ulnar) innervation of D4 in 2047 hands of 1260 patients. Comparion ofMedan and Radal S ory Cond c on s i i ens u ti Between Writ andT u s h mb. Table 20 presents the results of 3 studies which met all 6 AAEM CTS LI and evaluated C sensory conduction in the branches of the median and radial nerves to the thumb over equal conduction distances. Both son and Clifford110 determined the Carroll38 and Jack difference between the median and radial nerve latency measurements; findings in the normal control subj in the ects both studies were similar (less than 0.3 to 0.4 ms difference was normal). Carroll38 compared the median and radial nerve latency measurements to the thumb in the CTS patients in his study if the median sensory response was normal over the wrist-digit segment (see Table 11) and estimated a total incidence of abnormal median-radial sensory comparison studies in symptomatic hands of CTS patients to be 60%. Carrolls estimate is similar to the finding of Jack and Clifford110 (69%) who compared the son median and radial sensory latency in all of their CTS patients (Table 20). Padua188,189 computed the ratio of the radial to median sensory conduction velocity measured from the thumb to the wrist and found 76% of CTS patients showed abnormalities. Cioni and colleagues,47 in a study that met 6 AAEM CTS LI found 96% of CTS patients C showed abnormal median/radial comparison conduction studies. These findings are similar to the findings of 5 other studies that met 4 or 5 of the 6 AAEM CTS LI White and C: colleagues264 (1988), 58% (of mild CTS);Robinson and colleagues211 (1998) 76%;Pease and colleagues192 (1989), 87% (of mild CTS); Andary9 (1996), 90%;Johnson and colleagues114 (1987), 100%. Needle EM G of e Th th enar M uscle in CTS About 30 years ago, Buchthal and colleagues30 reported a 91% incidence of abnormal findings on the needle EMG ex amination of the APB muscle in patients with CTS: 50% fibrillation activity, 50% decreased recruitment, 66% abnormalities of motor unit action potential (MUAP) configuration. These findings were similar to an earlier study by Marinacci,159 which also reported a very high (96%) incidence of APB needle EMG abnormalities. The high incidence of needle EMG abnormalities in the APB noted by Buchthal and colleagues31 and by Marinacci,159 may be related to a combination of patient selection,31,159 the

Tab 1 . le 8 Comparison of edian and Ulnar M ix M ed Nerv Conduction Between W rist and Palm in CTS e .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: ub s M ean ( range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ub s ( range) Tech ue: Conduction niq Distance S timulation S ite Recording S ite M inimum Hand Temperature Diference M edian f Ulnar Onset Latency S D Diference M edianf Ulnar PeakLatency S D Criteria f Ab or normal Value Ab normal Value Diference in M edian and f Ulnar Latency S pecif of normal icity Ab Value S ensitiv of normal ity Ab Values Jack and son Clifford110 1989 38 (38) 42 (21 to 69) 131 (123) 53 (21 to 85) 8 cm Palm Wrist 31 C 0.08 0.12 ms 0.10 0.11 ms Mean +2 SD Onset > 0.32 ms Peak> 0.31 ms 95% (actual) 66% Uncini and colleagues254 1993 72 (47) 45 (18 to 78) 95 (70) 49 (26 to 78) 8 cm Palm Wrist 32 C 0.10 0.14 ms Not reported Mean +2 SD Onset > ms 0.4 Peak(not reported) 97.5% (estimate) 56% (78%)*

The technique for palmar stimulation of the median nerve described by Jack son and colleagues110 in Table 8 was adapted to study the ulnar nerve by placement of the recording electrodes over the ulnar nerve at the wrist and stimulating in the palm between the 4th and 5th metacarpal heads (see Table 4). The difference in the latency of the median and ulnar mix nerve latencies was evaluated. ed *I the Uncini and colleagues paper,254 comparison of median and ulnar sensory n conduction across the palm-wrist segment was done only in the CTS patients with (1) normal median sensory conduction from D2 to wrist (SCV > ms) and 45 (2) normal median motor conduction (MDL < ms) from wrist to APB so that 4.3 the percentage (56%) of median/ulnar sensory conduction abnormalities was reported for a subset of the CTS patient population; from the data in the paper, the max imum possible percentage of median/ulnar sensory conduction abnormalities for the whole CTS patient population was calculated to be 78%. S pecif equals the percentage of reference subj hands with normal results icity ects and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results ity calculated from the test data on the CTS population. APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome M DL = Motor Distal Latency S =Standard Deviation S =Sensory Conduction D CV Velocity

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 1 . le 9 Comparison of edian and Ulnar S M ensory Conduction Between W rist and Ring Finger in CTS .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ( ub s range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ( ub s range) Tech ue: Conduction Distance niq S timulation S ite Recording S ite M inimum Hand Temperature Diference M edian and Ulnar Onset f Latency S D Diference M edian and Ulnar Peak f Latency S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Jack and Clifford110 son 1989 38 (38) 42 (21 to 69) 131 (123) 53 (21 to 85) 14 cm Wrist Ring finger 31 C 0.13 0.15 ms 0.09 0.13 ms Mean +2 SD Onset > 0.43 ms Peak> 0.35 ms 95% (actual) 82% Uncini and colleagues254 1993 72 (47) 45 (18 to 78) 95 (70) 49 (26 to 78) I dentical for each subj ect Range: cm to 14 cm 12 Ring finger Wrist 32 C 0.14 0.13 ms Not reported Mean +2 SD Onset > ms 0.4 Peak(not reported) 97.5% (estimate) 77% (89%)*

Nerve conduction of the branches of the median and ulnar nerves to the ring finger can be measured by securing surface ring electrodes on the ring finger and surface disc electrodes over both the median and ulnar nerves prox imal to the wrist crease with identical conduction distances (14 cm). The conduction time (ms) from the stimulus artifact to the onset (onset latency) or peak(peaklatency) of the SNAP is determined and the medianulnar latency difference calculated. *I the Uncini and colleagues paper,254 comparison of orthodromic median and ulnar sensory conduction from D4 along an identical distance to the n wrist (range 12-14 cm for all tests) was done only in the CTS patients with (1) normal median sensory conduction from D2 to wrist (SCV > ms) 45 and (2) normal median motor conduction (MDL < ms) from wrist to APB so that the percentage (77%) of median/ulnar sensory conduction 4.3 abnormalities was reported for a subset of the CTS patient population; from the data in the paper, the max imum possible percentage of median/ulnar sensory conduction abnormalities for the whole CTS patient population was calculated to be 89%. S pecif icity equals the percentage of reference subj hands with normal results and was either actual based on analysis of the test data from the ects reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity APB =Abductor Pollicis Brevis CTS=Carpal Tunnel Syndrome Potential M DL =Motor Distal Latency S =Standard Deviation D S =Sensory Conduction Velocity S CV NAP =Sensory Nerve Action

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Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 2 .Comparison of edian and Radial S le 0 M ensory Conduction Between W rist and Th umbin CTS .
Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ub s ( range) Numb of er CTSHands ( patients) CTSS ject Age: M ean ( ub s range) Tech ue: Conduction Distance niq ( range) S timulation S ite Recording S ite M inimum Hand Temperature Diference M edian and Radial f Onset Latency S D Diference M edian and Radial f PeakLatency S D Ratio of Radial to M edian S CV Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Carroll38 1987 100 (50) 47 (16 to 82) 161 (101) 45 (22 to 82) 8.7 (6.7 to 10.5) cm Thumb Wrist 30 C Not reported 0.09 0.10 ms aged 16 to 39 0.15 0.12 ms aged 40 to 59 Not reported Mean +2 SD Difference in latencies age 16 to 39 > ms 0.3 age 40 to 59 > ms 0.4 age 60 to 82 > ms 0.3 99% (actual) 21% (60%)* Jack and Clifford110 son 1989 38 (38) 42 (21 to 69) 131 (123) 53 (21 to 85) 10 cm Wrist Thumb 31 C 0.08 0.12 ms 0.13 0.08 ms aged 60 to 82 Not reported Mean +2 SD Difference in latencies Onset > 0.32 ms Peak> 0.37 ms 100% (actual) 69% Padua and colleagues188 1996 40 (36) 44 (19 to 79) 50 (43) 45 (23 to 80) Anatomic landmark s Thumb Wrist 31 C Not reported Not reported 1.01 0.09 Mean +2 SD Ratio of SVC > 1.2 97.5% (estimate) 74%

Nerve conduction of the branches of the median and radial nerves to the thumb can be measured by securing surface ring electrodes on the thumb and surface diskelectrodes over both the median and radial nerves prox imal to the wrist crease with identical conduction distances (10 cm). The conduction time (ms) from the stimulus artifact to the onset (onset latency) or peak(peaklatency) of the SNAP is determined and reported as the onset or peak son latency. Carroll38 and Jack and Clifford110calculated the difference between the median and radial latencies. Padua and colleagues188 computed the SCV for the median and radial nerve segments and calculated the ratio of the radial SCV to the median SCV. * I the Carroll38 paper, comparison of median and radial sensory conduction was done only in the CTS patients with normal median sensory n conduction from D2 to wrist (13 cm conduction distance in Table 3) so that the percentage of abnormal median/radial sensory conduction abnormalities was reported for a subset of the CTS patient population;from the data in the paper, the max imum possible percentage of abnormal median/radial sensory comparison studies for the whole CTS patient population was calculated to be 60%. S pecif icity equals the percentage of reference subj ects hands with normal results and was either actual based on analysis of the test data from the reference population or an estimate based on the statistical distribution of test data from the reference population. S ensitiv equals the percentage of CTS patients hands with abnormal results calculated from the test data on the CTS population. ity CTS=Carpal Tunnel Syndrome S =Standard Deviation S D NAP =Sensory Nerve Action Potential S =Sensory Conduction Velocity CV

number of different sites ex amined in the APB,31 and the use of quantitative measurements of MUAP parameters.31 I more recent studies that met all 6 AAEM CTS LI a n C, much lower incidence of fibrillation activity has been described in the APB muscle of CTS patients: son and Jack er Clifford110 (1989), 131 APB, 25%;and Kuntz 140 (1994), 100 APB, 29%. Two other recent studies that met 4 or 5 of the 6 AAEM CTS LI report similar findings: C Kimura and 131 Ayyar: APB, 40% abnormal: 22% fibrillation activity and/or 31% decreased recruitment of abnormalities of MUAP configuration;and Seror228 (1994) 150 APB, 42% abnormal with a neurogenic pattern, Sander220 (1999) 79 APB, 12% abnormal with either fibrillation activity or

MUAPs of increased duration. I is the consensus of the t AAEM CTS Task Force that the reports by Kimura and son er, Ayyar,131 Jack and Clifford,110 Kuntz 140 Seror,228 and Sander220 are more representative of the percentage (12% to 42%) of abnormal results of qualitative needle EMG studies in CTS patients than the earlier studies of Buchthal and colleagues31 and by Marinacci.159 I a retrospective review of 480 CTS patients, Werner and n Albers261 (1995) reported that the median motor and sensory latencies were the most important predictors of an abnormal needle ex amination of the APB muscle of 480 CTS patients: 48% abnormalities of MUAP configuration and/or 258 fibrillation activity and 21% fibrillation activity. Vennix

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Prac c Parameter:Carpal T nnel S nd tie u y rome noted that 95% of CTS with evidence of denervation on needle EMG had APB CMAP amplitudes less than 7 mV but agreed with Werner and Albers261 that these models are not applicable in the clinical setting to predict denervation in individual CTS patients. I 1999, Gnatz and Conway87 debated the issue of the n performing needle EMG of the APB muscle and other hand 87 and limb muscles in CTS patients. Gnatz concluded that the needle EMG is important in all CTS suspects because the discomfort and ex pense of the ex was outweighed by am the diagnostic information obtained. Conway87 recommended that needle EMG be performed only when pathology prox imal to the carpal tunnel was suspected.13,184 Gnatzand Conway87 agreed that more studies are needed to evaluate the question of performing needle EMG in every patient suspected of CTS. There are a few other studies which address this issue.176 S ympath S in Response in CTS etic k Kuntz 140 in a study that met all 6 AAEM CTS LI er, C, reported a low (10%) incidence of abnormalities with an EDX test of the sympathetic sk response (SSR) in the CTS in patients (Table 21). Verghese,259 in a study that met 5 of 6 AAEM CTS LI reported that 24% (33/139) of C, symptomatic hands of CTS patients had a prolonged SSR latency (> 1.72 s). However, Sener,223 in a study that met all 6 AAEM CTS LI reported that none of the 44 C, symptomatic limbs in CTS patients showed a SSR latency greater than limbs of 20 normal subj (Table 21). Sener223 ects used sternal stimulation to avoid the potential effect of afferent dysfunction in a limb on the SSR results. These results indicate that CTS is an unlik cause of median ely nerve SSR abnormalities. Furthermore, the SSR study, lik e the F-wave study, does not localiz the abnormality to the e CTS segment of the median nerve. I nterestingly both Verghese259 and Sener223 noted over half of the CTS patients complained of at least 1 symptoms in the affected hand that may indicate autonomic dysfunction:swelling of the hand or fingers, dryness, ex cessive perspiration, pallor, red or purple discoloration, and coolness. However, for the reasons noted above, SSR studies are not recommended as an EDX study to diagnose CTS patients. Th Efect ofLimb I emia, e f sch Dynamic Hand Ex ercises, and Briefand S ustained W rist Positioning on M edian NCS in CTS s Ef t ofLmb Ic emi on Medan Nerv Cond c on i f ec i sh a i e u ti n Carpal T nnel S nd u y rome. I 1953, Gilliatt and Wilson86 n described the production of paresthesia in limbs of CTS patients with a pneumatic tourniquet. As noted above, in tremity 1963, Fullerton76 evaluated the effect of upper ex ischemia on median motor conduction in the forearm and hand and suggested that transient nocturnal symptoms were due to median nerve ischemia. Limb ischemia caused the median thenar CMAP amplitude to fall to less than 40% of the initial value after 25 minutes in 7 out of 15 CTS patients whereas the median thenar CMAP amplitude in normal subj remained above 50% of the initial value after 30 ects minutes of ischemia. Ef t of Dy f ec nami Hand Ex ie on Medan Nerv c ercs i e Cond c on i CT . I 1994, Clifford,48 in a study that u ti n S n met all 6 AAEM CTS LI evaluated the effect of 4 C, minutes of repetitive wrist and finger movements on median sensory nerve conduction to D4 and found a significant difference between a group of CTS patients and normal subj ects. However, the difference was of insufficient magnitude to discriminate individual CTS patients from control subj ects. Therefore, the effects of repetitive wrist and finger movements on median NCS in CTS patients are classified as investigational at this time. Ef t ofS s ned Writ Posti ng on Medan Nerv f ec u tai s i oni i e Cond c on i CT . u ti n S The effect of sustained (1 minute or greater) active or passive wrist and finger positioning (max imal flex or ex ion tension) on median sensory and motor nerve conduction in normal subj ects and CTS patients has been evaluated by several investigators: Schwartz222 Marin,158 Dunnan,62 Werner,262 Hansson and , Nilsson,97 Rosecrance,213 and Kiernan.126 I nitial studies which focused on the effect of sustained wrist positioning on the median distal sensory latency and the median motor distal latency produced conflicting results: Schwartz222 Marin,158 and Dunnan.62 More recent , studies have focused on the effect of prolonged positioning on the amplitude of the median SNAP and reported more promising results:Hansson and Nilsson,97 Rosecrance,213 and Kiernan.126 Hansson and Nilsson,97 in a study that met 5 of the 6 AAEM CTS LI evaluated C, the effect of prolonged (up to 45 minutes) passive wrist flex on the median SNAP amplitude and determined ion the time (T50) it tak for the SNAP amplitude to fall to es one-half the baseline value. Rosecrance and colleagues,213 in a study that met all 6 AAEM CTS LI C, evaluated the recovery time for the SNAP amplitude to return to baseline after 5 minutes of active ex treme wrist and fingers flex ion. I both reports, the changes in the n SNAP amplitude during (Hansson and Nilsson97) or after (Rosecrance and colleagues213 ) sustained wrist positioning distinguished CTS patients from normal subj ects. Because others have not yet confirmed these results, the effects of sustained wrist positioning on median nerve conduction in CTS patients are classified as investigational at this time. Hansson and Nilsson96,97 also provided evidence that the effect of prolonged ex treme wrist flex ion was due to ischemia and not to compression of the nerve. The results of the recent studies by Hansson and Nilsson96,97 and Rosecrance and colleagues213 are consistent with the effect

Mu c & Nerv S pplement X 2 0 S 5 s le e u 02 91

Prac c Parameter: Carpal T nnel S nd tie u y rome

Tab 2 .S le 1 ympath S in Response in CTS etic k .

Auth or Year Numb of er Normal Hands ( jects) sub Normal S ject Age: M ean ( ub s range) Numb of er CTSh ands ( patients) CTSS ject Age: M ean ( ub s range) S timulation S ite Recording S ite M inimum Hand Temperature Calculation Normal S D Criteria f Ab or normal Value Ab normal Value S pecif of normal Value icity Ab S ensitiv of normal Value ity Ab Kuntz 140 er 1994 30 (30)* 45 (25 to 70) 30 (30)* 48 (32 to 72) Opposite wrist D2 and D5 32 C D2/D5 amplitude ratio 100 69.8 16.9 Me n 2 S a D < 36 100% (a ta) cu l 10% Sener223 2000 42 (21) 38 (18 to 60) 46 (31) 46 (26 to 70) Sternum D2 and D5 32 C Onset latency D2: 1.42 0.13 s D5: 1.41 + 0.18 s Me n+ 2 S a D D2: > 1.68 s D5: > 7s 1.7 D2: 98% (a ta) cu l D5: 98% (a ta) cu l D2: 0% D5: 0%

*F r a hrfrn esu jc, ny1 h n wa tstd fr a hCT p t n, nytemo sy tmai h n wa tstd o e c eee c be to l a d s e e ;o e c S ai to l h e st mpo t a d s e e . c W r tnc mmu iain ie o t nc t . o W r tnc mmu iain ted t i T be3 o tep bi e p p r s mi a ee ms (tec re t nt wees) a dteD2 a dD5 S R ie o t nc t : h aa n a l fh u l d a e wa slb ld o sh h orc u i r s n h n S stde yedv le ge trh ntea n r l au s i 1 o te42 c nrl be t a dn n o teCT p t ns. u is il au s rae ta h b oma v le n fh o t su jcs n o e fh o S ai t e S pecif e u l tep re tg o rfrn esu jcs h n s wi n r le l a dwa ete a ta b se o a ay s o tetst aafo icity q as h ec na e f eee c be t a d t oma rsut n h s s i r cu l a d n n lsi fh e d t rm h terfrn ep p lt no a e i t b se o testt ia dst b t no d t fo terfrn ep p lt n h eee c o uai r n st e a d n h ai c l i r ui f aa rm h eee c o uai . o ma st i o o S ensitiv e u l tep re tg o CT p t ns h n s wi a n r le l c luae fo tetst aao teCT p p lt n ity q as h ec na e f S ai t a d t b oma rsut ac ltd rm h e d t n h e h s S o uai . o CTS=Cap l u n l y do S =Sa d r De it n S R =S mp tei S i Re o se ra T n e S n rme D tn ad vai S o y ah t kn sp n c

o wr p sio ig o it c ra tn e pe rs a d f i o t nn n nr ap l u n l rssue n st i a me in n re c n u t n ice se it c ra tn e da ev o d ci ; n ra d nr ap l u n l o a pe rs h v a ge tr efc o te a lu e o te rssue a e rae fe t n h mpi d f h t me in se soya d moo rsp n ta o teCV (dstl da n r n tr e o se h n n h ia ltn y I 1982, u d oga dc l a u s152 d mo st td ae c ). n L n b r n ol g e e e n re a ta c mpe o o teme inn rei tec ra tn e t h t o rssin f h da ev n h ap lu n lo pe rs o e 50 mm Hgc u darpdyrv r bebo k rssue v r a se a il e esil lc o me in se soy a d moo c n u t n I 1981, f da n r n tr o d ci . n o d ie t a rme t Geb r n a d c l a u s78 ma e drc me su e ns lema n ol g e e o te ita ap ltn e p e r wi a wik c tee f h nrc r a u n l rssu e t h c ah tr a d n td ta (1) ita ap ltn e p e r wi te n oe h t nrc r a u n l rssu e t h h wrsti ten urlp si o i ice se i p t ns wi i n h e ta o t n s n ra d n ai t t i e h CTS c mp rd t c nr lsu jcs (2) ita ap ltn e o ae o o to be t nrc r a u n l p e rice se i CTS a d c nr lsu jcs wi wrst rssu en ra s n n o to be t t i h fe in a d e tn o a d (3) ita ap l p e r lxo n xe sin n nrc r a rssu e c a g s i CTS p t ns (g e tr ta 50 mm Hg f r hn e n ai t rae h n e o se ea miue wee su fce t t c u rpdy v rl n ts) r fiin o a se a il rv r be (i h mi) n r e c n u t n bo k e esil sc e c ev o d ci o lc . y Geb r n 9 rc nl rve d te fn ig a d lema 7 e e t e iwe h se idn s n su se u n su p ri gltr t r o i ta a p l u n l b q e t p o tn ie au e n n r c r a t n e

me su e ns. a rme t Effect of Brief Wrist Positioning on Median Nerve Conduction in CTS. A p e o n nta tk s pa ed r g h n me o h ta e lc ui n wr f xo a d e tn o wi l i l in n xe sin t i p sio ig i st e h mb o t nn s i ln i dn l iigo teme inn rei tec ra tn e. o gt ia sl n f h u d da ev n h ap lu n l r e d da I 197 Mc eln f strp r d sl ig o te me in n 6, L l 164 i e ot i n f h a n re b se o o sev t n o te efc o l ev a d n b rai s f h fe t f i o mb mo e ns o teo inaino an e l pa e i te v me t n h re tt o f e de lc d n h me in n re po i l t te wr . Be a se te n re da ev rxma o h i st c u h ev sl e i te c ra tn e,te ln t o me in n re i s n h ap l u n l h e gh f da ev d b t e test lt gee t d s po i lotewr a d ewe n h i ai lcr e rxma t h i n mu n o st te rc rig ee t d s o e te te a mu l (moo h e odn lcr e v r h h n r sce o tr std ) o tedgt n r std ) i la wi wr f xo , u y r h ii(se soy u y s e st t i l in h st e itr daei ten urlp sio ,a d ge tstwi wr neme it n h e t o t n n rae a i t i h st e tn o . Th efc o ln i dn l sl ig o me in xe sin e fe t f o gt ia i n n da u d S NAP ltn y me sue ns i n r lsu jcs wa f st ae c a rme t n oma be t s i r d scie b Mc eln a d S sh a d su se u nl e r d y b Ll a n wa 164 n b q et y l o n sc ni d b Val S l a d c l a u s.257 Val S l a d o f me y l o n ol g e r se l oe h th ae c i rn e ewe n f c l a u s257ason tdta teltn ydfee c s b t e ol g e e f xo a de tn o wr p sio s weesinf a t lss l in n xe sin i o t n r g i c nl e e st i i y

S 5 CT L teratu Revew 92 S i re i 2 0 Amerian Asocati of 02 c s i on Elec i nos cMedcne trodag ti ii

Practice Parameter:Carp Tunnel ndrome al Sy i CTSp t ns c mp rdt c nrl be t c n stn wi n ai t o ae o o t su jcs o si e t t e o h l td sl ig o teme in n rei tec ra tn e o i e in fh mi d da ev n h ap l u n l f CTS p t ns. Na a c i a d Ta hb n 17 po ie ai t e k mih n c ia a 7 rvd d id p n e t c ni t n o te l td sl ig o te n e e d n o f mai r o f h i e in f h mi d me in n re i CTS p t ns wi ut so n da ev n ai t e t h la u d r me sue ns. Be a se te efc o bifp sio ig o a rme t c u h fe t f r o t nn n e i me inn reltn yme sue ns i CTS i lss ta ta da ev ae c a rme t n s e hn ht o n r l be t ii u l eyta te stde wo l b f oma su jcs,ts ni l h th se u is ud e k o v le t dst g i CTS p t ns fo n r lsu jcs f au o i i ush n ai t rm oma be t e 27 o nay o ato g teei 1 dsp tdrp r a dac mme tr203 t l u h hr s h i ue e ot n tec nrr. F rte ra n stde o teefc o bif h o t y o h se e so s, u is n h fe t f r a e wr p st nn o me in n re c n u t n i CTS ae i o i ig n da ev o d ci n st o o r c n d rdiv st ain l o siee n e i t a. g o Oth EDX S er tudies in CTS S v rl te v r t n o me inse soya dmoo NCS e ea oh r ai i s n da n r n ao tr s h v b e rp r dt b u fl o tee au t no p t ns a e e n e ot o e seu fr h v lai f ai t e o e wi CTS Th rve o te leaue tru h 2000 t h . e e iw f h i rtr ho g t idc td ta tev leo te tst frteciia EDX n iae h t h au f h se e s o h l c l n e au t n o p t ns wi CTS stl rman t b v lai o f ai t e t h i e is o e l e a l e a d te stde aec n d rdiv st ain l stbi d n h se u is r o siee n e i t a. sh g o Th seEDX stde icu etefl wig (1) me sue n e u is n ld h ol n : o a rme t o te rfa tr p r d o te me in n re84, 249 f h ercoy ei o f h da ev , 190, (2) a tr ritrsse s ltn yme sue ns, (3) a tr r nei neo u ae c o a rme t 231 nei o itrsse u me in n re ltn y rt , (4) tmp rl neo o s/ da ev ae c ai 215 o e oa i a i ai f h mu o dsp r o o teS i esin f h NAP98 a d (5) dstlst lt n o te , n 229 p l o dgt up f ii s. S v rliv st aos h v u d CTS p t ns t e au t e ea n e i tr a e se g ai t o v lae e EDX stde n tfo te stn p ito u n te EDX u is, o rm h a d on f sig h std t da n seCTS b t rm testn p ith t u y o ig o , u fo h a d on ta CTS i s 8, 51, 208, 11, 126, 260 amo e o fc l ev c mpe o . d l f o a n re o rssin S tatistical Considerations: Normal Values, Normal Distrib utions, Use ofM ultiple Tests, Receiv Operating erCurv es Su is h v sh wn ta se ea d mo rp i a d tde a e o h t v rl e ga hc n a trp mer fcos if e c te rsut o NCS nho o t c a tr nl n e h e l f i u s a lu e a d ltn y v le 32, 34, 36, 180, 218, 242 mpi d n ae c au s. 33, 35, 162, 185, 219, t Th rfr ten r l au s u dfrNCS sh udtk it eeoe h oma v le se o s o l a e no a c u tte fcos. Ag ,h ih,a d b d ma id x c o n h se a tr e eg t n o y ss n e afc ltn y v le a d f g r cru ee c afc fe t ae c au s n i e i mfrn e fe t n c a lu e v le Boh ltn y a d a lu e v le ae mpi d au s. t t ae c n mpi d au s r t afce b c mobd c n io s: da ee tyod dse se fe td y o ri o dt n ib ts, h ri i a , i a d c n e t e t e dse se Th efc o alo te n o n ci i v ssu i a s. e fe t f l f h se fcos ma b rd c d b c mp r n o me in NCS a tr y e e u e y o ai so f da rsut t te rsut o NCS o a jc n n re e l o h e l f s s s f da e t ev se me t 218, g ns. 219 Dof n a d Ro iso 61 rve d tei otn picpe rma n bn n e iwe h mp r t r ils a n g v rig te a q i t n a d u o n r t e d t i o enn h c usio n se f omai aa n i v ee t da n st me iie a d te a tos ma e se ea lcr ig o i o c dcn n h uh r d v rl p it wot rstt g (1) EDX d t fo tedse sefe ons r e ai : h n aa rm h i a -re p p lt n ma b sk we rte ta h vn a Ga ssin o uai o y e e d ah r h n a ig u a dst b t n a d set g te a n r lv le b c luaig i r ui n tn h b oma au y ac lt i o i n te me n 2 stn ad d vain ma rsut i h a a d r e it s o y e l n mi lssi c t n o d t fo te p t ns,(2) tee ae sca f ai f aa rm h ai t i o e hr r se ea atraie stt ia st tge fr d aig wi v rl l n t e v ai c l r e is o e l st a n t h sa l dst b t n whc ae n nGa ssin t p r t mpe i r ui s i o ih r o - u a o emi ie t iain o a a n r lv let ma i z se sivt d ni c t f o f n b oma au o xmie n t i i y a d sp cf i o te tst rsut a d (3) i mut l n e i ct f h e e l n iy s, f lpe i id p n e tEDX tst ae p rome o a sige p t n, n eedn e s r efr d n n l ai t e tel eio d o f dn a a n r lv leo teb si o h i l o f i ig n b oma au n h a s f k h n c a c i sinf a t h n e s g i c n. i Ro iso a d c l a ue211 rp r d te u o a sige bn n n ol g rs e e ot h se f e nl su mmay v r be (c mbn d se soy id x o CS ) b se r ai l o ie n r n e r I a d a o tersut o 3 dfee t n h e l f i rn NCS t a ss me inse soy s f s o sse da n r c n u t n a rss te c ra tn e: me inun r o d ci o co h ap l u n l da -la mip l r oto rmi dfee c a 8 c (p l i ), d ama r do c i rn e t h f m amdf f me il la r g f g r a t rmi dfee c s a 14 c da- n r i i e ni o c i rn e t u n n d f m (r g i ), n me inrda tu a t rmi dfee c a i df a d da -a il h mb ni o c i rn e t n f d f 10 c (tu df). Th CS = p l i + r g i + m h mb i f e I amdf f i df n f tu df. Th oeial rn o (n n stmai) tc nc l h mb i f e rt l a d m o sy e t e h ia c y c err wo l b c n ee o t a moe o sev t n ae ros ud e a c ld u s r b rai s r o c l ce a drl blywo l b e h n e . Th p ssiit ol td n ei it ud e n a c d e o bly e a i i o ma ig a fl -o t e da n si b c a c ao e(i ., f kn asep siv ig o s y h n e ln .e i c a c o sev t n o a sige e t me v le i rd c d h n e b rai f n l xr o e au ) s e u e wh n mut l o sev t n ae c mbn d b c u i i e lpe b rai s r o ie e a se t s i o u l eyta alo sev t n i ah atysu jc wi h v ni l h t l b rai s n e l k o h be t l a e l c a c e t me v le i te sa drcin L w a d h n e xr e au s n h me i t s. e n e o o f me h t e - tst ei it f h r r a i I c l a u s145 c ni d ta tst ee rl blyo teCS ol g e e wa su eirt asigeNCS a d i a dt n teCS wa s pr o n l o n ,n d io ,h i I s lss afce b tmp rtr c a g s ta a soueltn y e fe td y e eaue h n e h n b lt ae c v le o idvd a NCS au s f n iiu l s. Fn l , c mbnn ial y o iig me sue ns it asigev r bea od tea dt er a rme t no n l ai l v is h d iv i a i sk o fl p siv rsut wh n ma ig ada n si b se o f ase o t e e l i s e kn ig o s a d n se n e l n s a y1 o ma ytst b iga n r l 61 Ba do rsut i n f n e s en b oma. 53 CTS p t ns a d 46 c nrlsu jcs,Ro iso a d ai t n e ot o be t bn n n e ot e I oe rae h n r q a o c l a u s211 rp r d aCS sc r ge trta o e u lt ol g e e 1.0 yed ase sivt o 83% a dasp cf i o 95%. Th ils n ti f i y n e i ct f i y e std aso c ni d ta d ig moe tst a d rq i n u y l o f me h t on r r e s n e ur g i ta o l 1 o ma yo tetst b a n r l o ada n si h t ny f n f h e s e b oma fr ig o s o CTS po u e a e c ss o fl -o t ersut (n al f rd c d n x e f asep siv e l e r i s y 8%). Itrst gy temo rc n rp r b Ro iso a d nee i l, h n st e e t e ot y bn n n c l a u s210 n td ta tee wee e d ons fr te 3 ol g e e oe h t h r r n p it o h idvd a tst ta c nie t pe itd tersut o te n iiu l e s h t o f nl rdce h e l f h d y s CS wi o to o sp cf i sota iwa n t e e r t I t u lss f e i ct h i y h tt s o n c ssay o d al3 tst p l i > ms,r g i > ms,o te o l e s: amdf 0.3 f i df 0.4 n f rh tu df > ms. h mb i 0.7 f
165 Mc i rc mme d dteu o rc ie-p rt gc re Nel e o n e h se f e ev ro eai uv n (ROC) a ay s a ameh dt u tersut o lb rtr n lsi s to o se h e l f a oaoy s stde t c luaetep re tg r o p t ns h vn a u is o ac lt h ec na e i f ai t a ig sk e dse se Two p p r h v u d ROC a ay s t d tr n ia . a es a e se n lsi o eemie teo t lc t f v lefrNCS a n r lis i p t ns h pi ma u- f au o o b omaie n ai t t e ao n lsi o v lai n wi CTS64, L mi t n o ROC a ay s fre au t g t h . 91 i t i f EDX stde i CTSp t ns icu etea se c o ahg l u is n ai t n ld h b n e f ihy e sp cf da n st tst o CTSid p n e t f e i c ig o i e fr i c n e e d n o EDX stde u is (su ha bo syo a tp ),h n e fra e i t o te c s ip r uo sy te e d o n st e f h ma t e pe ae c o CTS a d dfiut i g n rl ig r u rv ln e f , n i c l n e eai n f y z f dn s fo 1 lb rtr t a oh r i ig rm a oaoy o n te. n

Muscl & Nerve Sup l e pement X 2 0 S9 3 02 5

Practice Parameter: Carp Tunnel ndrome al Sy fo wr t dgt ln .9, 45, , , 110, 140, 148, 1, 3, 4, rm i o iiao e 38, 475763, 116, 143, 17 17 17 st Th se 20 stde icu e te 6 e u is n ld d h rp r ta me 6 AAEM CTS L C b Carl38 Jc so e ot h t t s I y rol a k n , 140 a u n ol g e 188, n e a d Cl fr, Ku te, P d aa d c l a u s, 189 a d n i od110 nz r f Un ii n c l a u s254 whc aesu cn a d ol g e e ih r mmaie i Ta ls 9, r d n be z 17 18, a d20. , 19, n
188, 192, 237248, 255 189, 228, , 254,

Comparison of ensitiv of f S ity Diferent EDX S tudies Ba d o ted t rve d i teResul me in se soy se n h aa e iwe n h ts, da n r a d moo n re CV stde icu ig c mp r n o n tr ev u is n ldn o ai so f me in se soy c n u t n t un r a d rda se soy da n r o d ci o la n a il n r o c n u t ni tesa h n aemoese siv a dsp cf o d ci n h me a d r r n t e n e i c o i i frteda n si o CTS ta me sue ns o (1) me in o h ig o s f h n a rme t f da S NAP a lu e a d a lu e rt s,(2) moo CMAP mpi d s n mpi d ai t t o tr a lu e a da lu ert s, Fwa ep rmees, n mpi d s n mpi d ai (3) - v aa tr a d t t o (4) sy ah t sknrsp n s. mp tei i e o se c S v rl u is ta me 4 o moeo te6 AAEM CTSL C e ea stde h t t r r f h I c mp rdterlt ese sivt o dfee te s o me in o ae h eai n t i f i rn tst f da v i y f se soy c n u t n me in moo c n u t n a d n e l n r o d ci , da o tr o d ci , n e de o EMG i CTSp t ns. n ai t e I 4 o 4 rc n (atr1980) stde o p t ns wi CTS n f ee t f e u is f ai t t e h , NCS sh we a n r lis moeotn ta n e l EMG s o d b omaie t r f h n e de e 131 o te AP mu l (Ki r a d Ay a, Jc so a d fh B sce mua n y r ak n n 110 228 140 eo, n nz r Cl fr, S rr a dKu te. ) i od f I 23 o 29 stde o CTS p t ns, da se soyNCS n f u is f ai t me in n r e s wee a n r l moe fe u nl r b oma r rq e t y ta h n moo tr NCS 31, , , 110, 128, 135, 159, , 1, 4, 189, 206, 220, s. 475791, 125, 131, 140, 16717 17 188, 200, 214, 221, 228, 237249, 254, 226, 233, , 253, 255 Th 2 stde p bi e b fr e u is u l d eoe sh 1990 ta wee e c pin ma rf c a smalsa l o ht r xet s o y el t e l mpe f p t ns (20 h n s o 13 p t ns), a d a lw trsh l ai t e ad f ai t 128 n e o he od (3.7ms) fr na n r l da moo dstlae c , (te o a b oma me in tr i a ltn y110 h lt rifr t n wa o tie b wr tn c mmu iain at nomai e o s ban d y ie o t nc t o fo tea to a dwa n tn ld di teoiia rp r rm h uh r n s o icu e n h r n l e ot g ). Th 4 stde p bi e sic 1990 ta wee e c pin e u is u l d n e sh ht r xet s o h v su g std ta c mp tt n o te me in tr n l a e g e e h t o uai f h o da emia 237 n o ai so ltn y id x (Smo i a d W en eg ) a d c mp r n ae c n e i vc n ib r o te se o d lmbia (me in a d itrsse (un r f h cn u r l c da ) n neo i la) dstl trltn ydfee c h s atst n t i e u l r i a moo ae c i rn e a e se sivt q a o f i y ge tr ta me in se soy c n u t n (P e o a d rae h n da n r o d ci o rstn n L gga , S e a , a d Trjb r253). Ho v r te o iin200 h e n233 n oa og we e, h se lt r me inun r lmbia/ trsse tstf dn s wee at e da /la u r lneo i e i ig c i n r n tc ni d i te std b Un ii ta me al6 o o f me n h u y y cn254 h t t l r AAEM CTSL C. I I 19 o 19 stde o p t ns wi CTS me in mie n f u is f ai t t e h , da xd NCS fo te p l t te wr (e .,8 c c n u t n s rm h am o h i .g st m o d ci o dstn e wee a n r l moe fe u nl ta me in i a c) r b oma r rq e t h n y da se soyNCS fo tedgt otewr (e ., c t 14 n r s rm h ii t h i .g 13 m o st c c n u t ndstn e 9, 5759,1, 128, 132, 17 188, 200, m o d ci i a c ). 31, , 7 110, 131, 140, 3, 189, o 214, 228, 237 221, 233, Th se 19 stde icu e te7 rp r ta e u is n ld d h e ot h t s me 6 AAEM CTS L C b Jc so a d Cl fr, t I y ak n n i od110 f 132 188, 189 Ki r, P d a a d c l a u s, mua au n ol g e e S esa a d cl n gi mo a d c l a u s, a d e n ol g e 59 n e c l a u s, Di Gu l l ol g e 221 e ih r mmaie i Ta ls 11 a d12. r d n be z n Ku te140 whc aesu nz r I 20 o 20 stde o p t ns wi CTS c mp r n o n f u is f ai t t e h , o ai so f me in se soymie n re c n u t n t un r da n r/ x d ev o d ci o o la se soymie n re c n u t n o rda se soy n re n r/ x d ev o d ci r a il n r ev o c n u t ni tesa l o CTSp t ns weea n r l o d ci n h me i f o mb ai t r b oma e moe fe u nl ta e au t n o me in se soy NCS r rq e t h n v lai f da n r y o s

Th p oe se sivt o te se ea tst e au td i e o ld n t i f h v rl e s v lae s i y sh wn i Ta l 22 (d t a ay s b GayGrn t,MD). o n be aa n lsi y r o seh Th d t i te a po r t tbe fr e c std wee e aa n h p rpi e a l o a h u y r a su jce t ameaa ay s wi 95% c nie c l t t be td o t-n lsi t h o f ne i s o d mi tk it a c u ttefc ta so o testde icu e a e no c o n h a t h t me f h u is n ld d moeCTSp t ns ta oh r u is. CONCLUS ONS r ai t h n te stde e I Ths rp r po ie c n icn sce t i e ie c ta i e ot rvd s o vn ig ini c vd n e h t f me inse soya dmoo NCS da n r n tr s: 1. Ar v l a d rpo u il ciia lb rtr e ai n e rd cbe l c l a oaoy d n stde u is. 2. Co f m a ciia da n si o CTS wi a hg ni r l c l ig o s f n t h ih d ge o se sivt (> e re f n t i i y 85%) a d sp cf i n e i ct iy (> 95%). Th se sivt s o tese ea dfee t da NCS wee e n t ie f h v rl i rn me in i i f s r c mp rd Th c mp r nd mo st tdta: o ae . e o ai e n r e h t so a 1. M e in se so y NCS c n im te ciia da n r s o fr h l c l n da n si o CTS mo eo tnta me inmoo ig o s f r fe h n da tr NCS (63% t 69% v r s 65% t 85%: Ta ls s o esu o be 3, 12, 19, a d22). 11, 18, 20, n 2. Th me in se so y o mie n r ec n u t n e da n r r x d ev o d ci o fo wrst odgt o d cindstn e13 t 14 r m i t ii (c n u t o iac o c i lss se si v (65%: Ta ls 11a d22) f r m) s e n te i be n o c n imain o te ciia da n si o CTS o fr t o f h l c l ig o s f n c mp rdt: o ae o a Te h iu s whc e au t me in se so y . c nq e ih v lae da n r o mie n r ec n u t no e ash r (7t r x d ev o d ci v r o t o o 8 c c n u t n dstn ea r ss tec r a m) o d ci i a c co h ap l o tn e (e .,p l rstde 7 u n l .g ama u is 4%: Ta ls 12 be a d22); r n o b Te h iu s whc c mp r se so y o . c nq e ih o ae n r r mie n r ec n u t no teme inn r e x d ev o d ci f h o da ev tr u h te c r a tn e t se so y o h o g h ap l u n l o n r r mie n r e c n u t n o te un rn r e x d ev o d ci f h la ev o (85%: Ta ls 18, a d22) o rda n r e be 19, n r a il ev (65%: Ta ls 20 a d22) i tesa h n ; be n n h me a d o r c Te h iu s whc c mp r se soy o mie . c nq e ih o ae n r r x d n rec n u t no teme inn retru h ev o d ci f h o da ev ho g tec ra tn e t se soyo mie NCS o h ap lu n lo n r r x d s f po i l(fram) a d dstl(dgt se me t rxma oe r n i a ii g ns ) o te me in n re i te sa l (85%: fh da ev n h me i mb Ta ls 16 a d22). be n

S9 4CTS L 5 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice Parameter:Carp Tunnel ndrome al Sy

Tab 2 .Comparison of le 2 Pooled S ensitiv ities and S pecif icities of EDX Tech ues to Diagnose CTS niq . Tech ue niq Pooled S ensitiv ity*
A B C D E F G H I J Me inse soya dmie n rec n u t n wr a d da n r n x d ev o d ci : i n o st p l se me t o ae t fram o dgt g n am g n c mp rd o oe r r iise me t Co ai no me ina dun r n r c n u t n mp r so f da n la se soy o d ci o Bewe nwr a dr gf g r t e i n i i e st n n Me inse soya dmie n rec n u t n da n r n x d ev o d ci o Bewe nwr a dp l t e i n am st Co ai no me ina dun r x dn re mp r so f da n la mie ev Co d cinb t e wr a dp l n u t ewe n i n am o st Me inmoo n rec n u t n da tr ev o d ci o Bewe nwr a dp l t e i n am st Co ai no me ina drda se soyc n u t n mp r so f da n a il n r o d ci o Bewe nwr a dtu t e i n h mb st Me inse soyn rec n u t n da n r ev o d ci o Bewe nwr a ddgt t e i n ii st Me inmoo n redstlae c da tr ev i a ltn y Me inmoo n retr n lae c id x da tr ev emia ltn y n e Co ai no me inmoo n redstlae c (se o d mp r so f da tr ev i a ltn y c n lmbia) t teun r tr ev dstlae c (se o d u r l o h la moo n re i a ltn y c n c itrsse) neo i S mp tei sknrsp n y ah t i e o se c 0.85 (0.83, 0.88) 0.85 (0.80, 0.90) 0.7 4 (0.7 0.7 1, 6) 0.7 1 (0.65, 7 0.7 ) 0.69 (0.64, 4) 0.7 0.65 (0.60, 1) 0.7 0.65 (0.63, ) 0.67 0.63 (0.61, 0.65) 0.62 (0.54, 0) 0.7 0.56 (0.46, 0.66)

Pooled S pecif icity*

0.98 (0.94, 1.00) 0.97 (0.91, 0.99) 0.97 (0.95, 0.99) 0.97 (0.91, 0.99) 0.98 (0.93, 0.99) 0.99 (0.96, 1.00) 0.98 (0.970.99) , 0.98 (0.96, 0.99) 0.94 (0.870.97 , ) 0.98 (0.90, 1.00)

0.04 0.52 (0.00, 0.08) (0.44, 0.61) *F re c EDX tc nq et su o ah e h iu o mmaiersut a rss stde se sivt s weep oe fo idvd a stde b c luaiga r e l co u is, n t ie r o ld rm n iiu l u is y ac lt z s i i n weg tda ea e I c luaigteweg tda ea e stde e rln moep t ns rc ie moeweg th nstde e rln ihe v rg . n ac lt h ihe v rg , u is nol g r ai t e ev d r ih ta u is nol g n i e i fwe p t ns. S e i ct s wee si lr p oe b c luaig te weg td a ea e Th d t i te p rnh se b lw te e r ai t p cf ie e i i r mi l o ld y ac lt h ay n ihe v rg . e aa n h ae te s eo h se sivt a dsp cf i v le rpe n telwe a du p r95% c nie c l t o teweg tda ea e rsp ciey Daa n t i n e i ct au s e rse t h o r n p e i y i y o f n e i s fh d mi ihe v rg , e e t l. t v a ay s c utsyo DrGayGrn t. n lsi o r e f . r o seh K Th r wa h trg n i b t e so o testde (te95% c nie c itras o tese sivt s a dsp cf ie d n t ee s eeo e et ewe n me f h u is h y o f n e nev l f h n t ie n e ict s o o d i i i i o elp Ths dsp r y ma b rltd t dfee c s i c se d f io o CTS te u o dfee tc t ons t d f e a v r ). i i ai a t y e eae o i rn e n a ei t n f f ni , h se f i rn u- it o ei n f p n a n r l au , n dfee c s i tea ea ese ei o teCTSp t ns i tedfee t u is. b oma v le a d i rn e n h v rg v r y fh f t ai t n h i rn stde e f Re l b se o asigestd . sut a d n n l u y s

RECOM M ENDATI ONSREGARDI EDX NG S TUDI TO CONFI A CLI CAL ES RM NI DI AGNOS SOF CTS I Th rc mme d t n b lw aeie t a t to ma e e eo n ai s eo r d ni l o h se d o c yh te MR, n te ad h a de d r di 19937b teAAN,h AAP n n ose n AAEM wi tecaic t no rc mme d t n1 a d2a t h lr iai f e o h f o n ai o n a dtea dt no 2cb se o n w e ie c rve di n h d io f a d n e vd n e e iwe n i n ai t sp ce e tese o dCTS L h cn iterature Review.2 I p t ns su e td o p siv CTS te fl wig EDX stde ae f o te i , h ol n o u is r rc mme d d(se Ta l 22 frse sivt a dsp cf i eo ne e be o n t i n e i ct i y iy o Te h iu s A K): f c nq e 1. Me inse soyNCSa rss tewr wi a da n r co h i t st h c n u t n dstn e o 13 t 14 c o d ci o ia c f o m (Te h iu G). I tersuts a n r l c nq e fh e li b oma,

c mp r n o te rsut o te me in o ai so f h e l f h da se soyNCS t tersut fase soyNCS n r o h e lo n r o 1 oh r a jc n se soy n re i te f te da e t n r ev n h sy tmai l ( tandard) mpo t i S c mb . 2. I teiia me inse soyNCS a rss te f h nt l da n r i co h wr h s ac n u t ndstn ege trta i a st o d ci i a c rae h n o 8 c a d te rsuti n r l 1 o te m n h e l s oma, f h fl wiga dt n l u is irc mme d d ol n d io a stde s e o o i n e: a Co ai n o me in se soy o . mp r so f da n r r mie n rec n u t na rss tewr x d ev o d ci co h i o st o e a sh r (7 t 8 c c n u t n vr ot o m) o d ci o dstn e (Te h iu C) wi un r ia c c nq e t la h se soy n re c n u t n a rss te n r ev o d ci o co h wr o e te sa sh r (7 t 8 c i v r h me ot o m) st

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Practice Parameter: Carp Tunnel ndrome al Sy

c n u t n dstn e (Te h iu D) o d ci o ia c c nq e ( tandard)o S ,r b Co ai n o . mp r so f me in se soy da n r c n u t n a rss tewr wi rda o o d ci co h i t a il r o st h un rse soy c n u t n a rss tewr la n r o d ci co h i o st i te sa l (Te h iu s B a d F n h me i mb c nq e n ) ( tandard)o S ,r c Co ai n o me in se soy o mie . mp r so f da n r r x d n re c n u t n tru h te c ra ev o d ci o ho g h ap l tn e t se soy o mie NCS o u nl o n r r xd s f po i l (fram) o dstl (dgt rxma oe r r ia ii ) se me t o teme inn rei tesa g ns f h da ev n h me l (Te h iu A) ( tandard) i mb c nq e S . 3. Moo c n u t n std o te me in n re tr o d ci o uy f h da ev rc rig fo te te a mu l (Te h iu H) e odn rm h h n r sce c nq e a d o 1 oh rn re i te sy tmai l t n f te ev n h mpo t i o c mb icu eme sue n o dstlae c ( n ld a rme t f i a ltn y Guideline) . 4. S p lme tr NCS Co ai n o te me in u pe nay : mp r so f h da moo n redstlae c (se o dlmbia) t te tr ev i a ltn y c n u r l o h c un rmoo n redstlae c (se o ditrsse) la tr ev i a ltn y c n neo i (Te h iu J me in moo tr n l ltn y c nq e ), da tr emia ae c id x (Te h iu I me in moo n re ne c nq e ), da tr ev c n u t nb t e wr a dp l (Te h iu E), o d ci ewe n i n am o st c nq e me in moo n re CMAP wr t p l da tr ev i o am st a lu ert t d tc c n u t nbo k me in mpi d ai o ee t o d ci lc , da t o o S NAP wr t p l a lu e rt t d tc i o am mpi d ai o ee t st t o c n u t n bo k sh r se me t (1 c o d ci o lc , ot g n m) ice na me in se soy n re c n u t n n rme tl da n r ev o d ci o a rss tec ra tn e ( co h ap lu n lOption) . 5. Ne de ee t my ga h o a sa l o mu ls e l lcr o rp y f o mpe f sce in rae b teC5 t T1 spn l o t icu iga n ev td y h o ia ros,n ldn te a mu l in rae b te me in n re o h n r sce n ev td y h da ev f tesy tmai l ( h mpo t i Option) c mb . h Ba d o te se o d AAEM CTS L se n h c n iterature Review2 te fl wig EDX stde aenot rc mme d d t c ni a ol n o u is r eo n e o o fm r ciia da n si o CTS ete b c u te EDX stde l c l ig o s f n i r e a se h h u is rc mme d d a o eh v ge trse sivt a dsp cf i eo n e b v a e rae n t i n e i ct i y iy o tetsts b st e r e a iv st ain l ths t . rh e i e d sci d s n e i t a a ti i b g o me 1. L w se sivt a d sp cf i c mp rd t oh r o n t i n e i ct o ae o te i y iy EDX stde mut l me in Fwa ep rmees, u is: lpe da - v aa tr i me in moo n re RL a d sy ah t skn da tr ev , n mp tei i c rsp n (Te h iu K). e o se c nq e 2. Iv st ain lstde e au t n o teefc o n e i t a u is: v lai f h fe t n g o o me in NCS o l da f i i h mi, d n mi h n mb sc e a y a c a d e ecse a dbif r stie wr p sio ig x ri s, n r o su an d i o t nn . e st i Def inition Of Practice Recommendation S trength s Th st n t o arc mme d t no c n lsini b se o e r gh f e o e n ai r o cu o s a d n o te q ai a d c n stn y o su p r n e ie c . Th h u ly n o si e c f p ot g vd n e e t i fl wigrt gsy e i u d ol n ai stm s se : o n
S9 6CTS L 5 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice standards: g n rl a c pe picpe fr e eal c e td r ils o y n p t n ma a e n ta rf cs a hg d ge o ciia ai t n g me t h t el t e e ih e re f l c l n c r it. et ny a Practice guidelines: rc mme d t n fr p t n eo n ai s o o ai t e ma a e n ta rf c mo eaeciia c r it. n g me th tel t d rt l c l et ny e n a Practice options: oh rst tge frp t n ma a e n te r e is o ai t n g me t a e fr ihteciia uit i u c r i. o whc h l c l ti s n et n n ly a RECOM M ENDATI ONSFOR FUTURE RES EARCH S TUDI I CTS ES N Th AAEM rc mme d ta ftr ciia rse rh e eo n s h t uue l c l e ac n stde o te u fle o EDX stde t c ni te u is f h seun ss f u is o o f m h r da n si o CTSme t ciia std ci r : ig o s f e 3 l c l u y r ei n t a 1. P o e t estd . r sp ci u y v 2. Cl ia da n si o CTS id p n e to EDX i c l ig o s f n n eedn f stde F re a l,a da n si o prob le u is: o x mpe ig o s f ab CTS a d fn d i te se o d CTS L s eie n h c n iterature ih s a d n o se su Review2 whc i b se o a c n n s rc mme d t nb Re e a dc l a u s.205 eo n ai y mp l n ol g e o e 3. A u io m p oo o f r d t c l cin a d nf r r tc l o aa ol t e o n me su e n wi tep y ca s p ro miga d a rme t t h h siin ef r n n h itr rt g teEDX stde u d riv st ain nep ei h n u is n e n e i t g o bid dt teciia da n si o al h h ma l e o h l c l ig o s f l te u n n n su jcs (n r l CTS dse se c nr l i te be t o ma, , i a o to) n h std a la u t te d t c l cin a d u y t e st ni h aa ol t l e o n me su e ns aec mpee . a rme t r o ltd Th AAEM rc mme d ta f tr ciia rse rh e eo n s h t uu e l c l e ac n stde o te u f le o EDX stde t c n im te u is f h seun ss f u is o o fr h da n si o CTS me t a dt n l to oo ia std ig o s f e 4 d i o a meh d lgc l u y i ci ra rt i: e 1. De rpin o EDX tc nq e su fce t t scit o f e h iu fiin o p r t e l aino testd . emirpi t c o fh u y 2. M o i r l nt i tmp rtr c niu u y d rn o mb e eau e o t o sl u ig n teEDX std . h uy 3. No ma v le f rEDX tc nq eo tie wi r l au s o e h iu ban d t h c n o tn stde o wi p e iu stde i o c mi t u is r t rvo s u is n a h tesa lb rtr . h me a o ao y 4. Crtra o EDX a n r l y o tie fo i i f e b o mai ban d r m t n r l p p lt n a d d fn d i stt ia o ma o uai o n eie n ai c l st tr ems.
2 Th f st n se o dAAEM CTS L e i ad cn r iterature Reviews1, u d se 6 CTS L C. Th se o d CTS L I e cn iterature Review2 rc mme d d (1) te a dt n o ci r n 3 a d (2) ta eo ne h d io f r ei i t o n ht ftr AAEM CTS L uue iterature Reviews u al CTS L C t se l7 I o rve rp r o te u fle o EDX stde i te e iw e ot f h seun ss f s u is n h e au t n o CTS p t ns. Th se o d AAEM CTS v lai o f ai t e e cn l rvd d t f e i c r ei o i t a L iterature Review2 asopo ie ase o sp cf ci r t ma eaciia da n si o CTS b se o e p r o iin k l c l ig o s f n a d n x et pno

Practice Parameter:Carp Tunnel ndrome al Sy (Ta l 2). be Th AAEM rc mme d ta stde whc c mp r te e eo n s h t u is ih o ae h se sivt a dsp cf i stde o NCS a dn e l EMG n t i n e i ct u is f i y iy s n e de t tese sivt a d sp cf i o oh rtst po o d fr o h n t i n e i ct f te e s rp se o i y iy tediagnosis o CTS u teciia da n si o prob le h f se h l c l ig o s f n ab CTS a d f e i Ta l 2. Th se atraie da n st s ei d n be n e l nt e v ig o i c stde icu e te fl wig q a taie c tn o s u is n ld h ol n : u ni t o t v ua e u se soytst go p re t ntrsh l frvbain 2-on n r e i f ec pi he od o irt , p it n o o dsci n t n tu h wamt, c l, a d ee t c i r ai , o c , mi o r h od n lcr i 21, c re t 22, 153, 168, h n sy tm da rms; 123, urn; 120, 160, 247 a d mpo iga 122, 124 ma n t rso a c i gn a d c mp td tmo rp i g ei e n n e ma ig n o ue o ga hc c 16, stde o tec ra tn e; 1799, temo rp y100, 0, u is f h ap l u n l , 169 h r ga h ; 17 240 90 wr rt ; po o aino sy tms b ut so n ; 2 a d i ai st o rv c t f mpo o y la u d17 n r 7 212 8, c ra tn e pe r me sue ns. ap lu n l rssue a rme t Boh te f sta d se o d AAEM CTS L t h i n cn r iterature Reviews rc mme d d ta o to stde sh udb p rome t eo n e h t uc me u is o l e efr d o a ss te h r b n f s,a d c st o p romig NCS sse h ams, e ei n o s f efr n t s a d n e l EMG i p t ns wi sy tms su g st eo n e de n ai t t mpo e h ge i f v CTS . Th AAEM rc mme d ta ftr o to stde o e eo n s h t uue uc me u is f treatment o CTSu teciia da n se o def f se h l c l ig o s f inite CTS n (a d f e i Ta l 2) wi EDX stde o hg se sivt s ei d n be n t h u is f ih n t i i y a d sp cf i frte da n si o CTS p rome b a n e i ct o h ig o s f iy efr d y sp cal t ie p y ca ,.e me inmie n rep l r e il r n d h siin i ., da x d ev ama y a stde a do c mp r n o me in t un ra do rda u is n /r o ai so f da o la n /r a il se soyNCSi tesa h n . n r n h me a d Th AAEM CTS Ta F reh s a de dftr rse rh e sk oc a d rsse uue e ac picpe o e ftr rse rh tpc (e c p fro to r ils v r uue e ac o is x e t o uc me n stde b c u te Ta F re c n ld d ta ftr u is) e a se h sk oc o cu e h t uue rse rhstde n e t me th sepicpe (1) t po ie e ac u is e d o e te r ils n o rvd rl bea d rpo u il d t t e au t teu fle o ei l n e rd cbe aa o v lae h seun ss f a EDX stde t c ni teciia da n si o CTS a d u is o o f m h l c l ig o s f r n n (2) p r tc mp r n o te rlt e uit o dfee t emi o ai so f h eai ti f i rn v ly f EDX stde frh t up se u is o ta p ro . I i rc mme d dta teAAEM rve ti rp r e ey ts eo n e h th e iw hs e ot v r 5 y as a du d t terp ra n c ssay e r n p ae h e ot s e e r. DI CUS I S S ON Ths rp r icu e 2 rc mme d t n i a dt nt to i e otn ld s e o n ai s n d io o h se o i i te 1993 CTS L n h iterature Review t i rv ftr o mpo e uue ciia rse rhstde o teu fle o EDX stde t l c l e ac u is f h seun ss f n u is o c ni teciia da n si o CTS o f m h l c l ig o s f r n . 1. Ths rp r po ie an w c n n s b se se o i e ot rvd s e o se su a d t f icu o a d e cu o ci r fr te ciia n lsin n x lsin r ei o h l c l t a n da n si o CTS a c rig t tec r it o te ig o s f c odn o h et ny f h a da n si possib CTS prob le CTS a d ig o s: le , ab , n def inite CTS(Ta l 2). W erc mme dteci r be eo n h r ei t a fr te da n si o prob le CTS b u d i o h ig o s f ab e se n ftr stde o EDX tst t rd c tep ssiit uue u is f e s o e u e h o bly i o see t n ba t po ie a moe u i r f lci o is, o rvd r nf m o p p lt n o CTS p t ns, n t po ieav l o uai f o ai t a d o rvd e ai d sce t i b si fr c mp r n o te rsut o ini c a s o o ai f so f h e l f s ftr stde fo dfee t lb rtr s. Ths uue u is rm i rn a oaoi f e i su g st n i a rf e n o te oiia ge i o s ei me t n h n r nl g rc mme d t nma ei te1993 CTS L eo n ai o d nh iterature Review. 2. S c et a d c l a u s217 a d oh r h v ak t n ol g e e n tes a e rc mme d d ta ciia rse rh stde o eo n e h t l c l e ac u is f n da n st tst (icu ig EDX stde b ig o i e s n ldn c u is) e p rome wi te p y ca p romig a d efr d t h h siin efr n n h itrrt g te da n st tst bid d t te nepei h ig o i e s l e o h n c n da n si o te su jc wi te g a o ig o s f h be t t h o l f h ei n t g o sev rba Th r i asoi b d o l ai b re is. ee s mi n l oy f d ciia e ie c a d e p r n e whc idc ts l c l vd n e n x ei c n e ih n iae ta NCS ae u flt c ni te da n si o ht s r seu o o f m h ig o s f r CTS ab d o e ie c si lri weg tt te , o y f vd n e mi n ih o h a ciia e ie c ta rdo rp s ae u fl t l c l vd n e h t a iga h r seu o n ie ty fa trs o te l d ni f rcue f h i mb b n s a d oe n ee t c riga lcr ado rms ae u fl t ie t y o r seu o d ni f my c rili h mi a d ifrt n Ne etee o ada sc e a n naci . o v r lss, h i i wot p romig ftr e au t n o EDX ts r efr n uue v lai s f h o stde i CTS wi te e a n rbid d t te u is n t h x mie l e o h h n ciia da n si o tesu jc a ten x stpt l c l ig o s f h be t s h e t e o n e a l ig te v l i o te c n lsin stbi n h ai t f h se o cu o s sh dy b y n a ra n be d u t I fc,so ciia e o d e so a l o b. n a t me l c l n iv st aos h v ara y b g n t p rom n e i tr a e l d e u o efr g e e au t n o NCS i CTS i abid d fsho v lai s f o s n n l e a in n re n (S lro a d c l a u s218, a d W en r a d aen n ol g e 219 n e c l a u s263 ). ol g e e I te 1993 AAEM CTS L n h iterature Review, i wa t s rc mme d dta a o to std b p rome t a ss eo n e h t n uc me u y e efr d o sse te h r b n f s,a d c st o p romig NCS a d h ams, e ei n o s f efr n t s n n e l EMG i p t ns wi sy tms su g st eo CTS e de n ai t t mpo e h ge i f v . I 1994,Bo i c a d c l a u s20 p bi e apo e t e n nf e n ol g e u l d rsp ci a e sh v std fo En ln whc d mo st td ta NCSEMG u y rm ga d ih e n r e h t a / stde wee u fla d c stefcie i ma a e n o u is r seu n o fe t n n g me t f v i a p t ns su e td o CTS20 I a dt n te AAEM h s ai t sp ce f e . n d io , h e c ua e a dt n l o to n o rg d d io a uc me stde icu ig te i u is n ldn h p biain o g ieie fr o to ul t c o f ud l s o n uc me stde i u is n 108 Th AAEM e n uo sc lr dse se icu ig CTS e rmu ua i a s n ldn . Re ac a d Ed c t n F u d t n h s rc nl fn e a se rh n u ai o n ai a e e t u d d o o y po e t e o to std o 400 p t ns t e au t te rsp ci uc me u y f v ai t o v lae h e u fle o EDX stde i te e au t n a d seun ss f u is n h v lai o n ma a e n o p t ns wi sy tms su g st eo CTS n g me t f ai t t mpo e h ge i f v . I i rc mme d d ta o to stde c niu t b a t s eo n e h t uc me u is o t e o e n pir y fr ftr ciia rse rh i te da n si a d r i o uue l c l e ac n h ig o s n ot n ma a e n o CTSa doh r e rmu ua dse se n g me t f n te n uo sc lr i a s. I NTERFACE W I AAEM GUI TH DELI NES I 1999,te AAEM rp bi e g ieie b se u o n h e u l d ud l s a d p n sh n e p r o iina df st u l e i 1992 frtee au t n x et pno n i p bi d n r sh o h v lai o iei s e o n n h o CTS p t ns.2, Th AAEM Gud l e rc mme d te f ai t 4 e e fl wig EDX stde (1) me in se soyo mie NCS ol n o u is: da n r r x d t icu ed tr n t n o (a tea lu ea d (b p a o n ld eemiai f ) h mpi d n ) e k o t ltn yo o se ltn yo CV o tese me t f h me in ae c r n tae c r f h g n o te da n rep ssig tru h tec ra tn e;(2) me in moo ev a n ho g h ap l u n l da tr

Muscl & Nerve Sup l e pement X 2 0 S9 7 02 5

Practice Parameter: Carp Tunnel ndrome al Sy NCS t icu e d tr n t n o te a lu e dstl o n ld eemiai o f h mpi d , i a t ltn y a dCV i tefram; un r(o rda) se soy ae c , n n h oe r (3) la r a il n r a dmoo c n u t nstde i tesa l t e cu ea n tr o d ci u is n h me i o x ld o mb p r h rln uo ah ;(4) n e l EMG e a n t n o te ei ea e rp ty p e de x miai f h o AP t d tr n te se ei o teme in moo n re B o eemie h v r y f h t da tr ev p too y a d (5) n e l EMG e a n t n o l ah lg ; n e de x miai o f i mb ia ev o t o mu ls in rae b te C5/T1 spn ln re ros t sce n ev td y h 6 e cu eac ria rdc lp ty ba ha pe o ah , n a x ld evc l a iuo ah , rc il lx p ty a d po i l da n uo ah .2, Th f st n se o dAAEM rxma me in e rp ty 4 e i a d c n r CTS L iterature Reviews b t ct p bi e stde ta oh i u l d u is h t e sh po iea e ie c b si fr rvd n vd n e a s o AAEM Gud l e 1, a d4, iei s 2, n n b td n ta de Gud l e 3 a d 5 frEDX e au t n u o o d rss iei s n n o v lai o o p t ns su e tdo CTS f ai t sp ce f e . S M ARY OF HARM S BENEFI ,AND COS UM , TS TS FOR I NTERVENTI ONSCONS DERED I Th AAEM h s pe ae a d c me tta d scie te e a rp rd ou n ht e r s h b r s i ee t da n st me iie5 Br f ,h r s t te i n lcr ig o i dcn . i l te i o h sk o c ey sk p t n o n e l EMG icu et n e t i o otbuse ai t f e de e n ld r sin dsc mfr ri , a , h mao , n ifcinfo ten e l iset nrq i d e tma a d ne t rm h e de n r o e ur o i e t p rom n e l EMG. Th r s o NCS t te p t n o efr e de ei sk f o h ai t e icu et n e tdsc mfr o teee t csh c s. Th r n ld r sin i o ot f h lcr o k a i ei sk o n e l EMG t teEDX c n l n icu e ia v r n f e de oh o sut t n ld s n d et t a e n e l p n tr o teEDX c n l n b ten e l u dt e de u cue f h o sut t y h e de se o a e au t te p t n a d ifcin b h p ti h ma v lae h ai t n ne t e o y e ais, u n t i n -eiin yvrs, r te c mmu ia l dse se mmu od f e c i o oh r o c u nc be i a . Th AAEM h s pe ae a d c me tta d scie te e a rp rd ou n ht e r s h b ey t b n f s o ee t da n st me iie4 Br f , h b n f s e ei f lcr ig o i dcn . i l te e ei t o c o n e l EMG a d NCS icu e c ni t n o te f e de n n ld o f mai r o fh ciia da n si o CTS a d tepo a it o ie t yn l c l ig o s f n n h rb bly f d ni ig i f c n o tn o atraie n uoo ia dsod r a te o c mi t r l n t a e v e rlgc l i res s h c u o te p t ns sy tms. I a po e t e std , a se f h ai t mpo e n rsp ci u y v e o sut i , ao Hag a d c l a u s95 rp r d ta a EDX c n l t n i n ol g e e ot h t n e icu ig EMG a d NCS c a g d te f a ciia n ldn n , h n e h i l l cl n n da n si 42% o tet . ig o s fh i me Ths std h s n t n etk nasy e t e au t no te i u y a o u dr e a stmai v lai f h c o e o o cc st a de o o cb n f s o NCS a dn e l c n mi o s n c n mi e ei f t s n e de EMG i tee au t n o p t ns su e td o CTS Th n h v lai f ai t sp ce f o e . e itrstd ra e i rfre t te o to nee e e d r s eerd o h uc me std b uy y Bo i c a dc l a u s.20 nf e n ol g e a e DI CLAI ER S M Ths rp r i po ie a a e u ain lsevc o te i e ot s rvd d s n d c t a rie f h o AAEM. I i b se o a a ssme to c re tsce t i t s a d n n sse n f urn ini c f a d ciia ifr t n I i n titn e t icu e al n l c l nomai . t s o ne d d o n ld l n o p ssil meh d o c r o ap r c lrciia po lm o o be to s f ae f at ua l c l rbe r i n al lgt t ci r fr c o sig t u a sp cf l e imae r ei o h o n o se i t a e ic i po e ue Nete i i itn e t e cu ea yra n be rc d r. i r s t ne d d o x ld n e so a l h atraie meh d lge Th AAEM rc g ie ta l nt e v to oo is. e e o nz s h t sp cf p t n c r d csin ae te peo aie o te e i c ai t ae e i o s r h rrg t i e v fh p t n a d hs/e p y ca a d ae b se o alo te ai t n i h r h siin n r a d n l f h e cru a c s iv le . i mstn e n ov d c Approv b th Board ofDirectors ofth American ed y e e Association of Electrodiagnostic M edicine: M ay 2 0 . 02 AAEM woul l e to th th fol d ik ank e l owing wh reviewed th o e manuscrip and made h p t elful suggestions: Gay M. r F a ki,MD;Cah r eA. Za n MD;Mio Al r MD, rn l n tei n h ln t, t e P D; Se h n Ash l MD; J h R. Cav r y MD; h tp e wa, on lel , e Rih r M. Du isk , MD; Jc u l e F e c , MD; c ad bn y a q ei n rn h Mih e Glnz MD;Gay S Grn t,MD;De oa c a l a t, r . o seh b rh Hi z MD; Jme Se e s,MD;W iim W in r MD; r, t a s tv n la l e e, W iim W . Ca b l MD; o p V. Ca eln J, la l mp el , J se h mp l e rMD; o W iim H. Co p r MD;EalJ Cri,MD;Rih r M. la l o e, r . ag c ad Du isk ,MD; Ke n t Jme Gan s,MD; Jme F bn y n eh a s ie a s . Ho r,MD;J h C. Kic i,MD;Yu n T. S ,MD, wad on n ad e o P D;F e eik M. Vic n,MD;Ro etA. W en r MD, h rd r c net br re, MS Da il miuMD, h Jc u l eJ W et h MD; ; ne Du t r P D; a q ei . n r , sc NelA. Bu s,MD;L i M. Noa MD,J Mury E. i si os r, D; ra Brn sttr MBBS P D,F a d ae , h RCP J h C. Kic i,MD; ; on n ad L wrn eRo iso , a e c bn n MD; c adK. Ole , Rih r n y MD; n aL Do n . F a k lMD; n Jnc M. Ma y MD. rn e, a d a ie sse ,

S9 8CTS L 5 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice Parameter:Carp Tunnel ndrome al Sy

BIBLIOGRAPHY std sh we ta me in n r e p o i l c n u t n v lct u y o d h t da ev r xma o d ci o eo i y slwig i p t ns wi CTS i rstitd t te fb r ta dstl o n n ai t t e h s e rce o h ies h t i al y p ss tr u h te c r a tn e a d d e n tn c ssai i l a a h o g h ap l u n l n o s o e e rl mpy n y a dt n lp o i llsin W esu g stta c mp rso o F d i o a r xma e o . i g e h t o ai n f CVma x AP a d F B n CVma - Q c ud b u f lwh n teq e in ai s i a x P o l e seu e h u st o rse f sige (dstl o t (o e dstl o e p o i l lsin ae nl i a) r wo n i a, n r xma) e o s r rsp n bef rap t ns sy tms. e o sil o ai t mpo e An ay M T,F n h u rM J Ri n J S ig lN,Huc V,Yo f dr a k a se , t so L, pe e le se M . Co ai n o se so y mi- am stde t oh rtc nq e i mp rso f n r d p l u is o te e h iu s n c r a tn e sy d o . Elcr my g Cl ap l u n l n r me e to o r i Ne r p y o n u o h sil 1996; 36:27 285. Crtra M e (5/ 1, 4, 6) S u c : M e l e 9i i e t 6: 3, 5, o re di n S ac . Ab rc: P o e t estd t c mp r terlt ese si vt e rh sta t r sp ci u y o o ae h eai v v n ti i y o se ea NCS t ie t y a n r l is i p t ns wi (1) mi f v rl o d ni b o mai e n ai t t f t e h l d CTS (a t r mi me in se so y p a ltn y lss ta o e u lt ni o c da n r e k ae c e h n r q a o d 4.0 ms (c n u t n dstn e 14 c a d (2) a la o e NCS o d ci o iac m) n t e st n a n r l y Of a ttlo 205 p t ns wi 27 h n s,a std b o mai . t oa f ai t t e h 5 ad uy su g o pwa see tdo teb si o tersut o NCS 81 p t ns b ru s lce n h a s f h e l f s : ai t e wi 90 h n s. Th d t fo ti su g o pwa u dt c luaete t h ad e aa r m hs b r u s se o ac lt h rlt e se si vt o f u tst (1) M e in un r se so y ltn y eai v n t i f o r e s: i y da - la n r ae c dfee c s a r ss tewrst(se so yp l [ - ), M e in rda ifrn e co h i n r am M U] (2) da -a il se so y dfee c (se so y tu [ - ),(3) M e in un rmie n r ifrn e n r h mb M R] da - la x d p l dfee c (mi p l [ - ) a d(4) M e in un r n r dgt am ifrn e x am M U] n da - la se so y ii dfee c (se so ydgt [ - ). 90 h n s me teee to ig o i ifrn e n r ii M U] s ad t h lcr da n st c (EDX) ci ra f r mi CTS Th se so y tu rt i o e l d . e n r h mb (M - wa R) s a n r li 90% o teh n s f l we i o d rb mi p l (M b o ma n f h a d ol d n r e y x am o U) 61%, se so y dgt (M - 42% a d se so y p l (M - 33%. n r ii s U) n n r am U) se so yp l (M - ddn t g iia t a dt teda n si o CTS n r am U) i o sinfc nl d o h ig o s f y . Ash rhNL, ash l S S tu a LE. Th efc o tmp rtr wo t M r al C, ak n m e fe t f e eau e o n r e c n u t n p rmees i c r a tn e sy d o . M u l n ev o d ci aa tr n ap l u n l n r me o sce Nev 1998; re 21:10891091. Ba k r u d Reee c . S u c : M e l e c go n frn e o re di n S ac . Ab rc: Ths std p o ie e ie c ta tmp rtr e rh sta t i u y r vd s vd n e h t e eau e c re t n fco s b se o n r ln r e fo n r lidvd as o rci a tr a d n o ma ev s r m o ma n iiu l o c n o b u dt n r l e NCSd t fo CTSp t ns. a n t e se o o mai d z aa r m ai t e Au o a S Ah d BK,Au o a TK. S ln p ro a n r l is i r r K, ma rr i t eid b o mai e n e t c r a tn e sy d o . M u l Nev 1998; ap l u n l n r me sce r e 21:12131215.Crtra i i e M e (3/ 1, 5) S u c : M e l eS ac . Ab rc: Cua e u si n t 6: 2, o re di e rh n sta t tn o s l t e p ro (CS ) wa me su e o st lt g dgt 2 a d 5 i 19 eid P s a rd n i ai mu n ii s n n p t ns wi c r a tn e sy d o (CTS a d c mp rd wi 20 ai t t ap l u n l n r me e h ) n o ae t h h atyv lne r I 2 p t ns wi se eeCTS CS wa a se t n el h ou tes. n ai t t v r e h , P s b no dgt2 b tp e n o dgt5. Ex mpeo u o CTS a amo e f r ii u rse t n ii a l f se f s d lo iv st aigteefc o ac mp e v n u o ah o teCS . CS n e i t h fe t f o rssie e r p ty n h g n P P a n r l yd e n tlc l e p too yt c r a tn e se me to b o mai o s o o ai d ah lg o ap l u n l g n f t z teme inn r e 3004 h da ev . Ba e EL,Eh e b r RL. P e e t g tewo k rltd c r a tn e kr rn eg rv ni h n r -eae ap l u n l sy d o : p y ca rp rig a d da n st ci ra An Itr n r me h siin e o t n n ig o i rt i. c e n nen M e 1990; d 112:317 319. Ba k r u d Reee c . S u c : M e l e c go n frn e o re di n S ac . e rh BabezJ , t el lir M Cot l AC, t el D. I n e l e a n t nawa s r Cot l W r s e de x miai l y o n c ssay i e au t n o c r a tn e sy d o ?Arh P y M e e e r n v lai f ap l u n l n r me c h s o d Re a i 1998;9:514h bl 7 516. Crtra M e: (2/ 2, S u c : M e l e i i e t 6: 3) o re di n S ac . Ab rc: Rer sp cie rve o EM G/ e rh sta t to e t v e iw f NCS rp rs t e ot o d tr n i n e l EM G e au t n wa a n r li NCS wee eemie f e de v lai o s b o ma f r n r l u igtee au t no p t ns su e tdo CTS I p t ns o ma d rn h v lai f ai t sp ce f o e . n ai t e i wh m o l CTS wa su e td n r lNCS p e itd ta EM G n o ny s sp ce , o ma rdce h t wo l b n r l ud e o ma 89.8% o tet . Th sefn ig su g st h t h r fh i me e idn s g e ta tee ma b a su p p lt n o p t ns rfre f r ee to ig o i y e b o uai o f ai t eerd o lcr da n st e c e au t n o CTS wh ma b a e u tl e au td b n r e v lai o f o y e d q aey v lae y ev c n u t nstde ao e o d ci u is ln . o Ba sa AI Ch n CW , Oh S . Te eau e efcs o n r e y l , ag J mp rtr fe t n ev c n u t n stde i p t ns wi c r a tn e sy d o . Aca o d ci o u is n ai t t ap l u n l n r me e h t Ne r lS a d 1993;88: 213uo c n 216. Ba k r u d Reee c . S u c : c go n frn e o re M e l e S ac . Ab rc: S u y t d tr n wh te dse se di n e rh sta t td o eemie eh r i a d n r e (CTS p t ns) rsp n e t tmp rtr rse i a dfee t ev s ai t e o d d o e eau e i n e ifrn ma n rfo n r lc nr l W i rsig tmp rtr moo NCV n e r m o ma o tos. t i n e eau e tr h ice se , wh ra ltn is, a l u e a d d rt n o te n ra d ee s ae ce mpi d s n t u ai o f h c mp u d mu l a t n p tnil d ce se i b t g o p o on sce ci o oe t a e ra d n oh r u s. Al o g te c a g s ween tstt ial sinfc n b t e te t u h h se h n e r o ai c l g iia t ewe n h h st y t g o p tee wa a tn e c wi tmp rtr c a g s f rte wo r u s, h r s e d n y t e eau e h n e o h h d ce sei tetr n lltn yo teCTS g o p t b g e trta e ra n h emia ae c f h r u o e rae h n ta o n r l o tos. (S eBotna dAsh rh h t f o ma c nr l e l n o wo t). Bh l RP Th p i E. Eal d tcin o c r a tn e sy d o b aa , o pl ry ee t o f ap l u n l n r me y se so y n r e c n u t n Elcr my g Cl Ne r p y o n r ev o d ci . o e to o r i n u o h sil 1981; 21:155164. Crtra M e (3/ 1, 3) S u c : P a , 1989. i i e t 6: 2, o re e se

Al at ls rve d a d ca fe b te Li rtr l ri e e iwe n lssiid y h c t au e e I cu o Crtra ae c nan d i te bbig a h n lsin i i r o tie n h il rp y e o b lw. Arils ta me 3 o lss ci raaen tctdi eo t e h t t r e rt i r o i n c e e tetx a daeie t idb a a ei (* h e t n r d ni e y n strsk ). f
Ab rvain a d co dgt mii (ADM );a d co p l cs b e i b e it s: b u tr ii o i nmi b u tr ol i rvs i (AP B);c mp u d moo a t n p tnil(CM AP c r a tn e (CT); o on tr ci o oe t a ); ap l u n l c r a tn e sy d o (CTS dstlmoo ltn y(DM L);dstlse so y ap l u n l n r me ); i a tr ae c ia n r ltn y (DS ae c L); ee to o rp y (EM G); n r e c n u t n stde lcr my g a h ev o d ci o u is (NCS n r ec n u t n v lct (NCV);se so y n r ea t n p tnil s); ev o d ci eo i o y n r ev ci oe t o a (S NAP ). 1. Ameia Ac d my o Ne r lg Qu l y S a d r s S b o rc n a e f u oo y ai tn ad u c mmi e . t te t P a t e p rmee f r c r a tn e sy d o . Ne r lg rci c aa tr o ap l u n l n r me u oo y 1993; 43:24062409. Ba k r u d Reee c . S u c : AAEM 2000 c go n frn e o re CTS Ta F re me e. S mmay sttme tta n ts ta te sk o c mb r u r ae n h t oe h t h l eio d o te da n si o CTS ice se wi te n mb r o i l o f h ig o s f k h n ra s t h u e f h ca c sy tms, p o o aie fco s, mi g t g fco s, a d lssi mpo rv c t v a tr t ai i n a tr n a n r l is o tep y c le a n t n Th ciia iv st ao b o mai e n h h sia x miai . e l c l n e i tr t o n g c n c n r c ase o ciia ci raf rteda n si o CTS fo a o stu t t f l c l rt i o h ig o s f n e rm te sy tms a dsin c mmo t CTS h se mpo n gs o no . Ameia Asso it n o Elcr da n st M e iie Gud l e i rc n cai f e to ig o i o c dcn . iei s n n ee to ig o i me iie M u l Nev 1992; lcr da n st c dcn . sce re 15:229253. Ba k r u dReee c . S u c : AAEM Co sutn 1993. c go n frn e o re n l t a Ameia Asso it n o Elcr da n st M e iie Gud l e i rc n cai f e to ig o i o c dcn . iei s n n ee to ig o i me iie P a t e p rmee f ree to ig o i lcr da n st c dcn . rci aa tr o lcr da n st c c stde i c r a tn e sy d o : su u is n ap l u n l n r me mmaysttme t M u l Nev r ae n. sce r e 1999; 8:S S 141143. Ba k r u d Reee c . S u c : AAEM 2000 c go n frn e o re CTSTa F reme e. sk o c mb r Ameia Asso it n o Elcr da n st M e iie Gud l e i rc n cai f e to ig o i o c dcn . iei s n n ee to ig o i me iie Reerlg ieie f ree to ig o i lcr da n st c dcn . fra ud l s o lcr da n st n c me iie c n l t n dcn o sut i s. M u l Nev 1999; 8:S - 108. ao sce re S 107 S Ba k r u d Reee c . S u c : AAEM 2000 CTS Ta F re c go n frn e o re sk o c me e. mb r Ameia Asso it n o Elcr da n st M e iie Gud l e i rc n cai f e to ig o i o c dcn . iei s n n ee to ig o i me iie Ri s i ee to ig o i me iie lcr da n st c dcn . sk n lcr da n st c dcn . M u l Nev 1999; 8:S S sce r e S 53- 58. Ba k r u d Reee c . S u c : c go n frn e o re AAEM 2000 CTSTa F reme e. sk o c mb r Ameia Asso it n o Elcr da n st M e iie Gud l e i rc n cai f e to ig o i o c dcn . iei s n n ee to ig o i me iie W h i q aiid t p a t e lcr da n st c dcn . o s ul e f o rci c ee to ig o i me iie M u l Nev 1999; 8:S lcr da n st c dcn ? sce re S 263- 265. S Ba k r u d Reee c . S u c : AAEM 2000 CTS Ta F re c go n frn e o re sk o c me e. mb r Ameia Asso it n o Elcr da n st M e iie Ameia rc n cai o f e to ig o i c dcn , rc n Ac d my o Ne r lg ,Ameia Ac d my o P y c lM e iie ae f u oo y rc n a e f h sia dcn a dRe a i tt n P a t ep rmee f ree to ig o i stde i n h bl ai . rci aa tr o lcr da n st u is n i o c c c r a tn e sy d o : su ap l u n l n r me mmay sttme t M u l Nev r ae n. sce re 1993; 16:13901391. Ba k r u d Reee c . S u c : AAEM 2000 c go n frn e o re CTSTa F reme e. sk o c mb r An stso o ls D,Ch o iE. Efe to c r a tn e sy d o o a a p uo rn fc f ap l u n l n r me n me in n r e p o i lc n u t n e i td b F wa e J Cl da ev r xma o d ci st e y o ma v s. i n Ne r p y o 199714:63- . Ba k r u d Reee c . S u c : u o h sil ; 67 c go n frn e o re M e l eS ac . Ab rc: S o n o me in n r ep o i lmoo di e rh n sta t lwig f da ev r xma tr c n u t n i p t ns wi c r a tn e sy d o (CTS c ud b o d ci n ai t t ap l u n l n r me o e h ) ol e c n d rd a a idc tro a a dt n lp o i llsin (d u l o siee s n n iao f n d i o a r xma e o o be i cu sy d o ). Th efc o CTS o p o i lc n u t n wa r sh n r me e fe t f n r xma o d ci o s a sse b c mp rn moo v lct s c luae b F wa e sse d y o aig tr eo i e ac ltd y - v s i o tie fo mu ls wi te sa r o a d n r e su py b t ban d r m sce t h h me o t n ev pl u dfee tme in b a c e o e e r ig b f r te c r a tn e ifrn da rn h s, n megn eo e h ap l u n l (p o ao q a rts mu l) a d o e p ssig tr u h te tn e r n tr u d au sce n n a n h o g h u n l (a d co p l cs b e i Daaweeo tie fo 26 p t ns wi b u tr ol i rvs). i t r ban d r m ai t t e h CTS a d 21 a emac e h aty su jcs. I tec nr lg o p te n g - th d e l h be t n h o to r u , h p o i l ia c r a deb w) F wa ema i l eo i c luae r xma (spn l o d n lo - v xma v lct ac ltd y wh n rc r ig fo a d co p l cs b e i (F e e o dn r m b u tr ol i rvs CVma - B) wa i x AP s n t dfee t fo te F wa e ma i lv lct c luae wh n o ifrn r m h - v xma eo i ac ltd e y rc r ig fo p o ao q a rts (F e o dn r m r n tr u d au CVma - Q), whl i wa xP i t s e sinfc nl dfee ti te g o p o CTS p t ns,e e il i g iia t ifrn n h r u f y ai t sp cal n e y p t ns wi tr n l moo ltn y g e tr ta 4.5 ms ai t e t emia h tr ae c rae h n (a p o i tl 9% lss,p = 0.001,W i o o sin d rn tst Th p r xmaey e l x n g e a k e ). e c

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Muscl & Nerve Sup l e pement X 2 0 S9 9 02 5

Practice Parameter: Carp Tunnel ndrome al Sy

Ab rc: W i st lt n a te wrst a t r mi S sta t t i ai h mu o t h i , ni o c NAP wee d s r rc r e fo 50 h n s i 25 h aty su jcs a d 36 h n s o 21 e od d rm ad n el h be t n ad f CTS p t ns. DS a l u e a d d rt n o te S ai t e L, mpi d , n u ai t o f h NAP wee r sy e c l e au td te wee aso c mp rd t DM Ls fo stmial v lae , h y r l o ae o y rm p e iu stde DS wa temo se si v f l we b DM L a d rvo s u is. L s h st n t e ol d y i o n t e d rt n o S h n u ai f NAP Th y rp r 4 o 36 h n s wh r te o l o . e e ot f ad ee h ny a n r l y wa d rt n o S b o mai t s u ai f NAP (te stt is su g stta te o h ai c g e h t h st ci raf ra n r l ywa dfee t o DS a dd rt no S rt i o b o mai e t s ifrn f r L n u ai f NAP o ). Ble k r M L. M e ia su v i a c f rc r a tn e sy d o i ec e dc l r el n e o ap l u n l n r me n l wo k r JHa dS r Am 198712(5 P 2):845r es. n ug ; t 848. CrtraM e (1/ i i e t 6: 1) S u c : M e l eS ac . o re di e rh n Ble k rM L,Ag e J Ne tc nq e f rteda n si o c r a ec e nw . w e h iu s o h ig o s f ap l tn e sy d o . S a J W o k En io He l 198713:385u n l n r me c n r vr n at h ; 388. CrtraM e (2/ 2, S u c : M e l eS ac i i e t 6: 3) o re di e rh n Botn CF CatrK,Ko a J. Te eau e efcs o c n u t n l o , re v l J mp rtr fe t n o d ci o stde o n r la d a n r ln r e M u l Nev 1982; 145u is f o ma n b o ma ev . sce r e 5:S S .Ba k r u d Reee c . S u c : M e l e S ac . Ab rc: 147 c g o n frn e o re di n e rh sta t Th r ae sinfc n q a t aie dfee c s b t e n r la d ee r g iia t u ni t t v ifrn e ewe n o ma n a n r l n r e i ter rsp n t p y oo ia tmp rtr b o ma ev s n h i e o se o h silgc l e eau e c a g . Th sedfee c s mu b rc g ie i c re t nfco s f r h n e e ifrn e st e e o nz d f o rci a tr o o tmp rtr aet b u dt n r l e NCSd t fo c o l s. e eau e r o e se o o mai d z aa r m o li mb * n b a eAR, en n e J M alyRJ Da aa J Ki rKJ A Bo e rk F r a d z E, re , h ln B, l me . te t n f r c r a tn e sy d o : e au t n o o jcie a d rame t o ap l u n l n r me v lai f be t o v n su jcieme su e JM a iuaieP y o Th r1990; be t v a rs. np lt v h sil e 13:507 520. CrtraM e (0/ S u c : M e l eS ac . i i e t 6) o re di e rh n Bo ia e S ,M o rs I M a lo A. Ho d e n u o h silgc l nfc J ri , ce d w o s e r p y oo ia a ssme tifu n etema a e n a d o to o p t ns wi sse n n le c h n g me t n uc me f ai t t e h c r a tn e sy d o ? Br J Rh u tl 1994; ap l u n l n r me e mao 33:1169- 0. 117 Ba k r u d Reee c : o to c go n frn e uc me std . S u c : M e l e S ac . u y o re di n e rh Ab rc: Th o jcie o ti std wa t d tr n h w sta t e be t v f hs u y s o eemie o n u o h silgc l a ssme t ifu n e te ma a e n a d e r p y oo ia sse n n le c d h n g me t n o to o 100 c n c t e p t ns rfre t a d p rme to uc me f o se ui ai t eerd o v e e at n f ciia n u o h silg i a dstit g n rl h sptl wi a l c l e r p y oo y n n i rc e ea o i a t h p o i o a ciia da n si o c r a tn e sy d o . Nev r vsin l l c l ig o s f ap l u n l n r me n re c n u t n stde e cu e te da n si i 36 p t ns wh ma o d ci o u is x ld d h ig o s n ai t e o y h v oh r se rc ie ia p o rae te t n. Th d csin a e tewi e ev d n p r p it rame t e ei o wh te t p ro m a c r a tn e d c mp e o wa g e t eh r o ef r ap l u n l e o rssin s ral y ifu n e b a p si v std . S mpo su se u nl rsov d i n le c d y o t e u y y tms b q e t e le n i y 7 86% o p t ns te td o ti b si d p n ig o temo eo 2f ai t rae n hs a s, e e dn n h e d f te t n a d te n r e c n u t n std fn ig wi si lr rame t n h ev o d ci o u y idn s, t mi h a o to s f rsu gc la d c n r aie me su e Th ciia a d uc me o r ia n o sev t v a rs. e l cl n n e i td rso rei l ain o ti da n st sevc weef u d st e e u c mpi t s f hs ig o i r ie r o n ma c o c t b su stnil o e b at . a Bo gK, n bo U. Dig o i v leo q a t aiese so ytst g r Lid lm a n st au f u ni t c t v n r ei n (QS i c r a tn e sy d o . Aca Ne r lS a d 1988;8:537 T) n ap l u n l n r me t u o c n 7 541. CrtraM e (1/ 1) S u c : M e l eS ac . i i e t 6: o re di e rh n Bo g K,Lid lm U. Ice se o vb ain trsh l d rn wrst r n bo n ra f irt o h e od u ig i fe in i p t ns wi c r a tn e sy d o . P i 1986; lxo n ai t t ap l u n l n r me an e h 26:211219. CrtraM e (2/ 1, S u c : M e l eS ac . i i e t 6: 5) o re di e rh n Bri W R,W rg tAD,W i iso M . S o tn o s c mp e o o an ih ln n k p na e u o rssin f b t me in n r e i tec r a tn e. S xc se te td su gc l . oh da ev s n h ap l u n l i a s rae r ial y La c t n e 19471:27 ; 7 282. Ba k r u dReee c . S u c : Geb r n , c go n frn e o re lema n 1980. * a Brmme AJ P y ko I Virt n id c d n u o ah . Dee t n r , y k l . b ai -n u e e r p ty o tci o b n r e c n u t n me su e ns. S a d J W o k En io He l y ev o d ci o a rme t c n r vr n at h 198713:317 322. CrtraM e (0/ S u c : M e l eS ac . ; i i e t 6) o re di e rh n * a n RM , Da iso K, Do h S P o o aie tst g i te Bru vd n e r . rv c t v ei n h n da n si o d n mi c r a tn e sy d o . J Ha d S r ey ig o s f y a c ap l u n l n r me n ug r 1989; A (2 P 1): 195- . CrtraM e (2/ 1, S u c : M e l e 14t 197 i i e t 6: 2) o re di n S ac . e rh Br mb r M B,J r s L. S mmer o n r lmoo a d se so y o eg ao y ty f o ma tr n n r n r e c n u t n me su e ns. M u l Nev 1998; ev o d ci o a rme t sce r e 21:498503. CrtraM e (n r lp p lt n std 4/ 3, 5, S u c : M e l e i i e t o ma o uai u y 6: 4, 6). o re o di n S ac . Ab rc: Rer sp ciestd t d tr n ten r ll t e rh sta t to e t v u y o eemie h o ma i s mi o sy f mmer o NCS me su e ns. Th d t su p r te t f l ty f a rme t e aa p o t h wo od l to siet- d dfee c s f ra l u e o te me in a d i mi f d -o sie ifrn e o mpi d s f h t da n un rS la NAP a dCM AP Th r weeg e trta t f l siet- d n . ee r rae h n wo od d -o sie dfee c s f rtep r n a,iil n su a n r ea l u e ifrn e o h eo e lt a a d rl ev mpi d s. b t Br n n J Be k J Gi e J P o o aie moo n r e c n u t n o so , c , l t . r v c t l v tr ev o d ci o tst g i p e mpie c r a tn e sy d o e i n rsu t n v ap l u n l n r me u c n ime b n o fr d y ta i o a ee to ig o i tst g J Ha d S r [ rdt n l lcr da n st i c ei . n n u g Am ] 199722:1041; 1046. CrtraM e (3/ 3, 6) S u c : M e l eS ac . i i e t 6: 5, o re di e rh n Ab rc: M e in dstlmoo ltn is (DM L) wee me su e i sta t da i a tr ae ce r a rd n h n s h l i fv wrstp si o s (n url fe in e tn o ,rda a d ed n ie i o t n e ta, lxo , xe sin a il i d vain un rd vain jst o ge o g (fw se o d t rc r a e it , la e it ) u ln n u h e c n s) o e o d o o rsp n . Th dfee t lltn y wa d fn d a te dfee c e o se e ifrni ae c a s eie s h ifrn e b t e tea soueg e tsta d la me in DM L rc r e i te ewe n h b lt rae n e st da e od d n h fv h n p si o s. Th a to s rp re ta te me n dfee t l ie a d o t n i e uh r e o td h t h a ifrni a ltn y i p oe d t fo b t h n s o 16 rfrn esu jcs (n ae c n o ld aa r m oh a d f eee c be t o sy tms,n r lNCS a d so wi p si v Ties sin wa mpo o ma ,n me t o t e n l g ) h i s 0.13 ms (me n + 2S wa 0.24 ms) a d ta teewa av r hg a D s n hthr s ey ih rt o a n r l is a n 22 CTS p t ns see td wi n r l ae f b o mai e mo g t ai t lce e t o ma h (b t n e iid NCS 91 % h dadfee t lae c a o e0.24 ms u u sp cfe ) : a ifrni ltn y b v a wi teme n0.44 ms. Th e mo ts atrsu gc l ee se teme n t h h a re nh fe r ia rla ,h a dfee t l ltn y o te CTS p t ns fl wi i te rn e o ifrni ae c f h a ai t el t n h a g f e h n r l Th a to s su g stta dfee t lltn y me su e ns o ma. e uh r g e h t ifrni ae c a a rme t c mpi n stn ad NCS i te da n si o CTS Ho v r te o l t adr me n h ig o s f . we e, h at l c nan itr a ic n stn is whc c ud n tb rsov d ri e o tis nen l n o si e ce c ih o l o e e le b iq iy F r e a l, te a to s stt ta te std wa y n ur. o x mpe h uh r ae h t h u y s p o e t e b t nee 22 c n c t ep t ns a dal a u i trl r sp ci , u e trd v o se ui ai t n lh d nl ea v e a CTS S n eCTS i sy tmai bltrl i a p o i tl 50% o . ic s mpo t i eal n p r xmaey c a y f p t ns,h o d o arn o seis o 22 c n c t eu i trl ai t te d s f a d m re f e o se ui nl ea CTS v a p t ns wo l b lss ta 1 i 4, 000. Th r ae stt ia ai t e ud e e h n n 000, ee r ai c l st c n en ta tev ra c o me su e ns fo c nr l be t wa o c r s h t h ain e f a rme t r m o to su jcs s ic re t c luae b c n d rn e c o te t h n s a a n o rcl ac ltd y o sieig a h f h wo a d s n y id p n e t v ra l. F rh r r, te rsut o ti rp r ae n e e d n aibe u temo e h e l f hs e o t r s c nrr t oh rp bi e rp rs o te efc o b ifc a g s i o tay o te u l d e o t f h fe t f re h n e n sh wrstp si o o me in ltn y me su e ns i CTS (se tx f r i o t n n da ae c i a rme t n e eto dsc ssin o efc o b ifa d p oo g d p si o ig o me in i u o f fe t f re n r ln e o t nn n da i NCSp rmees: ltn ya da l u e aa tr ae c n mpi d .). t Br wn W F F r u n GG,J n s M W ,Yae S Th lc t n o o , eg so oe ts K. e o ai f o c n u t n a n r l is i h ma e ta me tn u o ahe Ca J o d ci b o mai e n u n nrp n e r p tis. o t n Ne r l c 197 3:111u o S i 6; 122. Ba k r u dReee c . S u c : De a , c go n frn e o re Le n 1988. Bu h J e e N,F u h rG. Co rlt n o ciia sin wi n r e c -a g r oce reai f l c l g s t ev o n h c n u t n tst i te da n si o c r a tn e sy d o [ e o d ci e s n h ig o s f ap l u n l n r me se o c mme t . J Ha d S r [ ] 1994; 20- 24. Ba k r u d o ns] n u g Br 19:7 7 c go n Reee c . S u c : M e l e S ac . Ab rc: A p o e t e std frn e o re di e rh n sta t r sp ci v uy 112 p t ns wi sy tms o CTS (17 sy tmai h n s) so g t ai t t mpo e h f 2 mpo t a d c uh c reainwi 11 ciia ci ra(sy tms a dsin tk nete o rlt o t h l c l rt i mpo n e n g s) a e i r h sigyo i c mbn t n An lsi o tese si vt a dsp cfct o n l r n o iai . ay s f h n t i n e iii f o i y y v ro s ciia tst a d da n st ma e v r sh we me ice aiu l c l e s n ig o i n c n u es o d do r rl bl y i e a l ig te da n si o CTS Th a to s ei i t n stbi n h ig o s f a i sh . e uh r c n ld d ta NCS ae a idsp n be p r o te e au t n o o cu e h t r n n i e sa l at f h v lai f o p t ns su e tdo CTS ai t sp ce f e . Bu hh l , se flkA. S n r c n u t nfo dgtop l a d c ta F Ro n ac e so y o d ci r m iit am n o fo p l t wrst ntec r a tn e sy d o . JNe r l u o r r m am o i i h ap lu n l n r me u o Ne r su g P c ity 197 34:243sy har 1; 252. Crtra M e (6/ 1, 3, 5, S u c : i i e t 6: 2, 4, 6) o re Na ,1988. Ab rc: W i st lt n o tedgt (tu ,mide u sta t t i ai n h ii h mb d l, h mu o s a d l t fn e wi su d r lrc r ig o e teme in n r ea n i l ig r t b ema e o dn v r h te h da ev t tep l wrst n eb w), rh d o cS h am, i a d lo o to r mi NAP weerc r e u n S r e o d d sig a ea ig tc nq e M oo rsp n s wee e au td wi v rgn e h iu s. tr e o se r v lae t h st lt n a tewrst a deb w a dsu d r l e o dn o e te i ai t h mu o i , n lo n b ema rc r ig v r h AP Te n r l su jcs a d 22 h sptl e p t ns wee B. n o ma be t n o i i d ai t az e r e au td F c lslwig a r ss tec r a tn e wa se n i so v lae . o a o n co h ap l u n l s e n me p t ns wi ciia sin o CTS i wh m DM L a d se so y ai t t l c l g s f e h n n o n n r c n u t nfo dgt owrst r n r l o d ci r m ii t i wee o ma. o Bu hh l F Ro n ac A, Tr jb r W . Elcr p y oo ia c ta , se flk oa o g e to h silgc l fn ig i e ta me to te me in n r e a wrsta d eb w. J i d n s n n rp n f h da ev t i n lo Ne r lNe r su g P c ity 197 37 uo u o r sy har 4; :340360. Crtra M e (6/ i i e t 6: 1, 3, 5, S u c : P l y t, 2, 4, 6) o re al ah 1990. Ab rc: W i st lt no te i sta t t i ai n h h mu o dgt a d rc r ig fo te p l wrst a d eb w,o to r mi ii n e o dn r m h am, i , n lo s rh d o c S NAP weerc r e u n su d r lee to e M oo rsp n s S r e o d d sig b ema lcr d s. tr e o se weerc r e b st lt na tewrst n rc r igo e teAP r e o d d y i ai t h i a d e o dn v r h mu o B; 190 n r lc nr l 117 p t ns wi CTS a d 11 p t ns wi o ma o tos, ai t t e h ,n ai t t e h me in n r ec mp e o a teeb w weee au td Ad i o al da ev o rssin t h lo r v lae . dt n l i y 112 p t ns wee e au td b n e l EM G i te AP ai t e r v lae y e de n h B. Ab o mai e i CTS p t ns weef u di NCS a r ss tec r a n r l is n t ai t r o n n e s co h ap l tn e a d rlt eysp rd o n r li oh rp rin o ten r e u n l n eai l ae r o ma n te o t s f h ev . v o Th r wee n e l EM G a n r l is i 91% o te CTS p t ns ee r e de b o mai e n t fh ai t e e au td(a d fn db atrdp t r o dsc ag d rn f lef r, v lae s eie y l e at n f i h r e u ig ul fo t e e c a g i me n d rt n a d a l u e o moo u i a t n hne n a u ai o n mpi d f t tr nt ci o p tnil ice se icd n e o p lp a c p tnil o oe t s, n ra d n ie c a f oy h si oe t s, r a sp na e u a t i ). o tn o s ci t vy Bu h a h r RM . Bo y ma id x efc o c mmo n r e sc b c e d ss n e fe t n o n ev c n u t n std me su e ns. M u l Nev 1998; o d ci o u y a rme t sce r e 21:13981404.

16.

17 .

18.

19.

20.

28.

29.

30.

21.

22.

23.

24.

31.

25.

26.

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S9 0CTS L 6 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice Parameter:Carp Tunnel ndrome al Sy

Crtra M e (n r l p p lt n std 5/ 1, 4, 6) S u c : i i e t o ma o uai o u y 6: 3, 5, o re Bu b c e 1999 mo o rp . Ab rc: S u y p ro me t sh a h r n ga h sta t td ef r d o d tr n efc o b d ft o NCS p rmees. Th r wa n eemie fe t f o y a n aa tr ee s o c reain b t e Bo y M a Id x a d c n u t n v lct s b t o rlt o ewe n d ss n e n o d ci eo i e u o i se so ymie n r e a l u e wee 20n r/ x d ev mpi d s t r 40% lwe i te o e o r n h b se c mp rdt ti su jcs. o ae o hn be t Bu h a h r RM . M e in 14-m a d 7 c a t r mi se so y sc b c e da c n -m n i o c n r d stde t dgt t a dtre Am JP y M e Re a i1999;8:S u is o ii wo n h e . s hs d h bl 7 53S Crtra M e (n r lp p lt n std 5/ 1, 4, 6) S u c : 62. i i e t o ma o uai o u y 6: 3, 5, o re M e l e S ac ie t id Bu b c e 1999 M o o rp . Ab rc: di e rh d ni e n f sh a h r n ga h sta t Th p r o o te std wa t ce t a lr e d tb se o n r l e u p se f h u y s o rae ag aa a f o ma v le f rtea t r mi me in se so yc n u t n t D2 a dD34 au s o h ni o c da n r o d ci o d o n wi st lt n a tewrst(14 c a d p l (7 c bltrl i t i ai t h h mu o i m) n am m) i eal n a y 258 n r l su jcs. An lsi o v ra c d mo stae ta o ma be t ay s f ain e e n rtd h t ice sig a e a d ice sig b d ma id x c reae wi n ra n g n n ra n o y ss n e o rltd t h d ce siga l u e a dae . F rp a ltn yme su e ns, e ra n mpi d s n ra o e k ae c t a rme t 50% o te14 c ltn ywa atiue t tewrstt- am se me t Th fh m ae c s t b td o h i -o p l g n. e r u p r l t o n r l ice se i a l u e fo wrstt- am pe i mi f o ma n ra n mpi d r m t i -o p l st lt ni 50i ai s mu o 55%. Bu h a h rRM . M e in n r e moo c n u t n t te a d co sc b c e da ev tr o d ci o h b u tr o p l cs b e i Am JP y M e Re a i 1999;8:S S CrtraM e ol i rvs. i hs d h bl 7 1- 8. i i e t (n r l p p lt n std 5/ 1, 4, 6) S u c : M e l e S ac o ma o uai o u y 6: 3, 5, o re di n e rh ie t idBu b c e 1999 M o o rp . Ab rc: Th p r o o te d ni e f sh a h r n g a h sta t e u p se f h std wa t ce t alr ed tb seo n r lv le f rteme in u y s o rae ag aa a f o ma au s o h da moo c n u t n t te AP icu ig te a l u e (10.2 3.6 tr o d ci o h o B n ldn h mpi d t mv dstlltn y (3.7 0.5 ms) a d c n u t n v lct (57 5 ), i a ae c n o d ci eo i o y m/ An lsi o v ra c d mo stae ta a e afcs te dstl s). ay s f ain e e n rtd h t g fe t h i a ltn y a l u e ae a d f ram NCV. Ge d r afcs dstl ae c , mpi d , ra n o e r t n e fe t i a ltn ya d f ram NCV. Heg th s n sinfc n efc o a yo ae c n o e r ih a o g iia t fe t n n f te me su e ns. h se a rme t Bu h a h rRM . M e in n r eF wa eltn is rc r e fo te sc b c e da ev - v ae ce e o d d r m h a d co p l cs b e i Am JP y M e Re a i 1999;8:S S . b u tr ol i rvs. i hs d h bl 7 32- 37 CrtraM e (n r l o uainstd 5/ 1, 4, 6) S u c : M e l e i i e t o ma p p lt o u y 6: 3, 5, o re di n S ac ie t id Bu b c e 1999 M o o rp . Ab rc: Th e rh d ni e f sh a h r n ga h sta t e p r o o testd wa t ce t alr ed tb seo n r lv le u p se f h u y s o rae ag aa a f o ma au s f rte me in F wa e b a ay s o F wa e rsp n s fo te o h da - v s y n lsi f - v e o se r m h AP t tn c n c t esu rma i lst l a pid t tewrsto B o e o se ui v p a xma i i p l o h mu e i f e c am o 195 a mpo t su jcs wi o t rsk fco s f r ah r f sy tmai be t t u i a tr o c h n u o ah . An a ay s o v ra c d mo stae ta temii m e r p ty n lsi f ain e e n rtd h t h nmu a dme nFwa eltnce aed p n e t na e g n e a dh ih. n a v ae tis r e e d n o g , e d r n eg t Bu h a h rRM . M ie n r ec n u t nstde o teme ina d sc b c e x d ev o d ci u is f h o da n un rn r e Am JP y M e Re a i 1999;8:S S 4. CrtraM e la ev s. hs d h bl 7 69- 7 i i e t (n r lp p lt n std 5/ 1, 4, 6) S u c : M e l e S ac . o ma o uai o u y 6: 3, 5, o re di n e rh Ab rc: No ma d t fo a rfrn e p p lt n o 248 su jcs, sta t r l aa r m eee c o uai f o be t a ern e19- 9 y, g ag 7 r 45% mae tstdbltrl f rme ina dun r ls e e i eal o a y da n la mie n r e o to r mi c n u t n std a r ss te wrst x d ev rh d o c o d ci o u y co h i (c n u t ndstn e8-m) a dtedfee c s i ltn is (o se a d o d ci i a c c n h ifrn e n ae ce n t n o p a ) f rb t stde F rb t me in a d un rn r e teme n e k o oh u is. o oh da n la ev s, h a o se ltn ywa 1.6 0.2 ms, n teme np a ltn ywa 2.1 n t ae c s ad h a e k ae c s 0.2 ms. M e n siet- d dfee c f rteme in a d un ro se a d -o sie ifrn e o h da n la n t a d p a ltn is wa 0.0 0.2 ms. Th me n dfee c b t e n e k ae ce s e a ifrn e ewe n o se a d p a ltn is b t e te n r e wa 0.0 0.2 ms. n t n e k ae ce ewe n h ev s s Be a setest ls at a t yo sc r teo se i so c se te c u h i u ri c ma b u e h n tn me a s,h mu f p a ltn yi tep eerdv le Ampi d me su e ns, u n t e k ae c s h rfre au . l u e a rme t b t o t ltn yme su e ns, r d p n e t na e g n e a db d ma ae c a rme t wee e e d n o g , e d r n o y ss id x(me su eo o e t). ne a r f b si y Ca n n BW , v J Tad me in p l ;me in n u i s;me in no Lo e G. r y da asy da e rt i da te r n u i s a n be t su g r. S r ey 1946; h ma e rt me a l o r ey u g r i 20:210216. Ba k r u dReee c . S u c : Geb r n , c go n frn e o re lema n 1980. Car l G. Co ai n o me in a d rda n r ese so y ltn is rol mp rso f da n a il ev n r ae ce i te ee to h silgc l da n si o c r a tn e sy d o . n h lcr p y oo ia ig o s f ap l u n l n r me Elcr e c p ao rCl Ne r p y o 198768:101e to n e h lg i u o h sil n ; 106. CrtraM e i i e t (6/ 1, 3, 5, S u c : M e l eS ac . Ab rc: W i st lt n 6: 2, 4, 6) o re di e rh sta t t i ai n h mu o o id xfn e a dtu , rh d o cS n n e ig r n h mb o to r mi NAP weerc r e a te S r e od d t h wrsti 100 h atyh n s a d 161 CTS h n s. W h n dfee c s i i n el h ad n ad e ifrn e n tedstlae ce b t e teme ina drda n r e weeu da h i a ltn is ewe n h da n a il ev s r se s a n r l 60% se si vt wa o tie . Th me in rda b o ma, n ti i y s ban d e da -a il c mp rso ice se teyed o a n r l is i 17 o 161 h n s o ai n n ra d h il f b o mai e n t f ad wh nc mp rdt teid xDS ltn yao e e o ae o h n e L ae c ln . Ca y EB,Le e eP . Dii ln r ea t n p tnil i h aty se Qu sn M gt ev ci oe t s n e l a o a h su jcs, a d i c r a tn e a d da ei p t ns. J Ne r l be t n n ap l u n l n ib t ai t c e uo Ne r su g P c ity 197 35:612uo r sy har 2; 623. Crtra M e (6/ i i e t 6: 1, 3, 5, S u c : P l y t, 2, 4, 6) o re al ah 1990. Ab rc: W i st lt no te i sta t t i ai f h h mu o mide fn e, me in se so y n r e c n u t n v lct s wee d l ig r da n r ev o d ci o eo i e i r c luae fo teo se a dp a ltn is o S ac ltd r m h n t n e k ae ce f NAP rc r e fo s e od d rm te wrst a d p o i l p aa x wi su fc ee to e Th h i n r xma h ln t h ra e lcr d s. e c n u t nv lct s o b t tedgtwrst n dstlp o i l ii o d ci eo i e f oh h ii i a d i a- r xma dgt o i se me t wee rd c d u io ml i 18 p t ns wi da ei g ns r e u e nf r y n ai t e t ib t h c p ln u o ah . I c nrst te c n u t n v lct o te dstl oy e r p ty n o ta , h o d ci eo i f h i ao y p o i l dgt se me t wa o tn n r l whl te c n u t n r xma ii g n s fe o ma i h o d ci e o v lct o tedgtwrst g n wa rd c di 16 CTSp t ns. eo i f h ii i se me t s e u e n y ai t e * ssv nA, lsc S S a ioE, o k v i G, ess J M e in Ca a Rae u , h pr M sh o sk F W i . da a d rda se so y ltn is t dgt I a c mp rd wi oh r n a il n r ae ce o ii s o ae t te h sce nn tst i c r a tn e sy d o . Am JP y M e Re a i re ig e s n ap l u n l n r me hs d h bl 1988; :22167 224. CrtraM e (3/ 1, 5) S u c : M e l eS ac . i i e t 6: 3, o re di e rh n * ssv n A,Ro n eg A,Riea LF Ula n r e iv le n i Ca a se b r vr . n r ev n ov me t n c r a tn e sy d o . Arh P y M e Re a i 1986; :290ap l u n l n r me c h s d h bl 67 292. CrtraM e (1/ 3) S u c : M e l eS ac . i i e t 6: o re di e rh n * a gCW , e I Co ai no se so yn r ec n u t ni te Ch n Lin N. mp rso f n r ev o d ci n h o p l rc tn o s b a c a dfr dgtl rn ho teme inn r e ama ua e u rn h n ist ii b a c f h a da ev : a n w da n st meh d f rc r a tn e sy d o . M u l Nev e ig o i c to o ap l u n l n r me sce r e 1991; 14:117 117 Crtra M e (5/ 1, 3, 6) S u c : M e l e 3- 6. i i e t 6: 2, 5, o re di n S ac . Ab rc: Co ai n o o to r mi S e rh sta t mp rso f rh d o c NC i te me in n h da p l rc tn o s b a c a ddgtIn r e wa e au tdi 50 CTS ama ua e u rn h n ii ev s s v lae n p t ns a d 40 h aty p r n Th a n r l is wee d fn d a ai t n e el h eso s. e b o mai e t r eie s tedfee c s i ltn is a dS h ifrn e n ae ce n NCVs o mo eta me npu 2.5S f r h n a ls D o c nr l Ab o mai e ween td i 84% (36 o 43 p t ns) o f o tos. n r l is r oe n t f ai t f e tese so y ltn y c mp rso s a d 7 % (33 o 43 p t ns) o te h n r ae c o ai n n 7 f ai t f h e S NCVs c mp rso s atre cu o o 7 CTS p t ns wh se D1 o ai n fe x lsin f ai t e o S NAP wa u o tia l. Ths meh d ma sev a a a jn t e s n ban be i to y r e s n du ci v tc nq ei teda n si o CTS e h iu n h ig o s f . Ch n M H, Cha g HT, Ge LP Ya g DA, Lo YK. Cl ag in r , n i n Ne r p y o 2000; u o h sil 111:10391044. Th c u o slwe f ram e a se f o d o e r me in c n u t n v lct i c r a tn e sy d o . CrtraM e da o d ci eo i n ap l u n l n r me i i o y e t (5/ 1, 4, 6) S u c : M e l e S ac . Ab rc: A p o e t e 6: 3, 5, o re di n e rh sta t r sp ci v std o 20 CTS p t ns wi slwig (< m/ o f ram uy f ai t e t o n h 50 s) f o e r c n u t n v lct (CV),35 CTS p t ns wi n r l(> m/ o d ci eo i o y ai t t o ma 50 s) e h f ram CV a d20 n r l o to su jcs. M e inmoo n r eCV oe r n o ma c nr l be t da tr ev wa c luae fo te rsut o rc r ig fo te AP wi s ac ltd r m h e l f e o dn s r m h s B t h st lt n a te wrst eb w,mi-r a d a i a Th a to s i ai t h mu o i , lo d am n xl . l e uh r h p te z dta i teslwigo f ram CV wa d et c n u t n y oh sie h t f h o n f o e r s u o o d ci o bo ko lr emy l ae fb r a tewrst me inf ram CV a d lc f ag ei td ies t h i , da o e r n n asop o i l da CV wo l b d ce se . Ho v r terd c d l r xma me in ud e e ra d we e, h e u e me in CV wa l td t te f ram se me t Th a to s da s i e o h oe r mi g n. e uh r c n ld dta ted t idc tdta slwigo me inf ram CV o cu e h t h aa n iae h t o n f da o e r i CTS i d e t rto rd a o a ar p y rte ta c n u t n n s u o er g a e x n l to h ah r h n o d ci o bo k lc . Ch n M H,Lio KK,Ch n S ,Ko g KW ,Ch u g S P o i l ag a ag P n e n C. r xma slwig i c r a tn e sy d o rsut g fo ete c n u t n o n n ap l u n l n r me e l n r m i r o d ci i h o bo k o rto rd d g n rt n J Ne r l 1993; lc r er g a e e e eai . o uo 240:287 290. Crtra M e (4/ 1, 4, S u c : M e l e S ac . Ab rc: i i e t 6: 3, 6) o re di n e rh sta t De ra d CV i te me in n r e f ram se me t h s b e ce se n h da ev o e r g n a en d c me td b stn ad NCS i CTS p t ns. A n w tc nq e o u ne y a d r n ai t e e e h iu mo iidfo temeh do S o h e a. a dP a e a. wa u dt dfe r m h to f te r t l n e se t l s se o d tr n te f ram me in n r e a t n p tnil (F eemie h o e r da ev ci o oe t s a NAP ) a l u e a d f ram n r e c n u t n v lct (F mpi d n o e r ev o d ci eo i t o y NCV) p o i l r xma t te wrst Ag mac e su jcs wi n n sp cfc n mb e o h i. e th d be t t o - e ii u n ss h rfre t telb rtr a dp t ns wi CTS weestde b b t eerd o h a o ao y n ai t t e h r u id y oh stn ad NCS a d te n w F adr n h e NAP meh d CTS p t ns wee to s. ai t e r dvd d it su g o p a c r ig t tese ei o a n r l is o iie no b r u s c o dn o h v rt f b o mai e n y t stn ad me in se so y a d moo NCS Th r wa a sinfc n adr da n r n tr . ee s g iia t d ce sei F e ra n NAP a l u e p o o t n l ose ei o teCTS b t mpi d s r p ri a t v rt f h t o y ,u F NCV wa rd c d t a lsse e tn. I a dt n te stn ad s eue o e r xe t n d i o , h a d r i f ram me inmoo CV (M M CV) c reae wel t se ei , u oe r da tr o rltd lwi v rt b t h y terd c d M M CV dd n tc reaewi ted ce se F h eue i o o rlt t h e ra d NCV. W e h itr rtdte fn ig t idc t ta terd c df ram M M CV nep ee h se idn s o n iae h th e u e o e r i CTS rsut p i rl fo te bo k o te fstr c n u t g n e l rmai r m h lc f h a e o d ci s y n me in moo n r e fb r a te wrstrte ta fo rto rd da tr ev ies t h i ah r h n r m er g a e d g n rt no me inmoo n r efb r e e eai f da o tr ev ies. Ch re N,VilC,Ch u ln a G,Ba y B. Cl ia v l ain o als a a pa n z d i c l ai t n d o f a t r mi st lt n o tern fn e i e ry ee to ig o s o ni o c i ai f h ig ig r n al lcr da n si f d mu o mi c r a tn e sy d o . Elcr e c p ao rCl Ne r p y o l ap l u n l n r me e to n e h lg i d n u o h sil 1990;6:142- . CrtraM e (4/ 1, 5, S u c : M e l eS ac . 7 147 i i e t 6: 3, 6) o re di e rh n Ab rc: Th f l wig tc nq e wee stde : (a o to r mi sta t e ol n e h iu s o r u id ) rh d o c st lt n o teid xfn e wi rc r igo e teme in n r e i ai f h n e ig r t e o dn v r h mu o h da ev

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Muscl & Nerve Sup l e pement X 2 0 S9 1 02 6

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a tewrst (b a t r mi S t h i , ) ni o c NAP weerc r e o e tern fn e d s r e o d d v r h ig ig r u n rn ee to e atrst lt n o teme in n r ea d te sig ig lcr d s fe i ai f h mu o da ev n h n te un rn r e a te wrst (c DS dfee c b su ta t g te h la ev t h i, ) L ifrn e y brci h n un rDS t tern fn e fo teme inDS t tern fn e, la L o h ig ig r r m h da L o h ig ig r a d(d me inDM L wi st lt na tewrst n rc r igo e n ) da t i ai t h i a d e o dn v r h mu o AP Th e dfee tg o p weestde : (1) tec nr l r u wi B. re ifrn r u s r u id h o to g o p t h 100 h n s i 60 h aty su jcs;(2) 224 h n s fo 158 p tnil ad n el h be t a d rm oe t a CTSp t ns; n (3) 30 h n s fo 30 p t ns wi p rste a it ai t a d e a d rm ai t t aa h sis no e h te mide a d id x fn es d e t c r ia sp n yi c h d l n n e ig r u o evc l o d l i t rdc lp ty Th y f u d te me in un rDS dfee c t te a iuo ah . e on h da - la L ifrn e o h rn fn e te mo se si v tc nq e f l we i o d rb te ig ig r h st n t e e h iu ol d n r e y h i o me in se so y NCV t rn fn e,me in se so y NCV t id x da n r o ig ig r da n r o ne fn e a d me in DM L. Th y rp r n dfee c s b t e te ig r n da e e o t o ifrn e ewe n h c r ia sp n yi c rdc lp ty g o p a d te n r lg o p a d evc l o d l i a iuo ah r u n h o ma r u n t f u dn c se o a n r l da - la DS dfee c s t tern o n o a s f b o ma me in un r L ifrn e o h ig fn e i ti g o p (n fl p si v s). Th y aso rp r ta ig r n hs r u o ase o t e i e l e ot h t a l u ewa n t rl bep rmee f rteda n si o CTS mpi d t s o a ei l aa tr o h ig o s f a . * o DS M a Le n I Co ai n o n r lv le o me in Ch , c a C. mp rso f o ma au s f da , rda a dun rse so yltn is. M u l Nev 1984;:57 Crtra a il n la n r ae ce sce r e 7 5. i i e M e (0/ (Ab rc Ony S u c : Re mo d 1988. t 6) sta t l) o re d n , Cin R,P sseo S P rdso C,Gin iiF Bat iiN, sh rh oi a r , aa i a nn , t st i n Ru wo t G. Dig o i sp cfct o se so y a d moo n r e c n u t n a n st c e iii f n r n y tr ev o d ci o v ra ls i e ry d tcin o c r a tn e sy d o . J Ne r l aibe n al ee t o f ap l u n l n r me uo 1989; 236:208213. Crtra M e (6/ 1, 3, 5, S u c : M e l e i i e t 6: 2, 4, 6) o re di n S ac . Ab rc: Th me in rda, a d un r n r e wee e rh sta t e da , a il n la ev s r st ltd a tewrsta teh rz na l eo terda stli a d i ae t h mu i t h o io tl i f h a il yod n n S NAP wee rc r e o e e c fn e i 37 a n r la d 56 s r e o d d v r a h ig r n 5 b o ma n c nr l a d Ab lt ltn is o teme inn r et tu ,n e o to h n s. soue ae ce f h da ev o h mb id x a drn fn es weerc r e . Rais c mp rn teme inn r et n ig ig r r e o d d t o aig h o da ev o ete te rda n r e o un r n r e wee aso e au td Usig i r h a il ev r la ev h r l v lae . n ciia ci ra f r te d fnt n o CTS te f u d a n r l l c l rt i o h eii o f n e i , h y o n b o ma se so y NCVs t tern fn e a 100%,midefn e 92%,id x n r o h ig ig r t d l ig r ne fn e 80%,a d tu 64%. Ampi d s o te se so y rsp n s ig r n h mb l u e f h n r e o se t wee n tse si v . Th rt o ltn is me in id xun rl t r o n t e e ai f ae ce i o da n e /la i l te fn e wa a n r li 93.9%,me in rn /la rn 95.5%,a d ig r s b o ma n da igun r ig n me intu / a ilh mb82.8%. da h mb rda tu Cl f r J I a l H. P o o aie e ecse ma e v r i efc o i o d C, sres f rv c t v x ri n u e: t fe t n s n r e c n u t n stde i p t ns wi c r a tn e sy d o . ev o d ci o u is n ai t t ap l u n l n r me e h ArhP y M e Re a i 1994;5:8- CrtraM e (6/ 1, 3, 5, c hs d h bl 7 11. i i e t 6: 2, 4, 6) S u c : M e l e S ac . Ab rc: P o e t e std o 10 n r l o re di e rh n sta t r sp ci v uy f o ma c nr l a d 20 p t ns wi ciia sy tms o CTS wh sewo k o tos n ai t t l c l mpo e h n f o r iv le rp t ie mo e ns: 10 o te 20 CTS p t ns h d n ov d e ei v t v me t f h ai t a e a n r l me in NCS whc c n ime te p e n e o me in b o ma da ih o fr d h rse c f da n r ep too yi tec r a tn e se me tTh std e au tdte ev ah lg n h ap lu n l g n. e u y v lae h efc o d n mi e ecseo a t r mi me in(wrst otu a d fe t f y a c x ri n ni o c da d i t h mb n t D4) a d a t r mi rda (wrst t tu ) se so y n r e o n ni o c a il d i o h mb n r ev c n u t n Th d n mi e ecse c n std o 2 mi o rp t ie o d ci . o e y a c x ri o si e f n f e ei v t wrst lxo a de tn o tr u haf la t ern eo e a2 s c ce i fe in n xe sin h o g ul ci a g v r v yl f l we i daeyb f l a t efn e fe in a de tn o o a ol d mme itl y ul ci ig r lxo n xe sin f o v 3 s c cef ra a dt n 2 mi. Th e ecsep oo o wa su fce t y l o n d io i n e x ri r tc l s fiin t e o e sy tm e a eb t n i 50% o teCTS p t ns. Th 4 o v k mpo x c r ai n o fh ai t e e miue o d n mi e ecse p o u e a stt ial sinfc n (p n ts f y a c x ri r d c d ai c l g iia t st y < .05) p oo g t n o o l teme in S r ln ai f ny h o da NAP ltn y t D4,b tte ae c o u h dfee c wa tosmalodsci n t idvd a CTSp t ns fo ifrn e s o lt i rmiae n iiu l ai t r m e c nr l be t Th r wa n ice sei tedstl n r ltn is o to su jcs. ee s o n ra n h i a se so y ae ce o to p t ns wh sesy tms weee a eb td wh nc mp rd f h se ai t o e mpo r x c r ae , e o ae wi to p t ns wh se sy tms rman d u c a g d Th t h se ai t h e o mpo e ie n h n e . e a to s c n ld d ta tee wa l t v le i p ro mig te uh r o cu e h t h r s i l au n ef r n h te d n mi e ecsetst gt ice setelb rtr da n si o CTS y a c x ri e i o n ra h a o ao y ig o s f n . * u M at e A. Dig o i yed o dfee tee to h silgc l Cr z ri z n a n st il f ifrn lcr p y oo ia c meh d i c r a tn e sy d o (lt rt e i r M u l Nev to s n ap l u n l n r me et o dt ). e o sce r e 1991; 14:183184. CrtraM e (3/ 1, 3) S u c : M e l eS ac . i i e t 6: 2, o re di e rh n Cr z M at e A, Baro M , P rz Co d M C, Guire AM . u ri z n ri ee ne t rz e Elcr p y oo ia a e t o se so y c n u t n v lct i e to h silgc l sp cs f n r o d ci o eo i n y h aty a ut J Ne r lNe r su g P c ity 197 41:1092el h dl s. uo u o r sy har 8; 1096. Crtra M e (4/ 1, 5, S u c : Val 1988. Ab rc: I 47 i i e t 6: 3, 6) o re l s, sta t n h atysu jcs, h me ina dun rn r ec n u t nv lct wa el h be t te da n la ev o d ci eo i o y s me su e fo dgtt p l a d fo p l t wrst Ula n r e a rd r m ii o am n r m am o i . n r ev c n u t nv lct fo wrst ob lw suc s a dfo b lw suc s o d ci eo i r m i t eo o y lu n r m eo lu t a o e suc s. NCVs f r e c se me t wee d tr n d fo o bv lu o ah g n r eemie r m me su e ns o te o se ltn y (p r n lc mmu iain Th a rme t f h n t ae c eso a o nc t ). o e rsut su g stta a ig c u s ad ce n i c n u t n v lct e l g e h t gn a se s e rme t n o d ci eo i o y a dc a g s tesh p o e o e p tnil e e il a p it wh r n h n e h a e f v k d oe t s, sp cal t ons ee a y n r e aefe u nl c mp e d (c r a tn e a d c btltn e). ev s r rq e t o rsse ap l u n l n u i u n l y a NoCTSp t ns weestde . ai t r u id e Cuu i M , al ah S M oo u i n mb re i t (M UNE) tst g trc P l y t . i tr nt u e st e ma ei n i mae p t ns wi mi t mo eae c r a tn e sy d o . n l ai t t e h l o d d rt ap l u n l n r me Elcr my g a h a d Cl Ne r p y 2000; e to o rp y n i n uo h s 40:67 7 Crtra M e - 2. i i e t (4/ 1, 5, S u c : M e l eS ac . Ab rc: M oo u i n mb r 6: 3, 6) o re di e rh n sta t tr nt u e e i t (M UNE) tst g o te AP mu l o CTS p t ns wi st e ma ei fh n B sce f ai t t e h mi t mo eae CTS ie t id b a n r lme in se so y l o d d rt d ni e y b o ma f da n r a d moo NCS Co ae t 16 c nr lsu jcs, o te19 CTS n tr . mp rd o o to be t 14 f h p t ns wi a n r ln e l EM G fn ig i te AP h d a ai t t b o ma e de e h idn s n h B a rd c dme nM UNE. Th me nM UNE wa wi i n r l i t i eue a e a s t n o ma l s n h mi CTS p t ns wi p oo g d dstlmoo ltn is o p oo g d F ai t t r ln e i a e h tr ae ce r r ln e wa e ltn is a d n r l n e l EM G fn ig i te AP v ae ce n o ma e de idn s n h B. Cu iu y 8 o te19 CTS p t ns h d a n r l is o ten e l ro sl, f h ai t a b o mai e n h e de e t EM G o tec r ia p rspn l sce whc tea to s itr rtd f h evc l aa ia mu ls ih h uh r nep ee a e ie c o ac n o tn C8 rdc lp tya dti g o po CTS s vd n e f o c mi t a a iuo ah n hs r u f p t ns aso h d lwe me n M UNE v le c mp rd t tec nr l ai t l a o r a e au s o ae o h o to su jcs. be t Da b J P rua e u p l rme in n r est lt n f rc r a u e R. ec tn o s ama da ev i ai o ap l mu o tn e sy d o , a sta t Elcr e c p ao r Cl Ne r p y o u n l n r me b rc. e to n e h lg i n u o h sil 197 ; 743:139140. Crtra M e (0/ (Ab rc Ony S u c : i i e t 6) sta t l) o re P l y t, al ah 1990. i Da n GD. Th rlt e e ctbl y a d c n u t n v lct o wso e eai x i i t n o d ci v a i o eo i f y se so ya d moo n r efb r i ma . JP y o 1956; n r n tr ev ies n n h sil 131:436451. Ba k r u dReee c . S u c : Gi it 197 c go n frn e o re l at l , 8. Da n GD,S ot J . Th rc r ig o n r e a t n p tnil wso ct W e e o dn f ev ci o oe t s a tr u hteskni ma . JNe r l u o r P c ity1949; ho g h i n n u o Ne r su g sy har 12:259267 Ba k r u dReee c . S u c : M i s, . c go n frn e o re l 1985. l d Kr m M C,Knp hl P Ke e AD,S a n F Efia y o e o isc i G, str d p a s . fc c f p o o aie tst f rda n si o c r a tn e sy d o [ e aso r v c t e s o ig o s f ap l u n l n r me se l v c mme t i La c t 1990; o n n ne 335:7 ] La c t 1990; 27 . ne 335:393395. Ba k r u d Reee c . S u c : M e l e S ac . Ab rc: Twev c go n frn e o re di e rh n sta t le ciia p o o aietst f rCTS (Tie,P ae ,ec d mo stae l c l rv c t e s o n v n l h ln t.) e n rtd lw se si vt a d sp cfct f r te da n si o CTS (a o n ti n i y e iii o h ig o s f y s d tr n d b a n r lme in NCS i a rn o sa l o 504 eemie y b o ma da s) n a d m mpe f p o l fo teg n rl o uain e pe r m h e ea p p lt . o DeS tL, te wec xA, nd nBo a r G, u d P F b yG. me S e n rk Va e g et Cn d e , a r Vau o ciia p o o aie tst i c r a tn e sy d o . Aca le f l c l r v c t e s n ap l u n l n r me t n v Orh p Beg 1995; to l 61:17 7 182. Ba k r u d Reee c . S u c : c go n frn e o re M e l eS ac . Ab rc: P o e t estd o CTS p t ns, o ma di e rh n sta t r sp ci u y f v ai t n r l e c nr l a d dse se (da ee c nr l o te u f le o fv o tos, n i a ib ts) o tos f h seun ss f ie ciia p o o aietst (Tie, h ln Du k n co dfst Gi it l c l rv c t e s n v n l P ae , r a , lse i , l at l ) t da n se CTS Re l o std ld t a rc mme d t n ta o ig o . sut f u y e o e o s n ai h t o su g o s u tersut o me inNCS stde i a dt nt ciia r e n se h e l f da s u is n d i o o l c l i n fn ig (1) t ma eteda n si o CTSa d(2) t a stnd csin idn s o k h ig o s f n o ssi i e i o t p ro m CTSsu g r. o ef r r ey De a J Trn ap l da se so yc n u t n d tcino ltn Le n . a sc r a me in n r o d ci : ee t o o f ae t a n r l is i mi c r a tn e sy d o . Ca J Ne r lS i b o mai e n l ap l u n l n r me t d n uo c 1988; 15:388393. Crtra M e (6/ 1, 3, 5, S u c : M e l e i i e t 6: 2, 4, 6) o re di n S ac . Ab rc: M e in se so y stde wee p ro me wi e rh sta t da n r u is r ef r d t h st lt n o e te id x o mide fn e a d rc r ig wi i ai mu o v r h n e r d l ig r n e o dn t h su d r l lcr d s a temip l a dwrst v r h me inn r e b ema ee to e t h d am n i o e te da ev ; me in moo c n u t n stde wee p ro me wi su fc da tr o d ci o u is r ef r d t h ra e st lt n a d rc r ig ee to e o e teAP i 80 h n s fo i ai n e o dn lcr d s v r h mu o B n a d rm 43 h aty v lne r a d 253 h n s fo 150 CTS p t ns. Th y el h ou tes n a d rm ai t e e f u d a n r l is i 63% o te CTS p t ns. P l rltn is o n b o mai e n t fh ai t ama ae ce e weemo l ey t b a n r l te wrstDS a d fn l ,wrst r st i l o e b o ma, h n i k Ls, n ial y i DM L. Di n d t M , i M , ig el Be e et o M t z Kl b i GE, vd f D. Ne ci raf r n Da io f w rt i o e se so y n r e c n u t n e e il u f l i da n sig c r a n r ev o d ci o sp cal seu n ig o n ap l y tn e sy d o . Arh P y M e Re a i 1986; :586u n l n r me c h s d h bl 67 589. Crtra i i e M e (n r l o uainstd 5/ 1, 4, 6) S u c : M e l eS ac . t o ma p p lt o u y 6: 3, 5, o re di e rh n Ab rc: Ths p p rrp rs n r l au s i 45 h n s o 30 h aty sta t i a e e o t o ma v le n ad f el h a ut wi c rf l atnin t tmp rtr a d dstn e dl s t h aeu t t e o o e eau e n iac me su e ns. Anir mi a d o to r mi S a rme t t o c n rh d o c NAP fo me in d s rm da , un ra d rda n r e wrstt-h mb wrstt-n e fn e,wrst la n a il ev s, i -o tu , i -o id x ig r i t- d l fn e, i -o rn fn e, n p l t- i . Lae ce t o mide ig r wrstt-ig ig r a d am-o wrst tn is o o se,n g t ep a ,a l u e 2 me su e o d rt n a d n r l n t e ai e k mpi d , v t a rs f u ai , n o ma o v le f rsiet- d dfee c s aerp re . NoCTS p t ns wee au s o d -o sie ifrn e r e o td ai t r e stde . u id DiGu l l G,To reiF Re a iM ,Un iiA. Co d cin bo k gi mo e rir , p c cn n ut o lc a d se me tl v lct s i c r a tn e sy d o . n g na eo i e i n ap l u n l n r me Elcr e c p ao r Cl Ne r p y o 1997105:321- . Crtra e to n e h lg i n u o h sil ; 327 i i e

51.

46.

52.

47 .

53.

54.

55.

48.

56.

57 .

58.

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59.

S9 2CTS L 6 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice Parameter:Carp Tunnel ndrome al Sy

M e (6/ 1, 3, 5, S u c : M e l e S ac . Ab rc: t 6: 2, 4, 6) o re di n e rh sta t Co v nin lme in se so y a d moo c n u t n stde o CTS n et a o da n r n tr o d ci o u is f d n td tr n wh te lw a l u ersp n s aed et a o a o o eemie eh r o mpi d e o se r u o x n l t d g n rt n o d my l ain i te c r a tn e se me to te e e eai r e ei t o n o n h ap l u n l g n f h me in n r e I 88 c nr l a d 294 CTS h n s we rc r e da ev . n o to n ad e od d a l u ea d d rt n o teAP CM AP a d o a t r mi S mpi d n u ai f h t o B n f ni o c NAP d atrwrst n p l st lt nt d tr n wrst op l a l u e fe i a d am i ai o eemie i t am mpi d mu o t a d d rt n rt s a d se me tlc n u t n v lct s. I 16% o n u ai ai n g na o d ci eo i e n o o o i f CTS h n s tee wa a a n r l a l u e rd cin wi o t ad hr s n b o ma mpi d e u t t o t u h ice se d rt n o CM AP o S n ra d u ai o f r NAP fo wrst st lt n rm i i ai mu o idc t gp ril o d cinbo ki tec r a tn e se me t f h n iai at c n u t n a o lc n h ap lu n l g n o te me in n r e I 148 h n s dstlmoo ltn yt a d co p l cs da ev . n ad ia tr ae c o b u tr ol i i b e i a do se so y c n u t n t dgt2 wee a n r l I te rvs n /r n r o d ci o ii o r b o ma. n h rmann 146 h n s wrst op l moo c n u t nwa lss ta 35 e iig a d i t am tr o d ci o s e hn m/ i 22.6% a d wrstt p l se so yc n u t nwa lss ta 45 s n n i o am n r o d ci o s e hn m/ i 13%. At e st n se me tl o d cinwa a n r l n27 s n la o e g na c n u t o s b o ma i % o h n s. S g na stde alw te dsci n t n b t e f ad e me tl u is l o h i rmiai o ewe n c n u t n bo k a d a o a d g n rt n ice seda n st yed o d ci lc n x n l e e eai , n ra ig o i il o o c i CTS a d mih b u f li a d e n te t n a d p e it g n ,n g t e seu n d rssig rame t n rdci n o to . uc me Do a u J Ra n rEM ,Ruk v S F ram v lct i c r a n h e E, y o to e B. o e r eo i n ap l y tn e sy d o : wh ni slw toslw?[ u l e ertm a p as u n l n r me e s o o o p bi d rau p e r sh i Arh P y M e Re a i 1998;9:7 Arh P y M e Re a i n c hs d h bl 7 23. c h s d h bl 1998;9:1817 183. Crtra M e (3/ 3, 6) S u c : M e l eS ac . i i e t 6: 4, o re di e rh n Ab rc: I c se o CTS tefn igo mo eaet se eeslwig sta t n a s f , h idn f d rt o v r o n o me in moo f ram c n u t n v lct (< m/ sh ud f da tr o e r o d ci o eo i y 47 s) o l p o t a c rf l e au t n t e cu e su ei o d p o i l r mp aeu v lai o x ld o p rmp se r xma me inn r ep too yo p ln u o ah . da ev ah lg r oy e r p ty Do f n LJ Ro iso LR. AAEM M ii n g a h # : No maie rma , bn n nmo o rp 47 r t v d t i ee to ig o i me iie M u l Nev 199720:4aa n lcr da n st c dcn . sce r e ; 14. Ba k r u d Reee c . S u c : Bu h a h r 1999. Ab rc: Ths c go n frn e o re sc b c e, sta t i at l rve ri e e iws, wi o t mah mais, te i o tn p icpe c t u h te t c h mp ra t rn ils g v r ig te a q i t n a d u o enn h c usi o i n se o n r t e d t i f o mai v aa n ee to ig o i me iie lcr da n st c dcn . Du n n J W a lns GW . W rst fe in a a a jn t t te n a B, yo i i lxo s n du c o h da n si o c r a tn e sy d o . Arh P y M e Re a i ig o s f ap l u n l n r me c hs d h bl 1991;2:2117 213. CrtraM e (2/ 1, S u c : M e l eS ac . i i e t 6: 3) o re di e rh n Edtra. Dig o s o te c r a tn e sy d o . La c t i il o a n si f h ap l u n l n r me ne 1985; 1(8433):854855. CrtraM e (0/ S u c : Godn , i i e t 6) o re lig 1986. Ei n A,S h le M ,P n B,M a NelM ,S e r H,Tr e n S se c uz r at c i twat u ma , M a E. Re ev r o eaig c aa trst c r e a ay s i te k c ie p rt n h rcei i u v n lsi n h c p e it n o c r a tn e sy d o : a mo e f r rp rig rdci o f ap l u n l n r me d l o e ot n ee to h silgc ld t. M u l Nev 1993; 87 7 Crtra lcr p y oo ia aa sce r e 16:7 - 96. i i e M e (4/ 2, 5, S u c : M e l e S ac . Ab rc: Re ev r t 6: 3, 6). o re di n e rh sta t c ie o eaigc aa trst (ROC) c r e weeu dt p e it h rsko p rt n h rcei i c u v s r se o rdc te i f CTS P t ns wee ca fe ciial a (1) n r le a a d n . ai t r lssiid l c l s e n y o ma x m n o sy tms (169 h n s); (2) h vn moo a do se so y d fct mpo ad a ig tr n /r n r eii tpc l fCTS(115 h n s); h vn ahstr c aa trst o CTS y ia o a d (3) a ig i o y h rcei i f c (156 h n s);a d (4) n n da n st sy tmaoo y (122 h n s). ad n o - ig o i mpo tlg c ad M e su e ns wee ma e o me in a d un rdstlmoo ltn y a rme t r d f da n la i a tr ae c (DM L), da a dun rse so yp a ltn y(o to r mi 14 c me in n la n r e k ae c rh d o c m), a d me in a d un r mie p l rltn y (o to r mi 8 c n da n la x d ama ae c rh d o c m). Difrn e b t e me in a d un rmie p l rltn y wee fee c s ewe n da n la x d ama ae c r c luae . M e inDM L c mbn dwi me in un r ama ltn y ac ltd da o ie t da - la p l r ae c h dfee c s dsci n t o e oh r me su e ns a d c reae ifrn e i rmiae v r te a rme t n o rltd hg l f ral r u s (rv le = 0.7 0.7 Th sev ra ls weeu d ihy o lg o p au s 1- 3). e aibe r se t c n r c ROC c r e a d p e it n tbe Th a p o c u d o o stu t u v s n rdci a ls. o e p r a h se alws o et a g ap re tg rsko h vn CTS a dc nb u d l o n o ssin ec na e i f a ig n a e se no to stde uc me u is. Eku d G. A n w ee to ig o i p o e u ef rme su ig se so y ln e lcr da n st r c d r o c a rn n r n r ec n u t na r ss tec r a tn e. Up JM e S i 5; ev o d ci co h ap lu n l s o d c 197 80:6367 CrtraM e (0/ S u c : M a lo , . i i e t 6) o re ce d 1987 . Ev n BA,Da b J A c mp rso o 3 ee to ig o i meh d as u e R. o ai n f lcr da n st c to s o da n sig c r a tn e sy d o . M u l Nev 1984;:565. f ig o n ap l u n l n r me sce r e 7 CrtraM e (2/ 1, [ sta t ny S u c : Re mo d 1988. i i e t 6: 2) Ab rc o l] o re d n , * eesti M S Th p ro ma c a du f le o n r ec n u t n F ir en . e ef r n e n seun ss f ev o d ci o stde i teo to e i o fc . Orh pCl No t Am 1988; u is n h rh p dc fie to i n rh 19:859866. CrtraM e (0/ S u c : M e l eS ac . i i e t 6) o re di e rh n F l nh lG. Co ai n o e o e p tnil i tesa h n i ese ta mp rso f v k d oe t s n h me a d n a n r lsu jcs a d i p t ns wi c r a tn e sy d o . Am J o ma be t n n ai t t ap l u n l n r me e h P y M e 197 ; :228hs d 8b57 232. Crtra M e (3/ 3, 6) S u c : i i e t 6: 5, o re J c so , a k n 1989. F l nh lG. M e in a d un rdstlmoo a dse so yltn is i ese ta da n la i a tr n n r ae ce n tesa n r lsu jc. Arh P y M e Re a i 197 ; h me o ma be t c h s d h bl 758:297 302. CrtraM e (n r lp p lt n std 4/ 1, 5, S u c : J c so , i i e t o ma o uai o u y 6: 3, 6) o re a k n 1989. Ab rc: Th f l wig tc nq e weestde i 50 n r l sta t e ol n e h iu s r u id n o o ma su jcs: (a me inDM L atrst lt na tewrst n rc r ig be t ) da fe i ai t h i a d e o dn mu o o e AP (b un rDM L atrst lt na tewrst n rc r ig v r B, ) la fe i ai t h i a d e o dn mu o o e a d co dgt mii ,(c me in DS wi st lt n a te v r b u tr ii nmi ) i da L t i ai t h h mu o wrsta drc r igwi rn ee to e o e teid xfn e a d(d i n e o dn t ig lcr d s v r h n e ig r n ) h un r DS atr st lt n a te wrsta d rc r ig wi rn la L fe i ai t h mu o i n e o dn t ig h ee to e o e tel t fn e. Ad i o al, d -o siedfee c s lcr d s v r h i l ig r dt n l siet- d ifrn e te i y a d me in un rltn y dfee c s ae rp re . No d t o CTS n da - la ae c ifrn e r e o td aa n p t ns i rp re . ai t s e o td e F l nh l G. M e in a d un r mu l a d se so y e o e ese ta da n la sce n n r vkd p tnil Am JP y M e 197 ; :167 182. CrtraM e (n r l oe t s. a hs d 8a57 i i e t o ma p p lt n std 4/ 1, 5, S u c : J c so ,1989. Ab rc: Th o uai o u y 6: 3, 6) o re a k n sta t e f l wig tc nq e weestde i 50 n r lsu jcs: (a CM AP ol n e h iu s r u id n o o ma be t ) p tnil weerc r e atrst lt n a tewrsta d rc r ig oe t s r e o d d fe i ai t h a mu o i n e o dn o e te AP (b CM AP wee rc r e fo te a d co dgt vr h B, ) s r e o d d r m h b u tr ii i mii atrst lt n o te un rn r e a te wrst (c S nmi fe i ai f h la ev t h mu o i , ) NAP s weerc r e fo teid xfn e atr i lt nfo teme in r e o d d r m h n e ig r fe st ai r m h mu o da n r ea tewrst a d(d S ev t h i , n ) NAP weerc r e fo rn ee to e s r e o d d r m ig lcr d s fo te l t fn e atr un r n r e st lt n a te wrst r m h i l ig r fe la ev i ai te mu o t h i. Ampi d s o te CM AP a d S lu e f h t n NAP ae rp re a d lf-o rg t s r e o td n ett-ih c mp rso s a d me in t- la c mp rso s aerp re . NoCTS o ai n n da -o un r o ai n r e o td p t ns weestde . ai t r u id e F l nh lG,S ide H. P l rc n u t n t o me in a d ese ta pn lr ama o d ci i o me f da n un r n r e o n r l su jcs a d p t ns wi c r a tn e la ev s f o ma be t n ai t t ap l u n l e h sy d o . Am J P y M e 197 58:131n r me hs d 9; 138. Crtra M e (5/ i i e t 6: 1, 3, 6) S u c : Re mo d 1988. Ab rc: W i st lt n a te 2, 5, o re d n , sta t t i ai t h h mu o wrsta d p l a t r mi S i n am, ni o c NAP ltn is weed tr n d f rte d ae ce r eemie o h me ina dun rn r e fo 60 h n s i 30 n r l be t a d33 da n la ev s r m ad n o ma su jcs n p t ns wi CTS Th yf u dta b t tea soueme inwrsttai t t e h . e o n h t oh h b lt da i -o p l c n u t nt a dteme inun rwrstt- ii c mp rso am o d ci i n h o me da la i -o dgt o ai n wee mo e se si v ta te me in wrstt- ii ltn y Th r r n t e hn h i da i -o dgt ae c . e ltn y rt c mp rn me in wrstt- am a d wrstt- ii ae c ai o aig o da i -o p l n i -o dgt ltn ywa tov ra l t b u f lnteda n si o CTS ae c s o aibe o e seu i h ig o s f . * er S P i h r T,Ke n n J Cr f P S l n AJ Est t g te F ry , rt ad c e a , ot , i ma . i i h ma n p e ae c o d ly d me in n r e c n u t n i te g n rl rv ln e f ea e da ev o d ci n h e ea o p p lt n [ e c mme t . Br J Rh u tl 1998; :630o uai o se o ns] e mao 37 635. Crtra M e (4/ 1, 4, S u c : M e l e S ac . Ab rc: Th i i e t 6: 2, 6). o re di e rh n sta t e o jcie o ti std wa t d tr n te p itp e ae c o be t v f hs u y s o eemie h on rv ln e f d ly d me in n r e c n u t n a te wrst a d tr n d b ea e da ev o d ci o th i s eemie y p bi e ci rai arn o sa l o teg n rlp p lt n Th u l d rt i n a d m mpe f h e ea o uai . e sh e o d ti o teme inNCS i teat l ween tsu fce tt p r t eal f h s da n h ri e r o fiin o emi c rp o u t no testd . No -e o set teq e in ar a dn n e r d ci f h u y n rsp n o h u st n ie n o o o atn a c f r n r e c n u t n tst g ma h v ba d te t d n e o ev o d ci e o ei n y a e ise h p e ae c e i ts. Afe a jst n f rsu h ba s,ap e ae c rv ln e st e ma tr du me t o c ise rv ln e e i t f rd ly dme inn r ec n u t no b t e 7a d16% st e o ea e ma da ev o d ci f ewe n n o wa o tie , ayn wi tedfee t ae c v le u dt d fn s ban d v rig t h ifrn ltn y au s se o eie h d ly d me in n r e c n u t n Th se wi h n sy tms ea e da ev o d ci . o o t a d mpo h c n stn wi CTS o l e pan d 20% o al su jcs wi o si e t t h ny x lie f l be t t h p oo g d me in n r e ltn y v le Th a to s c n ld d ta r ln e da ev ae c au s. e uh r o cu e h t d ly dme inn r ec n u t na r ss tewrsts n t n o ea e da ev o d ci co h i i o u c mmo i o nn teg n rlp p lt n A su se u n lt rt tee i rp itd o t h e ea o uai . o b q e t et o h dt one u e o ta tea to s dd n tme su eun rn r ec n u t n so ta te h t h uh r i o a r la ev o d ci o hth ciia sinfc n e o te d ly d me in n r e c n u t n i n t l c l g iia c f h ea e n da ev o d ci s o o ce r I a dt n ti wa a co se t n l std so ta te la. n d i o , hs i s r ss- ci a u y o ht h su se u n d v lp n o CTS sy tms i su jcs wi d ly d b q e t e eo me t f mpo n be t t ea e h me inn r eltn yv le wo l n t a eb e d tce . da ev ae c au s ud o h v e n ee td F sh rM A,Ho fn B. F wa ea ay s i p t ns wi c r a tn e i e fe - v n lsi n ai t t ap l u n l e h sy d o . Elcr my g Cl Ne r p y o 199737 - Crtra n r me e to o r i n u o h sil ; :27 31. i i e M e (4/ 1, 5, S u c : M e l e S ac . Ab rc: Th c r a t 6: 3, 6) o re di n e rh sta t e ap l tn e sy d o (CTS p o ie amo e f ra ay igteefcs o u n l n r me ) r vd s d l o n lzn h fe t f f c l ev ijr o F wa e Twe t-o rp t ns wi ciia a d o a n r e nu y n - v s. nyf u ai t t l c l n e h n ee to ig o i fau e f ru i trl o bltrl lcr da n st e trs o nl ea (5) r i ea CTS (19) wee c a a r stde . F wa e weee au td f l wig 20 su rma i lst l u id - v s r v lae ol n o p a xma i i mu a d rc r ig fo a d co p l cs b e i mu ls. M ii la d n e o dn r m b u tr ol i rvs i sce nma n me n ltn is, p r stn e c r n dsp r o (CD), me n F M a ae ce esi e c s, h o o i esin a / a l u e rt s,a d rp ae wa e wee e au td CDs i to mpi d ai n e e tr v s t o r v lae . n h se l s wi te mo p oo g d dstlmoo ltn is (DM L) wee i mb t h h st r ln e i a tr ae ce r sinfc nl g e trta i to wi lss p oo g dDM Ls; g iia t rae h n n h se t e r ln e y h 80% o r g e trrp ae wa e weef u d amo e cu v l i to h n s rae e e tr v s r o n l st x lsiey n h se a d wi d ce se M - v a l u e a d me n F M v le wee t e ra d h wa e mpi d s; n t a / au s r amo awa s lr e i teh n wi temo ep oo g dDM L. Th l st l y ag r n h a d t h h r r ln e e

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Muscl & Nerve Sup l e pement X 2 0 S9 3 02 6

Practice Parameter: Carp Tunnel ndrome al Sy

d t su p r dfeig efcs o d my l aig a d a o a ijr o aa p o t ifrn fe t f e ei t n n n x n l nu y n F wa e a dsu g st h silgc l o e saini to h n s wi - v s n g e p y oo ia c mp n t n h se a d t o h temo ep o o n e n u o ahcd sf n t n h r r n u c d e r p ti y u ci . o F t W R, M y w W J J h so EW . F r lmb ia ltn y a d i z si , on n ist u rc l ae c n a l u e Co to v le a d fn ig i c r a tn e sy d o . mpi d . t nr l au s n idn s n ap l u n l n r me Am J P y M e Re a i 1990; hs d h bl 69:198201. Crtra M e (5/ i i e t 6: 1, 4, 6) S u c : M e l eS ac . Ab rc: W i st lt n a te 3, 5, o re di e rh n sta t t i ai t h h mu o wrst CM AP weerc r e fo tefr lmb ia a d AP fo i, s r e o d d r m h ist u rc l n B rm 44 h aty a ut a d 36 p t ns wi CTS S n r ltn is wee el h dl n s ai t t e h . e so y ae ce r aso rc r e ,b tn tsy e t al rp re . I CTS p t ns,8% l e o d d u o stmai l e o td n c y ai t e h d a a n r lDM L t te lmb ia wi a n r lDM L t te a n b o ma o h u rc l t h o ma oh AP Th ydd n tfn a yc se wh r teltn yt telmb ia B. e i o id n a s ee h ae c o h u rc l wa a n r l n se so ystde ween r l s b o ma a d n r u is r o ma. F rst C,Qu d iS Ra l M ,Tio iF Vi ad M ,UbaiE. oe i a r , sel a r n , sc r i il Cap l tn e sy d o : whc ee to ig o i p t sh ud we r a u n l n r me ih lcr da n st ah o l c f l w? A p o e t e std o 100 c n c t e p t ns. ol o r sp ci v uy f o se ui v ai t e Elcr my g Cl Ne r p y o 1996; e to o r i u o h sil n 36:37 7 384. CrtraM e (4/ i i e t 6: 1, 5, S u c : M e l e S ac . Ab rc: Ba d o wrt n 3, 6) o re di n e rh sta t se n ie t c mmu iain i wa lan dta ti wa ap o e t estd o 6 o nc t s, t s e r e h t hs s r sp ci u y f o v dfee tmoo a d se so y ee to ig o i tst o b t h n s o ifrn tr n n r lcr da n st e s n oh a d f c 100 p t ns a d o 25 h aty su jcs. Reee c v le o tie ai t n n e el h be t frn e au s ban d fo oh rso re i te rfrn e v le o tie fo te h at r m te u c s f h eee c au s ban d r m h e l h su jcs i testd weetofr fo rfrn ev le p e iu y be t n h u y r o a r m eee c au s rvo sl a o tdb telb rtr. d pe y h a o ao y F l ro P . Th efc o i h e a o n r e c n u t n i te ul tn M e e fe t f sc a mi n ev o d ci n h o c r a tn e sy d o . JNe r l u o r P c ity1963; ap l u n l n r me u o Ne r su g sy har 26:385397 Ba k r u dReee c . S u c : Gi it 1990. . c go n frn e o re l at l , Geb r n RH,Ar n n D,W esma M H. Cap ltn e sy d o : lema o so i n r a u n l n r me Re l o ap o e t etil fstr i ijcina dspit g JBo e sut f r sp ci ra o eod ne t n l i . s v o nn n J it u g1980; :1181on S r 62a 1187 CrtraM e (2/ 1, S u c : Bo g . i i e t 6: 6) o re r , 1986. Geb r n RH, Heg n o d r P Hag n AR, Lu d o g GN, lema r e r e e T, r e s nbr Ak so W H. Th c r a tn e sy d o : A std o c r a c n l e n e ap l u n l n r me u y f ap l a a p e rs. JBo eJ itS r 1981; A:380rssu e n on u g 63383. Crtra M e (0/ i i e t 6) S u c : Rovr j1990. o re jio, Geb r n RH,Ry e i BL,P ss GM ,S a o RM ,Lu d o g G. lema d vk e zb nbr Cap ltn e sy d o : a sce t i b si f rciia c r. Orh p r a u n l n r me ini c a s o l c l ae to f n Cl No t Am 1988; i n rh 19:115124. Ba k r u d Reee c . S u c : c go n frn e o re AAEM 2000 CTSTa F reme e. sk o c mb r Gel n H, Geb r n RH, Ta AM , Bot M J Cap l tn e l ma lema n t e . ra u n l sy d o . An e au t n o tep o o aieda n st tst JBo e n r me v lai f h r v c t o v ig o i e s. c n J it S r Am 1986; 35- 37 Crtra M e (1/ 1) S u c : on u g 68:7 7 . i i e t 6: o re M e l eS ac . di e rh n * a a iiM R,Ka e B,J z y r M ,Kh srwiS M e in rda Gh v nn z mi a a ei o a . da -a il se so yltn is c mp rso a an w tst nc r a tn e sy d o . n r ae ce o ai n s e e i ap lu n l n r me Elcr my g Cl Ne r p y o 1996; e to o r i u o h sil n 36:17 17 CrtraM e (2/ 1- 3. i i e t 6: 2, S u c : M e l eS ac . 3) o re di e rh n Gi it RW . Ch o i n r ec mp e o a d e ta me t I: S mn r l at l r nc ev o rssin n nrp n. n u e AJ e i r Th p y oo y o p rp ea n r edse se P i d lha , dt . e h silg f eih rl ev i a . hl ep i: o a W B S u d r 1980. p 316a n es; p 339. Ba k r u d Reee c . S u c : c go n frn e o re Lu d o g 1986. n b r, Gi it RW . S n r c n u t nstde i e ryrc g i o o n r e l at l e so y o d ci u is n al e o nt n f ev o i dso d r M u l Nev 197 1:352i r es. sce r e 8; 359. Ba k r u d Reee c . c go n frn e S u c : Ki r, 9. o re mu a 197 Gi it RW , e rJ Th rfa tr p ro o ta smi o i p t ns l at l M e . e erco y eid f rn ssin n ai t e wi c r a tn e sy d o . M u l Nev 1990; t ap l u n l n r me h sce re 13:445450. Crtra M e (4/ 1, 4, S u c : M e l e S ac . Ab rc: W i i i e t 6: 3, 5) o re di e rh n sta t t h st lt n a te wrsta d rc r ig a te fn e a d eb w,te i ai t h mu o i n e o dn t h ig r n lo h rfa tr p ro o ta smi o (RP wa d tr n d b t e 2 erco y eid f rn ssin T) s eemie ewe n su c ssie sh c s b u n a ea ig a d sin l su ta t n ce v o k y sig v rgn n ga brci o tc nq e F u te h n s fo 10 CTS p t ns a d 15 c nr l e h iu s. o re n a d r m ai t n e o to su jcs weee au td Th RP wa a n r l n11 o t f14 CTS be t r v lae . e T s b o ma i uo p t ns. ai t e Gi it RW ,S as TA. S n r n r e a t n p tnil i p t ns l at l er e so y ev ci oe t s n ai t o a e wi p rp ea n r e lsin J Ne r l Ne r su g P c ity t eih rl ev e o s. h uo u o r sy har 1958; 21:109118. Ba k r u dReee c . S u c : S e e s, c go n frn e o re tv n 1987 . Gi it RW ,W i n TG. A p e mai-o r iu ttsti te c r a l at l l so n u t tu nq e e n h ap l c tn e sy d o . La c t1953; u n l n r me n e 2:595- . CrtraM e (0/ S u c : 597 i i e t 6) o re Gel n 1986. l , ma Gn t S ,Co wa RR. Th r l o n e l ee to o rp yi te az M n y e oe f e de lcr my g a h n h e au t n o p t ns wi c r a tn e sy d o . M u l Nev v lai f ai t t ap l u n l n r me o e h sce r e 1999; 22:282286. Ba k r u dReee c . Edtra. S u c : M e l e c go n frn e i il o re o di n S ac . P o (1) Ie t y oh rn r e p too y whc ma mi c e rh r s: d ni te ev ah lg f ih y mi CTS e . (a p o i l me in n u o ah wi a c mp n ig , .g ) r xma da e r p ty t c o a yn h slwig o me in n r ec n u t n a r ss teCT a d (b c r ia o n f da ev o d ci co h o n ) evc l rdc lp ty wi n r lme in NCS a d (2) ie t y c e i ig a iuo ah t o ma h da n d ni o xst f n c r ia rdc lp ty wi CTS wi a n r lme in NCS Co s: evc l a iuo ah t h t b o ma da h . n I a se c o ciia su iinta teei n r ep too yp o i l n b n e f l c l spco h t h r s ev ah lg r xma n t CT,i i u ce rh w te n e l EM G e a n t n c a g s te o t s n la o h e de x miai h n e h o c u seo ma a e n o aCTSp t n. o r f n g me t f ai t e Godn DN, seDM , ev rjhK. Cl ia tst f rc r a tn e lig Ro S laaa i c l e s o ap l u n l n sy d o : An e au t n BrJRh u tl n r me v lai . o e mao 1986; 25:388390. Crtra i i e M e (2/ 1, S u c : M e l eS ac . t 6: 3) o re di e rh n Go d n C, Bo e BL, J h so EW . Elcr da n st ro wy r on n e to ig o i c c aa trst s o a ue c r a tn e sy d o . Arh P y M e h rcei i f c t ap l u n l n r me c h s c d Re a i198768:545h bl ; 548. CrtraM e (0/ S u c : P a , i i e t 6) o re e se 1988. Go d nC, o n nEW , tn P , tnJ. W rst ai c reain ro J h so Gae s F Asho J i rt o rlt o o wi c r a tn e sy d o i id sty Am J P y M e Re a i t ap l u n l n r me n n u r. h hs d h bl 1988; :27 268. CrtraM e (3/ 1, 5) S u c : M e l eS ac . 67 0i i e t 6: 3, o re di e rh n Gu n r n LG,Ami n A,Hel rn P Lessn rP P i p n L. n asso l o l a d , i e , hl so st i Th da n si o c r a tn e sy d o . S n t i a d sp cfct e ig o s f ap l u n l n r me e si vt n e iii i y y o so ciia a d ee to h silgc ltst J Ha d S r [ ] f me l c l n lcr p y oo ia e s. n n u g Br 199722:34- . Crtra M e (4/ 1, 4, S u c : M e l e S ac . ; 37 i i e t 6: 3, 6) o re di e rh n Ab rc: Cl ia (hstr,ciia e a h n da rm) a d NCS sta t i c l i o y l c l x m, a d ig a n n n stde wee p ro me bid d fo e c oh r o 100 p r n u is r ef r d l e r m a h te n n eso s rfre wi su e tdCTS Th da n si o CTS wa b se o te eerd t sp ce h . e ig o s f s a d nh rsut o b t ciia e a a dNCS a d i a dt n rl fo CTS e l f oh l c l x m n s n , n ,n d i o , ei f i e sy tms atr su g r wa aso rq ie . Th se si vt a d mpo fe r ey s l e urd e n ti n i y sp cfct f rtec mbn drsut o teciia e a n t n wee e iii o h o ie e l f h l c l x miai s r y s n o 94% a d 80% rsp ciey a d f r te n u o h silgc l n e e t l, n o h v e r p y oo ia e a n t n 85% a d 87 Of te n u o h silgc lmeh d x miai s, o n %. h e r p y oo ia to s u d teq oin o se so yn r ec n u t nv lct b t e p l se , h u t t f n r ev o d ci eo i ewe n am e o y t wrsta d wrstt eb w wa mo se si v a d sp cfc a d te o i n i o lo s st n t e n e ii n h i c to f f r ti tst wa stde b me n o a ROC-u v . u- f o hs e s u id y as f n c re Elcr da n st stde wee(1) mo esp cfcta ciia fn ig e to ig o i u is r c r e ii h n l c l idn s n a d (2) aep riual u f lt ie t y CTS su e t i teei a n r at lry seu o d ni c f sp cs f h r s hstr o p i,ay ia sy tms o p e iu fa trs i team, i o y f an tpc l mpo r rvo s rcu e n h r wrst rh n . i o ad Guma n L. M e in un r c mmu iain a d c r a tn e t n da - la o nc t s n o ap l u n l sy d o . JNe r lNe r su g P c ity 197 ; n r me u o u o r sy har 740:982986. Crtra i i e M e (1/ 3) S u c : Guma n 1986. t 6: o re t n , Guma n L,Guire A,Rig J Th c nrb t n o me in un r t n t rz e g s . e o tiui f da - la o c mmu iain i da n si o mi c r a tn e sy d o . M u l o nc t s n ig o s f l ap lu n l n r me o d sce Nev 1986; re 9:319321. CrtraM e (1/ 3) S u c : Rin r 1991. i i e t 6: o re v e, * g eg M ,Ny r m A,Zetru d B. Re o ey fo sy tms Ha b r sto t ln e c v r r m mpo atrc r a tn e sy d o su g r i mae i rlt nt vb ain fe ap l u n l n r me r ey n ls n eai o irt o o e p su e J Ha d S r Am 1991; x o r. n ug 16:66- 1. Crtra M e (1/ 4) 7 i i e t 6: S u c : M e l eS ac . o re di e rh n Hag AJ Tz n HM ,Le e k DB. Th v le o ee to ig o i i , eg Brc e au f lcr da n st c c n l t n f rp t ns wi u p re te t n r e c mpans: a o sut i o ai t t p e xrmi ev o lit ao e h y p o e t e c mp rso wi te hstr a d p y c le a n t n r sp ci o ai n t h i o y n h sia x miai . v h o ArhP y M e Re a i 1999; c hs d h bl 80:127 1281. Ba k r u dReee c . 3c go n frn e S u c : M e l e S ac . Ab rc: P o e t e std t d tr n o re di n e rh sta t r sp ci v u y o eemie wh te ee to ig o i tst g c a g s da n st c rany eh r lcr da n st e i c n h n e ig o i etit c c mp rd wi a d ti d hstr a d p y c l e a n t n a d o ae t h eal e i o y n h sia x miai , n o wh te itrcin b t e me ia if r t n te e tn o eh r nea t s ewe n o dc l n o mai , h xe t f o tst g a d da n st c rany i l an e f ra v n e me ia e i , n ig o i etit mpy e d o d a c d dc l n c k o e g o te p r o te e a n r Two h n rd ffyfv n wld e n h at f h x mie. u d e it-ie c n c t e rfras f r u p r e te t n r e c mpans wee o se ui eerl o p e xrmi ev o lit v y r su jcs o testd . Dig o s,da n st c n ie c ,a d se ei be t f h u y a n si ig o i o fd n e n v rt c y o n u oo i lsin wee c d d atr stn adz d hstr a d f e r lgc e o r o e fe a d r ie i o y n p y c l a d a an atr ee to ig o i tst g wa c mpee . h sia n g i fe lcr da n st e i c n s o ltd Elcr da n st tst g su stnil atrd 42% o da n se e to ig o i e i c n b at l l e ay e f ig o s, c n ime 37 a d dd n t caiy 21%. Th e tn o tst g o fr d %, n i o lrf e xe t f e i n c reae wi te sie o te dfee t lda n si te n mb ro o rltd t h z f h ifrni ig o s, h u e f h a p e iu h sptl ain a dten mb ro oh rme ia p o lms. rvo s o i i t s, n h u e f te dc l r be az o Co fd n e i fn lda n se c reae p si v l wi se ei o n ie c n ia ig o s o rltd o t ey t v rt f i h y te lsin b tn g t ey wi te sie o te dfee t lda n si h e o , u e ai l t h z f h ifrni ig o s v h a a d ten mb ro p if lb d ae s. Ho i l ain a d me ia n h u e f an u o y ra spt i t s n az o dc l p o lms aso tn e twad n g t e c reain Ths std ,i r be l e d d o r s e ai o rlt s. v o i uy n whc al ee to ig o is, hstre a d p y c l e a n t n ih l lcr da n st c i o is, n h sia x miai s o weep ro me b asigep y ca , n iae ta ee to ig o s r ef r d y n l h siin idc ts h t lcr da n si su stnil atr ciia i rssin i a lr e p re tg o b a t l l s l c l mp e o s n ay e n ag ec na e f p t ns. Th c mpe rlt n i b t e ciia if r t n te ai t e e o lx eai shp ewe n l c l n o mai , h o n o e tn o tst g a d fn l da n st c rany idc ts ta xe t f e i , n ia ig o i etit n iae h t n c sp caie me ia k o e g i rq ie f r a c rt e il d z dc l n wld e s e urd o c u ae

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S9 4CTS L 6 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

Practice Parameter:Carp Tunnel ndrome al Sy

ee to ig o s. lcr da n si 96. Ha sso S Th a cain b t e n r e c n u t n v lct a d n n . e sso it o ewe n ev o d ci eo i n o y te c mp u d a t n p tnila l u ed rn i h mi bo kn . h o o n ci oe t mpi d u ig sc e c lc ig o a t Elcr my g Cl Ne r p y o 1999; e to o r i u o h sil n 39:113122. CrtraM e (3/ i i e t 6: 1, 4) S u c : M e l eS ac . Ab rc: I h mi wa p o u e b 3, o re di e rh n sta t sc e a s r d c d y ifaig atu nq e ao n teu p ram i fv h aty su jcs. n lt n o r iu t r u d h p e r n ie e l h be t W h n a t r mi me in se so y NCV a d S e ni o c da n r d n NAP a l u e wee mpi d s r t rc r e fo tetiddgtwi st lt na teeb w, i a d e o d d r m h hr ii t i ai t h lo wrst n h mu o p l tea l u ea d CV d ce se i p rl l Ths se u n eo am, h mpi d n t e ra d n aal . i q e c f e c a g s d piae te bo kn o n r e c n u t n d rn wrst h n e u l ts h lc ig f ev o d ci u ig i c o fe in i h aty su jcs a d CTS p t ns d scie p e iu y lxo n e l h be t n ai t e rb d rvo sl e (Ha sso 1995). n n 97 Ha sso S Ni n BY. M e in se so y n r e c n u t n bo k . n n , l sso da n r ev o d ci o lc d rn wrst lxo i tec r a tn e sy d o . Elcr my g Cl u ig i fe in n h ap lu n l n r me e to o r i n Ne r p y o 1995; u o h sil 35:99105. Crtra M e (5/ 1, 3, 6) S u c : i i e t 6: 2, 5, o re M e l e S ac . Ab rc: P o e t e std o te efc o di n e rh sta t r sp ci v u y f h fe t f p oo g d p ssie wrst fe in o me in a d un r se so y r ln e a v i lxo n da n la n r a l u ea dltn yi 10 n r l o tos a d30 CTSp t ns wi mpi d n ae c n t o ma c nr l n ai t t e h a ciia da n si o CTS o wh m 10 h d mi a n r l is o l c l ig o s f n f o a l b o mai e f d t me in se so y ltn y me su e ns: dgtwrstCV < m/ o da n r ae c a rme t ii i 45 s r me in un r ltn y dfee c fo 4t dgtt wrst> da - la ae c ifrn e r m h ii o i 0.4 ms. Du igp oo g d(u t 45 mi) p ssiewrst lxo ,h a t r mi rn r ln e p o n a v i fe in te ni o c d me in (wrstt 2n fn e) a d un r(wrstt 5t fn e) S da i o d ig r n la i o h ig r NAP wee rc r e . Th me su e ns wee ma e e ey 2.5 mi d rn r e o d d e a rme t r d vr n u ig su an dp ssiewrst lxo f r pt 45 mi a dtet (T50) f r stie a v i fe in o u o n n h i me o tea l u et fl t 50% o teii a a l u ed tr n d Th h mpi d o al o t f h nt l mpi d eemie . e i t me in se so y c n u t n (b t n t te un r b c me p ril da n r o d ci o u o h la) e a at l ay bo k d i alCTS p t ns a d asoi 8 o to 10 c nr l M e in lc e n l ai t n l n u f e o tos. da se so y n r e c n u t n rtr e t n r l i al su jcs 30 n r ev o d ci eu n d o o ma n l be t o se o d atrrla o fe in At10 miue o wrstfe in n c n s fe ee se f lxo . n ts f i lxo , o sinfc n ice se o te me in S g iia t n ra fh da NAP p a ltn y i n r l e k ae c n o ma su jcs (me n 0.01 0.04 ms) a d CTS p t ns (me n0.24 0.26 be t a n ai t e a ms) wa n td Th t (T50) n c ssayt ra ha50% rd cini s oe . e i me ee r o ec eut n o me inS da NAP a l u ei 8 o t f10 p o a l CTS p t ns a di mpi d n u o t r b be ai t n n e 14 o to p ssil 20 CTS p t ns wa b lw te lwe rc r e u f o be ai t s eo h o st e o d d e v le i te c nr lg o p (25 mi). I wa sh wn ta i h mi au n h o to r u n t s o h t sc e a c u d te bo k (rd cin i me in S a se h lc eut o n da NAP a l u e b mpi d ) y t d mo staig (1) ta te rv r lo a 7 bo k wi rla o e n rt n h t h e esa f 0% lc t ee se f h wrstfe in wa p e e td b ifaigap e mai c f ao n te i lxo s rv ne y n lt n n u t u f ru d h c u p ram t a o esy oi p e r f r5 miue b f r rla o p e r o b v stl rssu e o c n ts eo e ee se f wrstfe in atrwhc (2) teS i lxo fe ih h NAP a l u ertr e t n r l mpi d eu n d o o ma t 30 se o d atr d faig te c f. Deemiain o T50 o te c n s fe elt n h u f tr n t o f fh me in n r eS da ev NAP d rn wrstfe in h s tep tnilt a d t u ig i lxo a h oe t o d o a tese si vt a dsp cfct o teee to h silgc l ig o s o h n t i n e iii f h lcr p y oo ia da n si f i y y CTS . 98. Hamo RL,Na lrAH. S n r a d mie n r e a t n p tnil r n yo e so y n x d ev ci oe t o a tmp rldsp r o i me in n u o ah a te wrst Am JP y e o a i esin n da e r p ty t h i. hs M e Re a i 1999;8:213d h bl 7 215. CrtraM e (1/ 6) S u c : M e l e i i e t 6: o re di n S ac . Ab rc: Rer sp ciestd t d tr n teu f le o e rh sta t to e t v u y o eemie h seun ss f me su ig S a rn NAP a d mie n r e AP tmp rl dsp r o t n x d ev e o a i esin o da n se CTS d mo stae ta ice se me in mie n r eAP ig o e n rtd h t n ra d da x d ev tmp rl dsp r o ma o c r i a cain wi p a ltn y e o a i esin y c u n sso it o t e k ae c h p oo g t n i CTS Ho v r tesmalma ntd o teice se r ln ai n o . we e, h l g i e f h n ra u ma e teciia u f le o ti o sev t nu ce r k s h l c l seun ss f hs b r ai n la. n o 99. He l C, aso J Lo g afA, mp el J M a n t rso a c ay W t n D, n stf Ca b lM . g ei e n n e c i gn o te c r a tn e. J Ha d S r Br 1990; ma ig f h ap l u n l n ug 15:243248. CrtraM e (3/ 1, 3) S u c : M e l eS ac . i i e t 6: 2, o re di e rh n 100. Herc RT,Herc S Th r g a h i te d tcin o c r a rik rik K. emo rp y n h ee t o f ap l tn e sy d o a d oh rc mp e v n u o ahe JHa d S r u n l n r me n te o rssie e r p tis. n ug Am 198712:943; 949. CrtraM e (1/ 1) S u c : M e l eS ac . i i e t 6: o re di e rh n 101. * l rnH, b w L. Itr a n u oy s o l a n dvsino l Homg e Ra o nen l e r lsi r i me t ii o ny g i c r a tn e sy d o . I. A 3 y a f l w- p wi a e au t n n ap l u n l n r me I e r ol u o t n v lai h o o v ro s n u o h silgc l p rmees f r da n si Aca f aiu e r p y oo ia aa tr o ig o s. t Ne r c i (W in 198787 47 Crtra M e (2/ 1, S u c : u o hr e) ; :44- . i i e t 6: 2) o re M e l eS ac . di e rh n 102. * l rn Lasso H, Le ne i W , Lid n U, Ra o L, Homg e - r n sz iwsk ne bw Th rig J Itr a n u oy s o l a n dvsin o l i c r a ol n . nen l e r lsi r i me t ii o ny n ap l g tn e sy d o rsut o a rn o z d std . Ac Ne r c i u n l n r me e l f s a d mie u y t u o hr (W in 1985;4:118e) 7 121. CrtraM e (0/ S u c : Homg e , i i e t 6) o re l rn 1987 . 103. * ma M M ,F a z lu A,W en rRA,Ales J ,Ar r n TJ Ho n rn ba re br W msto g , Br mb r M B. Ag e me t b t e sy tm su v y p y c l o eg re n ewe n mpo r e s, h sia e a n t n p o e u e a d ee to ig o i fn ig f rtec r a x miai r c d rs n lcr da n st idn s o h ap l o c tn e sy d o . S a d J W o k En io He l 1999; u n l n r me c n r vr n at h 25:115124. Ba k r u d Reee c . S u c : M e l eS ac . Ab rc: Th g a c go n frn e o re di e rh n sta t e o l o ti std wa t e au t tec n o d n eb t e v ro s ciia f hs u y s o v lae h o c r a c ewe n aiu l c l n sce nn p o e u e f r c r a tn e sy d o . Th su jc re ig r c d rs o ap l u n l n r me e be t p p lt nc n stdo 824 wo k r fo 6 fcl is. Th p o e u e o uai o si e f o r es r m a i t ie e r c d rs e au tdicu e bltrl da se so yn r ec n u t ntst g v lae n ld d i ea me in n r ev o d ci e i , a o n p y c l e a n t n a d sy tm su v y icu ig h n h sia x miai s, n o mpo r e s, n ldn ad da rms. Th a re n b t e te o to s o v ro s ig a e g e me t ewe n h uc me f aiu c mbn t n o te p o e u e wa a sse b d tr nn te o iai s f h se r c d rs o s sse d y eemiig h k p a c efce t Th r wa rlt ey p o o elp b t e te a p o fiin. ee s eai l o r v ra ewe n h v rp re sy tms, te p y c l e a n t n fn ig a d te e o td mpo h h sia x miai idn s, n h o ee to ig o i rsut c n stn wi c r a tn e sy d o . lcr da n st e l o si e t t ap l u n l n r me c s h Ov rl o l 23 o to 449 su jcs (5%) wi a la 1 p si v eal ny , u f be t t t e st o t e h i fn ig me al3 ci ra(sy tms,p y c le a n t n fn ig idn t l rt i mpo e h sia x miai idn s, o a d ee to h silgc l rsut c n stn wi c r a tn e n lcr p y oo ia e l o si e t t ap l u n l s h sy d o ) f rted mia th n . Th sce nn p o e u e sh we n r me o h o n n a d e re ig r c d rs o d p o o n a re n wi k p a v le rn ig b t e 0.00 a d o r r o g e me t t a p au s a gn ewe n h n 0.18 f ral h c sed fnt n e au tdf rc r a tn e sy d o . o l te a eii o s v lae o ap l u n l n r me i Th p o o elp b t e te v ro s sce nn p o e u e wan e o r v ra ewe n h aiu re ig r c d rs rs a an te u o ee to ig o i fn ig ao e wi o t te g ist h se f lcr da n st idn s ln c t u h h sy tm p e nainb igc n d rd Th rsut o ti std aso mpo rse tt o en o siee . e e l f hs u y l s p it oan e f rtef rh rd v lp n a de au t no meh d on t e d o h u te e eo me t n v lai f to s o f rd tcigc r a tn e sy d o . o ee t ap lu n l n r me n Hu h s ACR. An e au t n o 2 ee to ig o i p o e u e i ge v lai o f lcr da n st r c d rs n c p t ns wi ai t e t sy tms o a c r a tn e sy d o . h mpo f ap l u n l n r me Elcr e c p ao r Cl Ne r p y o 197 ; e to n e h lg i n u o h sil 743:140. Crtra M e i i e t (0/ (a sta t ny S u c : AAEM Co sutn 1993. 6) b rc o l) o re n l t a *ma T,M asu t H,M ia R. Asy tmai un rn u o ah I i t moo n mi mpo t la e r p ty c i c r a sy d o . Arh P y M e Re a i 1990;1:992n ap l n r me c hs d h bl 7 994. CrtraM e (3/ 1, 5) S u c : M e l eS ac . i i e t 6: 3, o re di e rh n I o aH, rf jS Ta a a i , k mu aY, tg c i , r i ma k Yo iui , k h sh M Na a r Ki u h M Tau a S I r v dic igmeh df rteda n si a dp o n si o c r a . mp o e n hn to o h ig o s n r g o s f ap l tn e sy d o . M u l Nev 1992; u n l n r me sce r e 15:318324. CrtraM e (5/ i i e t 6: 2, 4, 6) S u c : M e l e S ac . Ab rc: A mo iid se so y 3, 5, o re di n e rh sta t dfe n r ic ig meh d f rteee to ig o s o CTS i d scie . Th n hn to o h lcr da n si f s e rb d e me in n r e a st ltd a te c btlse me twi 8 c a n l da ev s i ae t h u i mu a g n t h hn e rc r ig ee to e pa e a 15 mm itr as ao g te me in e o dn lcr d s lc d t nev l ln h da n r efo ap it3 c p o i lt tedstlwrstce seu t te ev r m on m r xma o h i a i ra p o h mide fn e. Eih c n c t e S d l id r g t o se ui v NAP wee rc r e a d te r e od d n h n g t e p a ltn y me su e . Ea h ltn y (ms) wa potd e ai v e k ae c a rd c ae c s lt e a an dstn e(mm). Th rsut weeal e rrlt n i (1) fo g ist i a c ee l s r i a eai shp n o rm c a n l t 8 i 32 n r l be t a d(2) fo c a n l t a la hn e1 o n o ma su jcs n r m h n e 1 o te st c a n l4 i CTS p t ns. I 7 o 84 (87 l s o CTS p t ns, hn e n ai t n 3 f e %) i mb f ai t e tee wa a c n u t e a n r l y i te dstl rc r ig a hr s o d ci v b o mai n h i a e o dn s s t d tr n d b dsc niu u c a g s i te S eemie y i o t o s h n e n h NAP ltn y (g e tr n ae c rae ta 0.6 ms) o a l u e(a se c o rsp n ). Th rsut su g st hn r mpi d b n e f e o se t e e l ge s ta ti meh d p o ie hg se si vt a d sp cfct f r te h t hs to r vd s ih n t i n i y e iii o h y da n si o CTS A p o e t e std wi c mp rso t c re t ig o s f . r sp ci v u y t o ai n o u rn h tc nq e wo l h l d tr n wh te o n tte tc nq e h s e h iu s ud ep eemie eh r r o h e h iu a a v na e o e c re t e o d a tg s v r u rn rc mme d dtc nq e n e e h iu s. Ie V,F nc e GM . No ma me in n r e p o i lltn y i yr e ih l r l da ev r xma ae c n c r a tn e sy d o : a cu t c e i ig M at - u e ap l u n l n r me le o o xst n ri Gr b r n a a o si J Ne r l Ne r su g P c ity 197 39:449n stmo s. uo u o r sy har 6; 452. Ba k r u dReee c . S u c : AAEM Co sutn 1993. c go n frn e o re n l t a J be k CK, d r M T, Be e et M , r wi S M aioRJ a lc i An ay Di n d t o Ho o t H, rn z , Ro n a m RB,S ils RW ,S e e s J W i ims F Ameia se b u hed tv n C, l a l H. rc n Asso it n o Elcr da n st M e iie Gud l e f ro to cai f e to ig o i o c dcn . iei s o uc me n stde i ee to ig o i me iie M u l Nev 1996; u is n lcr da n st c dcn . sce r e 19:16261635. S u c : AAEM 2000 CTSTa F reme e. o re sk o c mb r J be k CK, An ay M T, S YT, W i is DE, W i ims F a lc i dr o ln k la l H. Li rtr rve o te u f le o n r e c n u t n stde a d t au e e iw f h seun ss f ev o d ci e o u is n ee to o rp y f rte e au t n o p t ns wi c r a tn e lcr my g a h o h v lai f ai t t ap l u n l o e h sy d o . M u l Nev 1993; n r me sce r e 16:13921444. Ba k r u dReee c . c go n frn e S u c : AAEM 2000 CTSTa F reme e. o re sk o c mb r J c so D, Cl f r J Elcr da n si o mi c r a tn e ak n i o d C. f e to ig o s f l ap l u n l d sy d o . Arh P y M e Re a i 1989;0:199n r me c h s d h bl 7 204. Crtra M e i i e t (6/ 1, 3, 5, S u c : M e l e S ac . Ab rc: Ths std 6: 2, 4, 6) o re di n e rh sta t i uy e au td te f l wig tc nq e (a me in n r est lt n i v lae h ol n e h iu s: ) o da ev i ai n mu o te p l a d rc r ig p o i la te wrst(8 c (b se so y h am n e o dn r xma t h i m), ) n r ltn ydfee c b t e me ina drda st lt na tewrst ae c ifrn e ewe n da n a il i ai t h i mu o a drc r igo tetu (10 c (c me ilun rse so yltn y n e o dn n h h mb m), ) da- la n r ae c dfee c wi st lt n a te wrsta d rc r ig o te rn ifrn e t i ai t h h mu o i n e o dn n h ig fn e (14 c ig r m),(d me in un r se so y ltn y dfee c wi ) da - la n r ae c ifrn e t h st lt n i te p l a d rc r ig a te wrst(8 c a d (e i ai n h am n e o dn t h mu o i m), n )

104.

105.

106.

107 .

108.

109.

110.

Muscl & Nerve Sup l e pement X 2 0 S9 5 02 6

Practice Parameter: Carp Tunnel ndrome al Sy

a l u ert b t e me inS mpi d ai ewe n da NAP t id xfn e/la S t o o n e ig run r NAPt o te l t fn e. On h n rd tit- n a n r l h n s i 123 h i l ig r te e u d e hryo e b o ma a d n su jcs a d 38 n r lh n s i 38 p o l wee e au td wi be t n o ma a d n e pe r v lae t h a ay s f c se o te40 h n s i temi CTS g o p S mpo n lsi o u d n h ad n h l d r u . y tms wee sy e t al rc r e a d rp re i e c p t n. Th r stmai l e o d d n e o td n a h ai t e c y e me in rda ltn y dfee c t te tu da -a il ae c ifrn e o h h mb a d me in un r n da - la ltn y dfee c t rn fn e wa sl hl mo ese si v ta te ae c ifrn e o ig ig r s i t g y r n t e hn h i mip l stde Ampi d rt s weev r ise si v . d am u is. l u e ai t o r ey n n t e i J e W H, y k vc RS W i o R. S v r c r a tn e sy d o he Orsh e ih , l x c e ee ap l u n l n r me wi sp rn o se so yfb r Orh pRe 1986; t aig f n r ies. to h v 15:103106. Crtra i i e M e (0/ S u c : M e l eS ac . t 6) o re di e rh n J h so EW , Ku l RD, W o g m P P e mo t A. S n r on n ka n sa E, id n e so y ltn is t tern fn e: n r l au s a drlt nt c r a tn e ae ce o h ig ig r o ma v le n eai o ap lu n l o sy d o . Arh P y M e Re a i 1981; n r me c h s d h bl 62:206208. Crtra M e i i e t (3/ 1, 5) S u c : Re mo d 1988. Ab rc: W i st lt na te 6: 3, o re d n , sta t t i ai th h mu o wrsta d rc r ig o e tern fn e,teme in a d un rn r e i n e o dn v r h ig ig r h da n la ev DS weerc r e a r ss tewrst 37n r l be t a d18 c se L r e o d d co h i ; o ma su jcs n a s o CTS wee e au td Th dfee c b t e me in a d un r f r v lae . e ifrn e ewe n da n la DS t tern fn e wa a n r lnal CTSp t ns. L o h ig ig r s b o ma i l18 ai t e J h so EW ,M evn J S n r c n u t n stde o me in a d on n li L. e so y o d ci o u is f da n un rn r e Arh P y M e Re a i 196748:25- Crtra M e la ev s. c h s d h bl ; 30. i i e t (4/ 1, 5, S u c : Du n n 1991. Ab rc: W i st lt no te 6: 3, 6) o re n a , sta t t i ai f h h mu o mide o id x fn e a d rc r ig o e te me in n r e a te d l r n e ig r n e o dn v r h da ev t h wrst o to r mi S i , rh d o c NAP a d DS wee d tr n d i 120 s n Ls r eemie n c nr l Orh d o c un rS o tos. to r mi la NAP a d DS weed tr n d atr s n L r eemie fe st lt no tern fn e o l t fn e a drc r iga tewrst i ai f h ig ig r r i l ig r n e o dn t h i mu o te a d 44 c nr l Th yrp r c se o a n r lDS i p t ns wi n o tos. e e o t a s f b o ma L n ai t t e h c r a tn e sy d o ,txcn u o ah ,e ryda ei n u o ah , ap l u n l n r me o i e r p ty al ib t e r p ty c a doh rp rp ea n r eiv le n p o lms. n te eih rl ev n ov me t r be J h so EW ,S p iM ,La on n isk mmet T. M e in a d rda se so y rse da n a il n r ltn is t dgtI n r lv le a d u f le i c r a tn e ae ce o ii : o ma au s n seun ss n ap l u n l sy d o . Arh P y M e Re a i 198768:140n r me c h s d h bl ; 141. Crtra M e i i e t (2/ 1, S u c : M e l eS ac . 6: 3) o re di e rh n * o d n S Grie J J. Auo o c a t i i te c r a tn e J r a E, ed r L r tn mi ci t n h ap l u n l vy sy d o . Orh p Re 198716:165n r me to v ; 169. Crtra M e (2/ 1, i i e t 6: 2) S u c : M e l eS ac . o re di e rh n J y tRL. Co ai no rsiu l ae c a dp l rst lt nf r on mp rso f e d a ltn y n ama i ai o mu o da n si o c r a tn e sy d o . M u l Nev 1984;:565. ig o s f ap l u n l n r me sce r e 7 CrtraM e (0/ (a sta t ny S u c : Re mo d 1988. i i e t 6) b rc o l) o re d n , J y tRL. Co rlt n stde o v lct,a l u ea d d rt n i on reai o u is f eo i mpi d n u ai n y t o me in n r e Arh P y M e Re a i 1989;0:47 da ev s. c h s d h bl 7 7 481. Crtra i i e M e (4/ 1, 5, S u c : M e l eS ac . Ab rc: Th f l wig t 6: 3, 6) o re di e rh n sta t e ol n o tc nq e weestde : (a st lt ni tep l b t e tetid e h iu s r u id ) i ai n h am ewe n h hr mu o a d f u t mea ap l a d me in rc r ig a te wrsta d (b n o rh tc r as n da e o dn t h i n ) st lt n a te wrsta d CM AP rc r ig o e te ABP Di a i ai t h mu o i n e o dn v r h . stl ltn is, mpi d s, u aino rsp n a drsiu lae ce wee ae ce a l u e d rt t o f e o se n e d a ltn is r e au td 390 p t ns weestde , l te weesy tmai a d v lae ; ai t r u id al h se r mpo t n e c ma yo te h dCTS Th rsut su g st h t mpi d , u ain n fhm a . e e l g e t a a l u e d rt , s t o a d c n u t n v lct ae rlt ey p o l c reae a d n o d ci o eo i y r eai l o ry o rltd n v id p n e t v ra ls. Th r i a v r hg c reain b t e n e e d n aibe ee s ey ih o rlt o ewe n rsiu lltn y a d dstlmoo ltn y tu su g st g l td e d a ae c n i a tr ae c , h s g e i i e n mi u f le f rrsiu lae c i teda n si o CTS seun ss o e d a ltn y n h ig o s f . J y t RL. Difrn e i se so y c n u t n v lct b t e on fee c s n n r o d ci o eo i ewe n y dfee tse so y b a c e a d se me t o te me in a d un r ifrn n r rn h s n g ns f h da n la n r e Am JP y M e Re a i 1989; ev s. hs d h bl 68:210214. CrtraM e (3/ i i e t 6: 1, 6) S u c : M e l eS ac . 5, o re di e rh n Ka ia M M U, Rae S Al h nAR, d l b a M , Bu y n brj Al jh , Ta a Ab uj b r Al n a a M , Daf AK, Awa a A. Cap l tn e sy d o : a ciio i d r a u n l n r me l cn ee to h silgc lstd . M e ia S in e Re ac 1998; lcr p y oo ia u y dc l ce c se rh 26:631633. Crtra M e (4/ 2, 4, i i e t 6: 3, 5). S u c : M e l e S ac . o re di n e rh Rer sp cie rve o 5 y as rc r t ie t y 7 CTS p t ns to e t e iw f e r e o d o d ni 2 v f ai t e 57 iip ti,19% a cae wi da ee mel u 11% wi % do ahc sso itd t ib ts h l ts, i t h r e maod atrt 7 wi h p tyodsm,a d 6% wi rn lo h u ti rh i s, % t y oh r ii i h n t ea r h h atfi r. Th g o p o CTS p t ns sh we a n r lme in e r al e e r u f u ai t o d b o ma e da se so y a d moo tr n l ltn is d ce se me in S n r n tr emia ae ce e ra d da NAP a l u ea d v lct a d me in tr n lltn yid xc mp rd mpi d n eo i n t y da emia ae c n e o ae t a g o p o 65 n r lsu jcs. Th r wa a p si v c reain o ru f o ma be t ee s o t e o rlt i o b t e te me in moo dstlltn y a d te me in tr n l ewe n h da tr i a ae c n h da emia ltn y id x Th std dd n te a n te p re tg o CTS ae c n e . e u y i o x mie h ec na e f p t ns sh wige c tp o NCSa n r l y ai t o n a h y e f e b o mai . t Kai J,Ro v ls P S de BT,W e ly S Cu rn p re t n t ms J u ea , a lr see A. re t ec pi o trsh l: Re r d cbl y a d c mp rso wi n r ec n u t n i h e od p o u ii t n o ai n t ev o d ci n i h o e au t n o c r a tn e sy d o . Trn Am S c Ari Itr v lai f ap l u n l n r me a s o o t nen f Or a s 1989; gn 35:280284. Crtra M e (2/ 1, S u c : M e l e i i e t 6: 2) o re di n S ac . e rh Kaz J Laso M G, F sse AH, Lin M H. Vaiain o a t N, r n o l ag l t d o f su v i a c c se d fnt n o c r a tn e sy d o (c mme ti r el n e a eii o f ap l u n l n r me o l i n n Am J P bi He l 1991; ul c at h 81:161162). Am J P bi He l ul c at h 1991; 81:189193. CrtraM e (2/ 1, S u c : M e l eS ac . i i e t 6: 2) o re di e rh n KazJ Laso M G, a r A, au C, t rtCR, eh R, tn t N, r n S b a Krr p S i a r S ti Eao HM ,F sse AH,Lin M H. Th c r a tn e sy d o : da n st o l ag e ap l u n l n r me ig o i c ui t o tehstr a dp y c l x miainfn ig (c mme t i t i f h i o y n h sia e a n t idn s o ly o ns n An Itr M e 1990; n nen d 113:254 a d An Itr M e 1990; n n nen d 113:409). An Itr M e 1990; n nen d 112:321- . Crtra M e (2/ 1, S u c : 327 i i e t 6: 5) o re M e l eS ac . di e rh n KazJ S irtCR,Laso M G,F sse AH, tn HM , a gM H. t N, t a r r n o l Eao Lin A sefa mii ee h n sy tm da rm f rte da n si a d l-d nstrd a d mpo ig a o h ig o s n e ie oo i std o c r a tn e sy d o . J Rh u tl pd milgc u y f ap l u n l n r me e mao 1990; :149517 1498. CrtraM e (3/ 2, 4) S u c : M e l eS ac . i i e t 6: 3, o re di e rh n Kaz J S irt CR. A sefa mii ee h n da rm f r te t N, t a r l-d nstrd a d ig a o h da n si o c r a tn e sy d o . JHa d S r Am 1990; ig o s f ap l u n l n r me n ug 15:360363. CrtraM e (1/ 1) S u c : M e l eS ac . i i e t 6: o re di e rh n Ke l F Elcr da n si o tec r a tn e sy d o . JNe r l mbe . e to ig o s f h ap l u n l n r me uo Ne r su g P c ity 1968; u o r sy har 31:23- . Crtra M e (4/ 1, 5, 27 i i e t 6: 2, 6) S u c : W in 1989. Ab rc: W i st lt n o e tu ,id x o re n, sta t t i ai v r h mb n e , h mu o mide a d rn fn es a d rc r ig o e teme in n r ea te d l, n ig ig r n e o dn v r h da ev t h wrsta d eb w,o to r mi S i n lo rh d o c NAP a d CM AP t teAP wee s n s oh B r d tr n di 120 h n s i 66 fmaep t ns wi CTS Th yf u d eemie n ad n e l ai t t e h . e on ta teDS wa mo el eyt b a n r lh nDM L. h th L s r i l o e b o ma ta k Kir a M C,M o y r s I Bu k D. Co d cin bo k i c r a en n g oo , r e n ut o lc n ap l tn e sy d o . Bri 1999; u n l n r me an 122(P 5):933t 941. Crtra M e (4/ i i e t 6: 1, 5, S u c : M e l eS ac . Ab rc: P oo g dwrst xe sin 4, 6) o re di e rh sta t r ln e i e tn o n wa p ro me p ssiey (wrt n c mmu iain i 6 h aty s ef r d a v l ie o t nc t ) n o el h su jcs a d 7 CTS p t ns. P ei n r e p rme t d mo stae be t n ai t rl ay x ei ns e n rtd e mi ta c a g s i te CS ht hne n h AP (c mp u d se so y a t n p tnil o on n r ci o oe t ) a d v lp d so n rta c a g s i teCM AP so su se u n stde e eo e o e h n h n e n h b q e t u is weec n ie t teCS . Du igmanan dwrste tn o t 90 r o fn d o h AP rn itie i xe sin o d g e s, l su jcs d v lp dg e trta 50% c n u t nbo ki e re al be t e eo e rae h n o d ci lc n o c tn o s afrns i tewrst u n t i a t tewrst a dsl h ua e u fee t n h i (b t o dstl o h i ) n i t g ice se i dstlltn y (0.44 0.07 ms f rn r lsu jcs a d n ra s n i a ae c o o ma be t n 0.51 0.05 ms f rCTS p t ns). Th c a g s i n r lsu jcs o ai t e e h n e n o ma be t b g n atrwrste tn o f r21.8 5.8 mi a d wa ma i la e a fe i xe sin o n n s xma t 49.3 10.7 mi. Th c a g s i CTS p t ns b g n atrwrst n e hne n ai t e a fe i e e tn o f r12.8 2.8 mi a dwa ma i l t xe sin o n n s xma a 28.1 3.3 mi. Th n e rd cin i tea l u eo teS e u t n h mpi d f h NAP p tnili n r lsu jcs o t oe t n o ma be t a a d CTS p t ns wa a cae wi c a g s i a o a e ctbl y n ai t s sso itd t h n e n x n l x i i t e h a i a te wrstwi a d ce se i su en r l y a d a ice se i th i t h e ra n p r o mai n n n ra n t rfa trn ss c mp t l wi a o a d p lrz t n Al su jcs erco ie o ai e t x n l e oaiai . b h o l be t (n r l a d p t ns) rp re mi p rste a d rn p oo g d o mas n ai t e o td l ae h sie u ig r ln e e d wrst e tn o a d mo e itn p rste a wee rp re i xe sin n r ne se ae h sie r e o td f l wig te rla o wrste tn o . I i c n ld d ta wrst ol n h ee se f i xe sin t s o cu e h t i o e tn o p o u e ad p lrz t nbo ki b t n r l be t a d xe sin r d c s e oaiai lc n oh o ma su jcs n o CTS p t ns,mu h a o c r wi i h mi c mp e o ,b tta ai t e c s c u s t sc e c o rssin u h t h ti bo k c n o b atrd meey b c mp n t g f rtea o a hs lc a n t e l e e rl y o e sai o h x n l n d p lrz t n I i ag e ta c n u t n bo k a d c n u t n e oaiai . t s r u d h t o d ci o o lc n o d ci o slwig n e n tawa s b atiue t dstr e my l ain a d o n e d o l y e t b td o i u b d ei t , n r n o ta i h mi c mp e o ma b su fce tt e pan so o te h t sc e c o rssin y e fiin o x li me f h itr t n sy tms a dee to ig o i fn ig i p t ns wi nemi e t mpo t n lcr da n st idn s n ai t t c e h c r a tn e sy d o ,p riual wh n i i o mi o mo eae ap l u n l n r me at lry e t s f l r d rt c d se ei . v rt y Ki LYS P l rdgtln r est lt n t da n sec r a tn e m . ama ii ev i ai o ig o ap l u n l a mu o sy d o . Orh p Re 1983; 63. Crtra M e (4/ 1, 5, n r me to v 59i i e t 6: 3, 6) S u c : J y t 1989. Ab rc: W i st lt n i temip l a d o re o n , sta t t i ai n h h mu o d am n rc r iga tewrst me in a d un rdstlltn is a dme in e o dn t h i , da n la i a ae ce n da un rdstlltn y dfee c s wee d tr n d i 66 h n s i 33 la i a ae c ifrn e r eemie n ad n n r lc nr lsu jcs a d 50 h n s i 39 mi CTS p t ns. M i o ma o to be t n ad n l d ai t e l d CTS wa d fn d a p t ns wh h d sy tms wh wee hg l s eie s ai t e o a mpo o r ihy su g st eo CTS b t a n r l L b t e tefn e a dwrst ge i f v , u h d o ma DS ewe n h ig r n i. S xy p re t o te mi CTS p t ns wee a n r lb te it ec n f h se l d ai t e r b o ma y h me in un rdfee c ci ra(g e trta o e u lo0.4 ms). da - la ifrn e rt i rae h n r q a t e Ki r J A meh d f r d tr nn me in n r e c n u t n mu a . to o eemiig da ev o d ci o v lct a r ss tec r a tn e. JNe r l c 197 38:1- Crtra eo i co h ap l u n l y u o S i 8; 10. i i e M e (5/ 1, 3, 6) S u c : P l y t, 1990. Ab rc: W i t 6: 2, 5, o re al ah i sta t t h st lt n a tewrsta d mip l a d rc r ig S i ai t h mu o i n d am n e o dn NAP o e te s vrh id x fn e a d CM AP fo te AP NCVs wee d tr n d n e ig r n s rm h B, r eemie a r ss tec r a tn e f rb t moo a dse so yn r e 50 h n s co h ap l u n l o oh tr n n r ev s; ad

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S9 6CTS L 6 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

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fo 25 c nr lsu jcs a d 20 h n s fo 13 p t ns wi mi rm o to be t n a d rm ai t t l e h d CTS weee au td Th moo a d se so y NCV a r ss tec r a r v lae . e tr n n r co h ap l tn e weemo el eyt b a n r lta c n e t n lDS a d u nl r r i l o e b o ma h n o v ni a k o Ls n DM Ls d tr n dfo tewrst eemie r m h i . Ki r J Col o tc nq e P y oo i bo ko n r ei use i mu a . l sin e h iu . h silgc lc f ev mp l s n i stde o moo n r ec n u t n v lct. Ne r lg 197 26:680u is f tr ev o d ci eo i o y u oo y 6; 682. Ba k r u dReee c . S u c : Ki r 197 c go n frn e o re mu a 8. Ki r J Th c r a tn e sy d o : Lo aiain o c n u t n mu a . e ap l u n l n r me c l t z o f o d ci o a n r l is wi i te dstlse me to te me in n r e Bri b o mai e t n h i a g n f h t h da ev . an 197 102:6199; 635. Crtra M e (6/ 1, 3, 5, S u c : S u r i i e t 6: 2, 4, 6) o re h r, 1986. Ab rc: W i st lt n a tewrsta d p l o to r mi sta t t i ai t h h mu o i n am, rh d o c S NAP weerc r e o e teid xfn e a dme inCM AP fo s r e o d d v r h n e ig r n da rm te wrstt AP wee rc r e fo 122 h n s fo 61 n r l h i o B r e od d rm a d rm o ma su jcs a d 17 h n s fo 105 CTS p t ns. S xyo ep re to be t n 2 a d rm ai t it- n ec n f e te me in CM AP wee a n r l 63% o te wrstt-ig r h da s r b o ma, f h i -o fn e ltn is weea n r la d 81% o tewrstt p l ltn is wee ae ce r b o ma n f h i o am ae ce r a n r l Th y aso rp re c se wh r lc ic ig st lt n b o ma. e l e o td a s ee m n hn i ai mu o a r ss te c r a tn e wa a n r li p t ns wi oh r se co h ap l u n l s b o ma n ai t t tewi e h n r l u is. o ma stde Ki r I Ay a DR. Th mu a , yr e c r a tn e sy d o : ap l u n l n r me Elcr p y oo ia a e t o 639 sy tmai e te t s. e to h silgc l sp cs f mpo t c xrmi e i Elcr my g Cl Ne r p y o 1985; e to o r i u o h sil n 25:151164. CrtraM e (4/ i i e t 6: 1, 3, S u c : M o t r 1988. Ab rc: Th f l wig tc nq e 2, 5) o re ri , e sta t e ol n e h iu s o weestde : (a wi st lt n a teeb w,wrsta d mi- am, r u id ) t i ai t h lo h mu o i n dp l o to r mi DS wee d tr n d t te id x fn e,(b DM Ls rh d o c L r eemie o h n e ig r ) weed tr n d t teAP atrst lt na tewrsta deb w, r eemie o h B fe i ai t h i n lo mu o a d (c ee to my g a h i 639 sy tmai h n s fo 438 CTS n ) lcr - o rp y n mpo t a d r m c p t ns a d 17 e te t s o 148 n r lsu jcs. Th r wa a ai t n e 5 xrmi e f i o ma be t ee s rlt e slwig o te se so y NCV a r ss te c r a tn e a eai v o n fh n r co h ap l u n l s c mp rdt tef ram i 100% o tep t ns wi CTS Ths wa o ae o h o e r n f h ai t t e h . i s mo ese si v ta teme in DS a d DM L. F ryp re to te r n t e hn h i da L n o t ec n f h p t ns h d a n r l is o n e l EM G wi 21.7 h vn ai t a b o mai e n e de e t t h % a ig p si v sh r wa e o fb i ain o t e ap v s r irl t s. i l o Ki r J M u p y M J Vad DJ Elcr p y oo ia std o mu a , r h , r a . e to h silgc l u y f a o lu in r ain o itisi h n mu ls. Arh Ne r l n mao s n ev t o f nrn c a d sce c uo 197 33:8426; 844. Ba k r u dReee c . S u c : Guma n 1986. c go n frn e o re t n , * p l HP Go d od J Cl ia a d ee to ig o i fau e o Ko el , o g l . i c l n lcr da n st e trs f n c c r a tn e sy d o . Arh P y M e Re a i 1968; ap l u n l n r me c h s d h bl 49:37 37 1- 6. CrtraM e (2/ 1, S u c : Lo i 1987 i i e t 6: 2) o re us, . Ko i e K,F r kl M ,P y k I J nt V,Aaoa S S ac J skmis ak i a yk o , at i tl , trk , Ia aR. Cap ltn e sy d o i vb ain dse se BrJId M e nb r a u n l n r me n irt o ia . n d 1990; :41147 416. CrtraM e (2/ 1, S u c : M e l eS ac . i i e t 6: 3) o re di e rh n Koh r M J Ruk v S Cae J Hic e J Lo iinEL, rstn tai , to e B, rss B, n h y , gga Pe o DC. Co ai n o dgtlse so y stde i p t ns wi c r a mp rso f ii a n r u is n ai t t ap l e h tn e sy d o . M u l Nev 1995; u n l n r me sce r e 18:127 127 Crtra M e 2- 6. i i e t (5/ 1, 4, 6) S u c : M e l eS ac . Ab rc: P o e t estd 6: 3, 5, o re di e rh n sta t r sp ci u y v t e au t terlt ese si vt o a t r mi se so ystde o te o v lae h eai v n t i f ni o c n r u is f h i y d f u me in in r ae dgt i 59 p t ns wi CTS da n se o o r da n ev td ii n s ai t t e h ig o d n teb si o ac mbn t no ciia a dme inNCSa n r l is. h a s f o iai f l c l n o n da b o mai e t Th c n u t ndstn ewa 10 c f r a d13 c f r D4. Th e o d ci i a c o s m o D1 n m o D2e rfrn e p p lt n o 30 wa c mp se o h aty v lne r o eee c o uai f o s o o d f el h ou tes r p t ns wi lwe e te t rdc lp tis. I te26 CTS p t ns ai t t o r xrmi a iuo ahe n h e h y ai t e wi an r l L t AP dgt1 wa a n r l n81%, ii 2 i t h o ma DM o B, ii s b o ma i dgt n 42%, ii3 i 54%, n dgt i 38%. I te33 CTSp t ns wi a dgt n a d ii4 n nh ai t t e h p oo g dDM L, ii 1 wa a n r ln94%, ii 2 i 88%, ii 3 r ln e dgt s b o ma i dgt n dgt i 91%, n dgt i 88%. W ec n ld ta i CTS p t ns wi a n a d ii 4 n o cu e h t n ai t t e h n r lDM L t teAP dgt1 i temo se si v i ie t yn o ma oh B, ii s h st n t e n d ni ig i f f c lslwig o se so y c n u t n a r ss te wrst Ho v r i o a o n f n r o d ci co h o i. we e, n CTS p t ns wi a p oo g d DM L, te se si vt o se so y ai t t e h r ln e h n ti f n r i y c n u t ni n t g iia t dfee t mo gtef u dgt o d ci s o sinfc nl ifrn a n h o r ii o y s. * u o mdin J M o i M d P Co ai no n r ec n u t n Ko y u j A, rt a a a . mp rso f ev o d ci o tc nq e i 95 mi c r a tn e sy d o e h iu s n l ap l u n l n r me h n s. Ar d ad q Ne r p q it 1999; :195- .Crtra M e (3/ 1, 4). S u c : u o siuar 57 197 i i e t 6: 3, o re M e l eS ac . Ab rc: P o e t estd o 5 NCS tc nq e i di e rh n sta t r sp ci u y f v e h iu s n p t ns su e td o CTS a d see td f rtestd a la o eo ai t sp ce f e n lce o h u y t e st n f te 5 stde wa a n r l (1) wrstid x fn e o se ltn y h u is s b o ma: i -n e ig r n t ae c (W I ), b o ma 2.8 ms, c (2) p l wrst n t ae c (P ), F anr l 14 m; am- i o se ltn y W a n r l 1.8 ms,8 c (3) c mp rso me inun rp l wrst b o ma m; o ai n da /la am- i o se ltn y (CP ), a n r l 0.4 ms; (4) c mp rso o n t ae c W b o ma o ai n f me inun ro se ltn y wrstrn fn e (CM U), b o ma 0.5 da /la n t ae c , i -ig ig r anr l ms,14 c (5) c mp rso o me inrda o se ltn y wrst m; o ai n f da /a il n t ae c , i tu (CM R), b o ma 0.4 ms, c Al95 CTSh n s see td h mb anr l 10 m. l a d lce h v teW I 3.5 ms t ie t ymi CTS W ef u d teCM R ae h F o d ni f l d . on h (97 .8%) tc nq etemo se si v f rmi CTS ee to ig o s e h iu h st n t e o l i d lcr da n si a dteo l c mp rt emeh dwi al oe t l rc r a l wh n n h ny o aai v to t l p tni s e o d be e h a c mp rd t CP (88.4%),P (84.2%),CM U (7 o ae o W W 2.6%) a d W I n F (68.4%). Krf GH,Hav r n GA. M e in n r e rsiu lltn y No ma at lo so da ev e d a ae c : r l v lea du i da n si o c r a tn e sy d o . ArhP y M e au n se n ig o s f ap lu n l n r me c h s d Re a i 1983; h bl 64:221226. Crtra M e (4/ 1, 5, S u c : i i e t 6: 3, 6) o re Ble k r 1987 Ab rc: W i st lt na teeb w a dwrst n e c e, . sta t t i ai t h lo n h mu o i ad rc r ig o e teABP DM Ls a d f ram NCVs weed tr n d e o dn v r h , n oe r r eemie i 100 n r lsu jcs a d 3 CTS p t ns. Th rsiu lltn y n o ma be t n ai t e e e d a ae c (DM Ldstn e b t e st lt n a d rc r ig ee to e i i a c ewe n i ai mu o n e o dn lcr d s n mm/o e r NCV i m/ Th y p e n 3 c se wh r tersiu l f ram n s). e rse t a s ee h e d a ltn ywa teo l a n r l yf u d ae c s h ny b o mai o n . t Krme M , l atRW , ligJ R, i nTG. Aco aa ste a e r Gi it l Godn S W l so r p re h sie i c r a tn e sy d o . La c t 1953; n ap l u n l n r me ne 2:590595. Ba k r u d c go n Reee c . S u c : P ae 1966. frn e o re h ln Ku l n KA,He n sse W J S n t i a d sp cfct o c r a hma n e y . e si vt n i y e iii f ap l y tn e sy d o sin Am JP y M e Re a i 19977 u n l n r me g s. hs d h bl ;6:451- . 457 Ba k r u d Reee c . S u c : M e l e S ac . Ab rc: Th c go n frn e o re di n e rh sta t e se si vt a d sp cfct o si CTS sin wee d tr n d b n ti n i y e iii f x y gs r eemie y e au t g 143 su jcs (228 h n s) wi sy tms o CTS v lai n be t ad t h mpo f . I mme itl atr p ro mig te si p y c l e a n t n tst daey fe ef r n h x h sia x miai e s, o stn adn r ec n u t nstde weep ro me o al h n s t a d r ev o d ci u is r ef r d n l228 a d o o d tr n tep e n eo a se c o CTS CTS wa p e n i 142 eemie h rse c r b n e f . s rse t n h n s a da se ti 86 h n s. Th sin ween tv r se si v (23ad n b n n ad e g s r o ey n t e i 69%),b twee fil sp cfc (66- %) f rCTS A sq aesh p d u r ary e ii 87 o . u r- a e wrsta d a d co p l cs b e i we k e weetemo se si v i n b u tr ol i rvs i a n ss r h st n t e i sin (69 a d66%, e e t ey a daerc mme d da p r o te gs n rsp ci l), n r e o v n e s at f h e a n t n o CTS M e in n r eh p ste a a d teP ae sin x miai f o . da ev y e h si n h h ln g b t h v fi se si vt (51%) b tg o sp cfct (85 a d 7 oh a e ar n t i i y u o d e iii y n 6%, rsp ciey Th me inn r ec mp e o sina dteHo f n e e t l). e da ev o rssin g n h v fma n Tie sinb t h v p o se si vt (28 a d23%, e e t ey a d n l g oh a e o r n t i i y n rsp ci l), n v tu aelss h lf lne au t gsu jcs wi su e tdCTS h s r e ep u i v lai n be t t sp ce h . Ku te T. Cap l tn e sy d o nz r r a u n l n r me i 100 p t ns: se si vt, n ai t e n ti i y sp cfct o mut n u o h silgc lp o e u e a d e i t n o e iii f l - e r p y oo ia r c d rs n st i f y i ma o a o a lss o moo , n r a dsy ah t me inn r efb r J x n l o f tr se so y n mp tei da ev ies. c Ne r l c 1994; :221uo S i 127 229. CrtraM e (6/ 1, 3, 5, S u c : i i e t 6: 2, 4, 6) o re M e l e S ac . Ab rc: S u y o 7 c nr lsu jcs a d o te di e rh n sta t td f 0 o to be t n f h mo e sy tmai h n s o 100 CTS p t ns da n se r mpo t c ad f ai t ig o d e id p n e t b ciia hstr a de a n t n S u ysp cfc l n e e d nl y l c l i o y n x miai . td e iial y n o y d sin dt me t lsi AAEM ci raf re au t no u f le o e g e o e al x rt i o v lai f seun ss f e o NCS t da n se CTS icu ig c niu u mo i rn o h n o ig o n ldn o t o s n nt ig f a d o tmp rtr d rn te NCS Re o t te ci ra f ra n r l is, e eau e u ig h . p rs h rt i o b o mai e e t se si vt s a d sp cfct s o 19 se so y moo a d a tn mi n t ie n i i e iii e f i n r, tr n uo o c p rmees. 9/ p rmees ra h dasp cfct o 97 Ate st 9 aa tr 19 aa tr e c e e iii f %. la 1/ y o te p rmees wa a n r l i 87 o te CTS p t ns. f h aa tr s b o ma n % f h ai t e Ab o ma me in CM AP a d S n r l da n NAP a l u e a d a n r l mpi d s n b o ma t me in F wa e p rmees wee n t a se si v o sp cfc t da - v aa tr r o s n t e r e ii o i da n seCTS a a n r lme in se so y a d moo c r a tn e ig o s b o ma da n r n tr ap l u n l se me t o d cinv lct s. Of da n r ec n u t nv lct s g n cn ut o eo i e i me in ev o d ci eo i e o i i te c r a tn e se me t te se so y stde wee mo e n h ap l u n l g ns, h n r u is r r fe u nl a n r lh ntemoo stde rq e t b o ma ta h y tr u is. La et EH. Dig o i v le o ee tia st lt n o moo mb r a n st au f lcrc l i ai c mu o f tr n r e Elcr e c p ao rCl Ne r p y o 1962; ev s. e to n e h lg i n u o h sil 22(su p):9p l 16. Ba k r u dReee c . S u c : Ki r 1985. c go n frn e o re mu a Lao V,S a n F Re ln J Nev c n u t n stde sh w n ry p a s , ue . r e o d ci o u is o o e cu v un r o me in in r ain o te rn fn e. Cl x lsie la r da n ev t o f h ig ig r i n Ne r p y o 1999; u o h sil 110:14921497 Crtra M e (2/ 1, S u c : . i i e t 6: 3) o re M e l e S ac . Ab rc: Co iain o rto e t e std o di n e rh sta t mbn t o f er sp ci v uy f 1617 h n s o 1000 p t ns a d p o e t estd o 430 h n s i ad f ai t n r sp ci u y f e v ad n 260 p t ns rfre f ree to ig o i e au t n o b a haga ai t eerd o lcr da n st v lai f rc ili e c o (n td fn d i p p r No c seo mo o e rlin r ain o D4 b o eie n a e). a f n n u a n ev t o f y teme in o un rn r ewa e c u trd I alc se i whc D4 h da r la ev s n o nee . n l a s n ih S NAP wee o tie wi b t me in a d un rst lt n i s r ban d t oh da n la i ai , t h mu o c udb d mo stae ta teS o l e e n rtd h t h NAP ween t u t c - i lt n s r o d e o o st ai mu o b si l n o s rc r ig o S y mut e u e o dn f NAP fo a oh rme in o un r a s r m n te da r la in r ae fn e. Th a to s dsc ss tera n wh so p e iu n ev td ig r e uh r i u h e so s y me rvo s ciia a de p rme tl u is ma h v mi a e l c n ld dta l c l n x ei na stde n y a e stk ny o cu e h t mo o e rlin r ain o D4 o c r a a p y oo ia v rain n n u a n ev t o f c us s h silgc l ait . o F n l , o ai no S ial c mp rso f NAP p rmees i 183 h n s wi ice se y aa tr n a d t n ra d h me inn r edstlae ce sh we c n u t nt b mo ei ard da ev i a ltn is o d o d ci o e r mp ie o i tefb r in r aigD4 ta i to su pyn D3. n h ies n ev t n h n n h se p lig La rte M , Liu r R, Tr jb r W . Orh d o c se so y ui n z g oi oa o g to r mi n r

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Muscl & Nerve Sup l e pement X 2 0 S9 7 02 6

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c n u t n ao g te rn fn e i n r lsu jcs a d i p t ns o d ci ln h ig ig r n o ma be t n n ai t o e wi ac r a tn e sy d o . Elcr e c p ao rCl Ne r p y o t ap l u n l n r me e to n e h lg i u o h sil h n 1991; 81(1):18- Crtra M e (5/ 1, 4, 6) S u c : M e l e 23. i i e t 6: 3, 5, o re di n S ac . Ab rc: W i st lt n o te rn fn e u n rn e rh sta t t i ai h mu o f h ig ig r sig ig ee to e a d n e l ee to erc r igwi a ea iga tewrst lcr d s n e de lcr d e o dn t v rgn t h h i o e teme ina dun rn r e DS a dme in un rdfee c s v rh da n la ev s, Ls n da - la ifrn e wee rc r e i 23 n r lv lne r a d 38 CTS p t ns. Th i r e od d n o ma ou tes n ai t e er fn ig su g stta te me in un ro to r mi DS dfee c idn s g e h t h da - la rh d o c L ifrn e fo tern fn e wa au f l re igtc nq ei teda n si r m h ig ig r s seu sce nn e h iu n h ig o s o CTS b t dd n t ie t y e ey p t n wh n c mp rd t f , u i o d ni v r ai t e o ae o f e st lt no tu a do midefn e. i ai f h mb n /r d l ig r mu o Le rEA, n ae S P e o DC, gga EL. S i lt ndstl sse Ve k tsh , rstn Lo iin t ai i a mu o t telsin i p t ns wi c r a tn e sy d o . M u l Nev o h e o n ai t t ap l u n l n r me e h sce r e 1995; 18:503- . Crtra M e (5/ 1, 4, 6) S u c : M e l e 507 i i e t 6: 3, 5, o re di n S ac . Ab rc: I CTS p t ns, lw a l u eme inCM AP o e rh sta t n ai t a o mpi d e t da r S NAP wi st lt n a te wrstce se (p o i lt te c r a t i ai t h h mu o i ra r xma o h ap l tn e) i d et ete d my l aino a o a d g n rt no b t. u n l s u o i r e ei t h n o r x n l e e eai r oh o W i a o a d g n rt n tea l u eo teCM AP a d S t x n l e e eai , h mpi d f h h o t n NAP i s tesa wi st lt n a o ea db lw tesi o tep too y h me t i ai b v n eo h t f h ah lg . h mu o e W i f c ld my l ain tea l u eo teCM AP a d S t o a e ei t , h mpi d f h h n o t n NAP i s g e trwi st lt nb lw c mp rdt st lt na o etesi rae t i ai eo o ae o i ai b v h t h mu o mu o e o te p too y Of59 c n c t e CTS p t n h n s,36 (61%) f h ah lg . o se ui v ai t a d e sh we sinfc n rd cin i CM AP a do a t r mi S o d g iia t e u t o n n /r ni o c NAP d a l u e wi st lt n a tewrstc mp rd t st lt n a mpi d s t i ai t h t h mu o i o ae o i ai t mu o te p l whc idc td te p e n e o f c l d my l ain h am ih n iae h rse c f o a e ei t n o rsut gi c n u t nbo ka do p too i dsp r o wi p a e l n n o d ci lc n /r ah lgc i esin t h se i o h c n elt n W e c n ld ta i p t ns wi CTS a i oh r a cl i . ao o cu e h t n ai t t e h , s n te e ta me tn u o ahe st lt n b t p o i la d dstlt te nrp n e r p tis, i ai oh r xma n i a o h mu o c r a tn e p o ie i o tn if r t na o tteme inn r e ap l u n l r vd s mp ra t n o mai b u h o da ev p too yi tec r a tn e. ah lg n h ap lu n l Le HL,W a g L,Ro iso LR. Te -ee rl bl y o c mbn d w n bn n strtst ei i t f o ie a i se so y id x i l ain f rda n sig c r a tn e sy d o . n r n e : mpi t s o ig o n ap l u n l n r me c o M u l Nev 2000; 1261sce r e 23: 1264. Crtra M e (5/ 1, 3, 6). i i e t 6: 2, 5, S u c : M e l e S ac . Ab rc: Ro iso a d c l a u s (1998) o re di e rh n sta t bn n n ol g e e p e iu y sh we ta,c mp rd t a sige NCS te c mbn d rvo sl o d h t o ae o nl , h o ie se so y id x (CS ) h s su eirse si vt a d sp cfct f rte n r ne I a p ro n t i n i y e iii o h y da n si o CTS Ths p o e t e std e au td te tstrtst ig o s f . i r sp ci v u y v lae h e -ee rl bl y o a sige NCS v r s teCS b tesa e a n ri ei i t f n l a i esu h I y h me x mie n o eh n o 32 su jcs: 26 n r l be t a d6 CTS p t ns. I a n ad f be t o ma su jcs n ai t n e su g o po 18 su jcs, h std e au tdteefc o tmp rtr b ru f be t te u y v lae h fe t f e eau e o a soue ltn is a d ltn y dfee c s d rv d fo se so y n b lt ae ce n ae c ifrn e eie r m n r NCS CS h dtehg e tst etst eibl ya dteCS sc r (te . I a h ih st e r-e rl i t n h a i I oe h su o 3 ltn y dfee c s) wa lss afce b tmp rtr m f ae c ifrn e s e fe td y e eau e c a g s ta a soueltn yv le o idvd a NCS h n e h n b lt ae c au s f n iiu l s. Lo iinEL, si NA, r e AR, u nn k F Kh l N, h h n gga Bu s Beg r Br y ic y , ai S a a i l BT, Yo n RR, Lu rc l sp rn i c r a tn e sy d o : ug mb ia aig n ap l u n l n r me a ao c p y oo i, a d da n st i l ain Ne r lg n tmi, h silgc n ig o i mpi t s. c c o u oo y 198737 ; :14991505. Crtra M e (5/ 1, 4, 6) S u c : M e l e i i e t 6: 3, 5, o re di n S ac . Ab rc: W i st lt n a te wrst si l n o s e rh sta t t i ai h mu o t h i , mut e u a rc r ig o CM AP t tese o d lmb ia a d AP weerc r e e o dn f o h c n u rc l n B r e od d i 61 p t ns wi CTS(a d fn db ee to h silgcci ra a d n ai t t e h s eie y lcr p y oo i rt i) n e i 16 n r lsu jcs. Th y f u d ta te lmb ia dstlltn y n o ma be t e o n h t h u rc l i a ae c wa rlt eysp rdwh nc mp rdt tedstl ae c t teAP s eai l ae v e o ae o h i a ltn y o h B a d ta ti ma b ase si v tstta c udb u di a dt nt n h t hs y e n t e e h t o l e se n d i o o i i oh rtst f rteda n si o CTS Th yaso f u d ta i wa n t te e s o h ig o s f . e l o n h tt s o sp cfcf rCTS sic i o c sin l wa a n r lnmo ep o i l e ii o n e t c a o al s b o ma i y r r xma lsin o teme inn r e e o s fh da ev . Lo n S o g C. Th c r a tn e sy d o : a ciia a d e ap l u n l n r me l cl n n ee to h silgc lstd o 250 p t ns. P o Au Asso Ne r l lcr p y oo ia u y f ai t r c st e c uo 197 ; 714:51- CrtraM e (3/ 1, 6) S u c : Homg e , 62. i i e t 6: 2, o re l rn 1987 . Lo n S S a CS Co ai n o me in a d un rse so yn r e o g C, e h . mp rso f da n la n r ev a t n p tnil i te da n si o te c r a tn e sy d o . J ci oe t s n h ig o s f h ap l u n l n r me o a Ne r lNe r su g P c ity 197 34:7 7 uo u o r sy har 1; 50- 54. Crtra M e (5/ i i e t 6: 1, 3, 6) S u c : M a lo ,1987 Ab rc: W i st lt n a te 2, 5, o re ce d . sta t t i ai t h h mu o id xa dl t fn es a drc r iga tewrst v rteme ina d n e n i l ig r n e o dn t h i o e h te da n un rn r e DS a dS la ev s, L n NAP a l u e weerc r e i 30 h aty mpi d s r e o d d n t el h fmaesu jcs a d22 h n s i 15 CTSp t ns. Th yf u dta te e l be t n ad n ai t e e o n h th me in t- la S da -o un r NAP a l u ert o lss ta 1 wa ase si v mpi d ai f e h n t o s n te i tsti teda n si o CTS a d p riual u f li p t ns wh e n h ig o s f n at lry seu n ai t o c e sh we an r l L a dDS o d o ma DM n L. * us DS Ha kn F . S mpo t rl ff l wig c r a tn e Lo i , n i M y tmai ei ol n ap l u n l c e o d c mp e o wi e o rssin t n r l ee to e r my g a hc stde h o ma lcr n u o o rp i u is (n t iain o rta t n b Ha kn a d Lo i i t su se u n oi c t f o f erci y n i n o us n wo b q e t i e Orh p dc 1988; ssu s: to e is 11:532 a d Orh p dc 1988; n to e is 11:1244). Orh p dc 198710:434to e is ; 436. CrtraM e (1/ 2) S u c : M e l e i i e t 6: o re di n S ac . e rh * c et R, S h e h b r R, La d A. Lo aie n r e d ma e Lu h t i con u e ni c l d ev a g z rc r e ita p rt ey i c r a tn e sy d o . Elcr my g e o d d nro eai l n ap l u n l n r me e to o r v Cl Ne r p y o 1988; i u o h sil n 28:37 383. CrtraM e (3/ 1, 5) S u c : 9i i e t 6: 3, o re M e l eS ac . di e rh n * c et R,S h e h b r R,Nah n P Co rlt n o se me tl Lu h t i con u e ta . reai f g na o c r a tn e p e rs wi c a g s i h n a d wrstp si o s i ap l u n l rssu e t h n e n a d n h i o tn n i p t ns wi c r a tn e sy d o a dc nr l JHa dS r [ ] ai t t ap l u n l n r me n o tos. e h n u g Br 1998; 23:598602. Crtra M e (3/ 1, 5) S u c : M e l eS ac . i i e t 6: 2, o re di e rh n Ab rc: Th a to s iv st ae p e rs wi a e d sc pc sta t e uh r n e i td rssu e g t n no oi h p e r mo i r a 1 c itr as ao g te c r a tn e i 39 rssu e nt t m nev l ln h ap l u n l n o p t ns wi CTS a d 12 c nr l P e rs wee me su e f r ai t t e h n o tos. rssu e r a rd o rlx d a d g ipn h n p si o s i c mbn t n wi n url ea e n rp ig a d o t n n o iai i o t e ta, h e tn e ,a d fe e wrstp si o s. Th std c n ime p e iu xe d d n lx d i o t n i e u y o fr d rvo s rp rs ta CT p e rs ae g n rl hg e i CTS p t ns ta e ot h t rssu e r e eal ih r n y ai t h n e c nr l a d ta itau n lp e rs ae g n rl ice se wi o tos, n h t nrtn e rssu e r e eal n ra d t y h wrst e tn o i c mp rso wi wrst fe in M a i m i xe sin n o ai n t h i lxo . xmu itau n lp e rs weeg n rl f u d i tec nrlp r o te nrtn e rssu e r e eal o n n h e ta at f h y tn e a d mii m p e rs i te dstltn e. Grp ig h n u nl n nmu rssu e n h i a u n l ipn a d p e rs i te tn e wee lwe wi te wrstfe e . I b t rssu e n h u n l r o st t h h i lx d n oh c nr l a dCTS p t ns, nyi ten url i a drlx dh n o tos n ai t o l n h e ta wrst n ea e a d e p si o s weep e rs hg e a tep itwh r n r ec n u t n o tn i r rssu e ih st t h on ee ev o d ci o stde h v idc tdten r ei mo l eyt b c mp o se (i u is a e n iae h ev s st i l o e o r mi d n k temip l jst i a t tedstl r i o tec r a tn e). h d am u dstlo h i a magn f h ap lu n l Lu d o g G,Geb r n RH,M ite- n ey M ,Le YF Hag n nbr lema ne rCo v r e , re s AR. M e in n r e c mp e o i te c r a tn e f n t n l da ev o rssin n h ap l u n l u ci a o rsp n t e p rme tl id c d c nr l d p e r. JHa d S r e o se o x ei nal n u e o tol rssu e y e n ug 1982;:2527 259. Ba k r u d Reee c . S u c : AAEM 2000 CTS c go n frn e o re Ta F reme e. sk o c mb r Lu d o g G,Li- tn r m AK,S l r n C,S r mb r T,P y k nbr eS e sto ol ma e to eg yk o I Dii lvb o rm: a n w da n st to f r se so y tst g i . gt ir g a a e ig o i o l o n r e i n c n c mp e o n u o ah . JHa dS r Am 1986; o rssin e r p ty n ug 11:693699. Crtra i i e M e (3/ 1, 3) S u c : M e l eS ac . t 6: 2, o re di e rh n * a d n l G, b rso M M , ik nJ Cap lu n l n r me M c o ad Ro et n Erc so A. r a tn e sy d o a n Caio na d na h ge i s. De tHy (Chc 1988; mo g l r i e tl y inst f n g i) 62:322327 CrtraM e (2/ 1, S u c : M e l eS ac . . i i e t 6: 2) o re di e rh n * a d n l RA,S h rz M S S sh M . Cap ltn e sy d o : M c o el c wat , wa r a u n l n r me W hc fn e sh ud b tstd An a ay s o se so yc n u t ni ih ig r o l e e e ? n lsi f n r o d ci n o dgtl rn h s o teme inn r e M u l Nev 1990; ii b a c e f h a da ev . sce r e 13:601606. CrtraM e (3/ 1, 3) S u c : M e l eS ac . i i e t 6: 2, o re di e rh n * a Le n I S k Ch D. Cap ltn e sy d o : ac mp rso o M c a C, i o r a u n l n r me o ai n f dstlse so y ltn is o me in a d rda n r e M u l Nev i a n r ae ce f da n a il ev s. sce r e 1981; 4:444. CrtraM e (0/ (Ab rc Ony S u c : Rin r 1991. i i e t 6) sta t l) o re v e, M a lo W N: Re e trF wa e a c mp rso o se si vt wi ce d p ae - v s: o ai n f n t i i y t h se so y a t r mi wrstt- am ltn y a d dstlmoo ltn yi n r ni o c i -o p l ae c n i a d tr ae c n teda n si o c r a tn e sy d o . Ne r lg 198737 7 7 8. h ig o s f ap lu n l n r me u oo y ; :7 3- 7 Crtra M e (4/ 1, 5, S u c : M e l e S ac . Ab rc: W i i i e t 6: 3, 6) o re di e rh n sta t t h st lt n a tewrsta d rc r ig o F wa e o e teAP te i ai t h mu o i n e o dn f vs vrh B, h fe u n yo rp ae Fwa e (ie t a rc rigFwa e i ltn y rq e c f e e tr v s d ni l e u rn c v s n ae c , c n iu ain a d a l u e wa d tr n d b me su ig 100 o fg rt , n mpi d ) o t s eemie y a rn su rma i lsh c s;209 h atyh n s a d 147 e ta p d me in p a xma o k el h ad n n rp e da n r e wee e au td Th rp ae F wa e wa c mp rd t te ev s r v lae . e e e tr vs s o ae o h se so y 1 c DS ic ig ltn y a r ss tewrst A hg p re t n r m L n hn ae c co h i. ih ec n rp ae F wa e v le wa c n d rd idc t e o CTS a d te e e tr - v au s o siee n iai f v n h se si vt a p o c e ta o te se so y a t r mi ic ig n ti i y p ra h s h t f h n r ni o c n hn d tc nq ea r ss tec r a tn e. e h iu co h ap lu n l M ai EL, Venc S F id n LW . Cap l tn e sy d o : rn r ik , re ma n r a u n l n r me M e in n r este tst Arh P y M e Re a i 1983; da ev rss e . c h s d h bl 64:206208. Crtra M e (5/ 1, 3, 6) S u c : Bo g 1986. Ab rc: W i i i e t 6: 2, 5, o re r, sta t t h me in st lt n a tewrsta drc r igo e teAP a drn da i ai t h mu o i n e o dn v r h B n ig ee to e t teid xfn e, L a dDS weeo tie fo te lcr d s o h n e ig r DM n L r ban d r m h me in n r e i te n url p si o , te i e te tlrbe da ev n h e ta o t n h n n xrme oea l i e tn o a 5 miue a d 10 miue f l we b tetst gi te xe sin t n ts n n ts ol d y h e i n h o n e te tlrbefe inp si o atr5 a d10 miue Ano to s xrme oea l lxo o t n fe n i n ts. rh si wa d vse t e a l te wrst t b h l i e te tlrbe s e i d o n be h i o e ed n xrme oea l e tn o whc rn e fo 45Exe sin ih a g d r m 85E a d e te tlrbefe in n xrme oea l lxo whc rn e fo 45Eih a g d r m 90E. F u te h n s i 14 p t ns wh h d o re n a d n ai t o a e CTS a d 12 h n s fo 12 v lne r wee e au td Ofte 14 n a d rm ou tes r v lae . h p t ns, o te h dn r l L a dDM L ltn is i ten url ai t 5 f h se a o ma DS n e ae ce n h e ta p si o . Th e o te 5 sh we a ice sei DS fo teu p r o t n re f h se i o d n n ra n L r m h p e rn eo n r loa o en r l olwige tn o o fe in a g f o ma t b v o ma f l n xe sin r lxo . o

150.

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S9 8CTS L 6 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

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159. M aia c AA. Co aaie v le o me su e n o c n u t n rn c i mp rt v au f a rme t f o d ci o v lct a d ee to o rp y i te da n si o c r a tn e eo i n lcr my g a h n h ig o s f ap l u n l y sy d o . Arh P y M e Re a i 1964; n r me c h s d h bl 45:548554. Crtra M e i i e t (4/ 1, 3, S u c : Nah n 1988. Ab rc: W i st lt na te 6: 2, 5) o re ta , sta t t i ai t h h mu o wrsteb w a da i a a drc r igo e teAP moo NCVs a d i , lo n xl , n e o dn v r h l B, tr n DM Ls wee d tr n d i 204 p t ns h vn CTS a d 64 c nr l r eemie n ai t a ig e n o to su jcs. Ne deEM G wa asop ro me i ti g o p 7 o CTS be t el s l ef r d n hs r u ; 0% f c se h da n r l i DM L a dten e l EM G wa a n r ln a s a b o ma wrst n h e de s b o ma i 96% o tec se (fb i ain p lp a cu i a dlr ea l u e f h a s irl t s, oy h si nt n ag mpi d l o s, t moo u i S n r ltn is weeasorc r e i 23 CTSp t ns. tr nt e so y ae ce r l e o d d n s). ai t e 160. M ashDR. Useo awh e e h simee f rtst gse sii t i te r f e l ste o tr o e i n n bl y n h i h n . J Ha d S r Br1986; ad n ug 11:182186. Crtra M e (3/ 1, 3) i i e t 6: 2, S u c : M e l eS ac . o re di e rh n 161. M a o H,S iz wa R. Anir mi dgtla d p l rn r e a t n vr ho a t o c ii n ama ev ci d a o p tnil Elcr e c p ao rCl Ne r p y o 197 30:210oe t s. e to n e h lg i a n u o h sil 1; 221. Crtra M e (4/ 1, 5, S u c : Bu hh l 197 Ab rc: W i i i e t 6: 3, 6) o re c ta, 4. sta t t h st lt n a te eb w a d wrsta d rc r ig o e te mide i ai t h lo n mu o i n e o dn v r h dl fn e, NAP a dDS fo teme inn r eweerc r e i 21 ig r S s n Ls r m h da ev r e od d n n r lsu jcs. W i st lt n o e teun rn r ea teeb w o ma be t t i ai v r h la ev t h lo h mu o a d wrst a t r mi S n i , ni o c NAP a d DS weerc r e i 13 n r l d s n Ls r e o d d n o ma su jcs. NoCTSp t ns weestde . be t ai t r u id e 162. M a e RF Nev c n u t nstde i ma . Ne r lg 1962; 33y r . r e o d ci u is n n u oo y o 12:7 7 Crtra M e (4/ 1, 5, S u c : Krf,1983. Ab rc: Th 44. i i e t 6: 3, 6) o re at sta t e f l wig tc nq e wee stde i 64 n r lsu jcs a d 31 ol n e h iu s o r u id n o ma be t n da eis wi o t p rp ea n u o ah : (a st lt n i a i a ib t c t u eih rl e r p ty ) i ai n xl , h mu o l a o e eb w a d wrstwi rc r ig o teCM AP o e teAP b v lo n i t e o dn f h h vr h B. S ra e a d c n e ti n e l ee to e wee u d (b wi u fc n o c nrc e de lcr d s r se , ) t h st lt n i te a i a a o e te eb w a d wrst S i ai n h xl , b v h lo n mu o l i , NAP wee s r rc r e fo dgtln r e u n su fc a d n e l ee to e (c e o d d r m ii ev s sig ra e n e de lcr d s, ) a un r (d p r n a,(e t il a d (f H rfe . Th y f u d a sl h la, ) eo e l ) i a, n ) b elx e o n i t g d ce se i NCV i p t ns od r ta 50,a d i p t ns wi e ra n n ai t le h n e n n ai t t e h da ee mel u wi o tciia sin o p rp ea n u o ah . No ib ts l ts t u l c l g s f eih rl e r p ty i h n CTSp t ns weestde . ai t r u id e 163. * a u A. Roe o te a ee to o rp y i te e au t n o M zr l f h n r lcr my g a h n h v lai o f c r a tn e sy d o . P y M e Re a i Cl N Am 1998; 55ap l u n l n r me h s d h bl i n 9:7 7 Re iw at l. Ba k r u dReee c . S u c : M e l eS ac . 64. ve ri e c g o n c frn e o re di e rh n Ab rc: Th a to su g st ta n e l EM G o teAP (1) i n t sta t e uh r g e s h t e de fh B s o n c ssay t e au t mo c se o CTS a d (2) b rsev d f r e e r o v lae st a s f n e e re o ay ia si ain o u u a p e nain o CTS su h a wh n (a tpc l t t s r n su l rse tt s f u o o c s e ) NCS c n o b p ro me o (b wh nteme inn r ep too yi a n t e ef r d r ) e h da ev ah lg s p tnil a g e v c u n sinfc n a o a ijr o e a sh r oe t l g rssie a sig g iia t x n l nu y v r ay ot t . i me 164. M c l n DL,S sh M . Lo gtdn lsl ig o te me in n r e Lel a wa n i ia i n f h u d da ev d rn mo e ns o te u p rl . JNe r lNe r su g P c it u ig v me t f h p e i mb uo u o r sy ha. 197 39:566- 0. Ba k r u d Reee c . S u c : AAEM CTS Ta 6; 57 c go n frn e o re sk F re 2000 me e. No ma su jcs. An icd na fn ig d rn oc mb r r l be t n ie tl idn u ig rc r ig o me in NAP wi mo o oa n e l ee to e i te e o dn f da t h n p lr e de lcr d n h me in n r ei teu p ram wa ta ten r esl ln i dn l da ev n h p e r s h t h ev i o gt ial d u y se ea mm wh n te l v rl e h i mo e a a jit W rste tn o a d mb v d t on. i xe sin n fe inrsutdi o p si drcin o sl igmo e n. Noe te lxo e l n p o t ie t s f i n e e o d v me t t: h n e l i n r e ma h v i e e mo e n la ig t e de n ev y a e mp d d v me t e dn o u d rst ts o ma ntd o sl ig n ee i e f g i e f i n . ma u d 165. M c i BJ KelrE,Ad l en S . P i ro c ran ee ns o Nel , l e esti J rme n eti lme t f me ia d csin ma ig NEJ 197 293:211dc l e i o kn . M 5; 215. Ba k r u d c go n Reee c . S u c : Gu n r n1997p p r frn e o re n asso a e. 166. M evn J Hars DH,J h so EW . S n r a d moo c n u t n li L, ri on n e so y n tr o d ci o v lct s i te un ra d me in n r e Arh P y M e Re a i eo i e n h la n i da ev s. c h s d h bl 1966; :51147 519. Crtra M e (4/ 1, 5, S u c : J y t 1989. i i e t 6: 3, 6) o re o n, Ab rc: Th f l wig tc nq e wee stde : (a o to r mi sta t e ol n e h iu s o r u id ) rh d o c S NAP weerc r e fo teme in n r ea tewrsta deb w, s r e od d rm h da ev t h i n lo (b o to r mi S ) rh d o c NAP wee rc r e fo te un r n r e atr s r e o d d r m h la ev fe st lt n o tern a d l t fn es a d rc r igo e tewrst i ai f h ig n i l ig r n e o dn v r h mu o te i a deb w, ) a t r mi S n lo (c ni o c NAP weerc r e fo teme ina d d s r e od d rm h da n un rn r eatrrv r n teee to e f rteo to r mi S la ev fe e esig h lcr d s o h rh d o c NAP s, (d me in CM AP rc r ig o e te o p n n p l c s,a d (e ) da s e o dn v r h p o e s ol u n ) i un rCM AP o e tea d co dgt q it Th o to r mi NCVs la v r h b u tr ii uni e rh d o c i . weed tr n di 48 n r l eso s, trc n u t nNCVs wee r eemie n o ma p r n moo o d ci o r d tr n d i 47 n r l p o l a d a t r mi S eemie n o ma e pe n ni o c NAP wee d s r c mpee i 36 n r lp o l. NoCTS p t ns weestde . Th y o ltd n o ma e pe ai t r u id e e f u d tee wa n sinfc n dfee c b t e o to r mi a d o n hr s o g iia t ifrn e ewe n rh d o c n a t r mi se so yNCVs a d ta tefststafrn se so yNCVs ni o c n r d n h t h a e fee t n r weefstrta tefstst fee t trfb r r a e h n h a e efrn moo ies. 167 M evn J S h c ma n J La e RR. Dig o i sp cfct o . li L, c u h n A, n se a n st c e iii f y moo a d se so y n r e c n u t n v ra ls i te c r a tn e tr n n r ev o d ci aibe n h ap l u n l o sy d o . ArhP y M e Re a i 197 54:69- 4. CrtraM e (5/ n r me c h s d h bl 3; 7 i i e t 6: 1, 3, 6) S u c : Re mo d 1988. Ab rc: W i st lt n a te 2, 5, o re d n , sta t t i ai t h h mu o wrsta d rc r ig CM AP o e teAP a d S i n e o dn vrh B n NAP o e teid x vrh n e a d mide fn e, ltn y v lct s, a d a l u e wee n d l ig r ae c , eo i e i n mpi d s t r d tr n d fo 24 n r lv lne r a d 19 p t ns wi CTS eemie r m o ma ou tes n ai t t e h . Th y f u d ta te DS f l we b te DM L wee te b sttst e on hth L ol d y h o r h e es a d ta se so y d rt n se so y a l u e moo a l u e a d n h t n r u ai , n r mpi d , tr mpi d , n o t t moo d rt nween t n t e tr u ai o r o se si v . i 168. M ec u M P Kel M A, lii S Qu ni t ese so ytrsh ls rh t , l y Toeks C. a t ai t v n r h e od i c r a tn e sy d o . Elcr my g Cl Ne r p y o n ap l u n l n r me e to o r i n u o h sil 1990; 30:119124. Crtra M e (5/ 1, 3, 6) S u c : M e l e i i e t 6: 2, 4, o re di n S ac . Ab rc: Twe t-ih h n s fo 23 p t ns wi CTS a e rh sta t nyeg t a d r m ai t t e h s d fn d b 1 o mo e o te a n r lNCS o to r mi DS eie y r r f h se b o ma s; rh d o c L me in un r dfee c fo rn fn e-o wrst p l t- i da - la ifrn e r m ig ig rt- i , am-o wrst me inDS fn e-o wrst da DS o DM L fo tewrsttda L, ig rt- i me in L, r r m h i -o AP Qu ni t e se so y trsh l (QS tst g wa d n u n B. a t ai t v n r h e od T) e i n s o e sig vb aintrsh ls a dtema se si vt trsh ls c mp rn te irt h e od n h r l n t i h e od o aig h o i y id x t l t fn e i 23 a e mac e c nr lsu jcs. Ab o ma n e o i l ig r n te g th d o to be t nr l QS wa f u di o l 3 o te28 sy tmai h n s (11%) a dwa T s o n n ny f h mpo t a d c n s f u dt b mu hlss se si v ta NCS on o e c e n t ehn i s. 169. M eh r GL, Clr RA, S h ee HJ S en P . Hih rsouin ra ak c n ir , tr J g -e lt o c mp td tmo rp y o te wrsti p t ns wi c r a tn e o ue o g a h f h i n ai t t ap l u n l e h sy d o . S eea Ra il n r me k ltl do 1986; 15:549552. CrtraM e (3/ 1, 6) i i e t 6: 3, S u c : M e l eS ac . o re di e rh n 17 M e es S Cr s D, S er B, Vemer P Liud cy a 0. yr , o h ry r ie . q i rstl temo rp y q a t aiestde o a n r l is i c r a tn e h r g a h : u ni t t v u is f b o mai e n ap l u n l t sy d o n r me (c mme t i Ne r lg 1990; o ns n u oo y 40:1146). Ne r lg u oo y 1989; 39:14651469. CrtraM e (2/ 1, S u c : M e l eS ac . i i e t 6: 2) o re di e rh n 17 M i s KR. Orh d o c se so y a t n p tnil fo p l r 1. l l to r mi n r ci o oe t s r m ama a st lt n i te da n si o c r a tn e sy d o . J Ne r l i ai n h ig o s f ap l u n l n r me mu o uo Ne r su g P c ity 1985; u o r sy har 48:250255. Crtra M e (4/ 1, 5, i i e t 6: 3, 6) S u c : Godn ,1986. Ab rc: W hl rc r ig a te wrsto e o re lig sta t i e o dn t h e i vr teme ina dun rn r e S h da n la ev s, NAP weeeii db st lt no e s r l t y i ai v r ce mu o teid x a d l t fn es a d fo st lt n i tep l (mie h n e n i l ig r n r m i ai n h am te mu o xd n r e 7 h n s wi CTS 53 h atyh n s a d20 h n s o p t ns ev ); 2 a d t h , el h ad n a d f ai t e wi u rltd n u oo ia c n i o s wee e au td Th y f u d t n eae e r lgc l o dt n h i r v lae . e on ta te p l t- i c n u t n v lct a d te p l t- i h t h am-o wrst o d ci o eo i n h am-o wrst y me in un rc mp rso wa mo e l ey t b a n r lta te da - la o ai n s r i l o e b o ma h n h k DS o DM L. Th yasof u d n sinfc n dfee c b t e te L r e l o n o g iia t ifrn e ewe n h n r lc nr lg o p a d te 20 h n s wi u rltd n u oo i o ma o to r u n h ad t n eae e r lgc h c n i o s. o dt n i 17 M oi r P . A da n st tst f r c r a tn e sy d o 2. lo J t ig o i e o ap l u n l n r me u n c sig uta u d JHa dS r Br l so n . r n u g 1988; 13401341. CrtraM e (3/ 1, 5) i i e t 6: 3, S u c : M e l eS ac . o re di e rh n 17 M o g TN,Lado DM . Cap ltn e sy d o me su e n o 3. na ilw r a u n l n r me a rme t f se so y p tnil u n rn a d id x fn es. Am J P y M e n r oe t s sig ig n n e ig r a hs d 1982; 61:123129. CrtraM e (4/ 1, 3, S u c : Re mo d 1988. i i e t 6: 2, 5) o re d n , Ab rc: W i st lt n o te f u t dgt (D4), o to r mi sta t t i ai h mu o f h o rh ii rh d o c S NAP wee si l n o sl rc r e a te wrsto e te me in s r mut e u y e o d d t h a i vr h da a d un rn r e i 15 c nr lsu jcs a d 30 CTS p t ns a d te n la ev s n o to be t n ai t n h e rsut c mp rd t me in se so y stde wi st lt n o te e l o ae o da n r u is t i ai f h s h mu o se o d dgt(D2). Th D4 S c n ii e NAP wa a se to te p a ltn y s b n r h e k ae c p oo g dmo efe u nl ta teD2 S r ln e r rq e t h n h y NAPi p t ns wi CTS n ai t t e h . 17 M o g TN,S a k GL,P oe BJ S n r p l rst lt n i 4. na hn s o l . e so y ama i ai n mu o da n si o c r a tn e sy d o . Arh P y M e Re a i ig o s f ap l u n l n r me c hs d h bl 1985; 66:598600. CrtraM e (5/ 1, 3, 6) S u c : J c so , i i e t 6: 2, 5, o re a k n 1989. Ab rc: Th f l wigtc nq e weestde : (a rn st lt n sta t e ol n e h iu s r u id ) ig i ai o mu o o e te id x a d l t fn es a d rc r ig a tewrsto e te v r h n e n i l ig r n e o dn t h te i vr h me ina dun rn r e (b me inp l st lt na drc r iga da n la ev , ) da am i ai n e o dn t mu o tewrst a d(c wrstst lt no e me ina dun rn r e a d h i , n ) i i ai v r da n la ev s n mu o rc r ig o e teAP a d ADM weee au td i 36 h n s i 22 e o dn v r h B n r v lae n ad n CTS p t ns a d 22 n r lp t ns. Th y f u d tep l t- i ai t n e o ma ai t e e o n h am-o wrst st lt n t b a n r li 88%, h me inid xfn e DS (i i ai o e b o ma n mu o te da n e ig r L n 86%),me in un rfn e DS c mp rso (i 81%),a d me in da - la ig r L o ai n n n da DM L (i 81%). n 17 * o t rG,De k r K,Di H,Va d rAu r J Co ai n o 5. M ri e c es j s ne wea C. mp rso f tedstlmoo ltn yo teun rn r ei c r a tn e sy d o h ia tr ae c f h la ev n ap l u n l n r me wi a c nr lg o p Elcr my g Cl Ne r p y o 1988; 5t h o to r u . e to o r i n u o h sil 28:7 7 . CrtraM e (3/ 1, 5) S u c : M e l eS ac . 7 i i e t 6: 3, o re di e rh n 17 M u g L,M o e o J ,M e e d zC,Ca i aJ . Th c r a tn e 6. ra rn M nn e st l M l e ap l u n l sy d o . Reain i b t e me in dstlmoo ltn y a d n r me lt shp ewe n da i a o tr ae c n

Muscl & Nerve Sup l e pement X 2 0 S9 9 02 6

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g a e rsut o n e l ee to o rp y Elcr my g Cl rd d e l f e de lcr my g a h . s e to o r i n Ne r p y o 1994; 34: 37 u o h sil 7 383. Crtra M e (1/ 2) S u c : i i e t 6: o re M e l eS ac . di e rh n Na a c i Ta hb n S Re rce moino teme inn r ei k mih K, c ia a . stitd t o fh da ev n c r a tn e sy d o . JHa dS r 1995; ap lu n l n r me n ug 20B:460464. Ba k r u d c go n Reee c . S u c : AAEM 2000 CTS Ta F re me e. frn e o re sk o c mb r Ul a u di gn o temi c r a tn e p r t me su e n o t so n ma ig f h r d ap l u n l emi s a rme t f te ma ntd o me in n r e sl ig wi fn e fe in Th h g i e f da ev i n u d t ig r lxo . h e stde d mo stae c nr l be t me inn r e sl 1.7 0.49 u is e n rtd o to su jcs da ev s i d 5 mm wi fn e fe inwh ra CTSp t ns me inn r e sl 0.37 t ig r lxo h ee s ai t da ev s i e d 0.49 mm. Th fn ig weec mp t l wi l td ln i dn l e idn s r o ai e t i e o gt ia b h mi u sl igo teme inn r ei teCT o CTSp t ns. in nh d da ev n h f ai t e * r a AD. Th r l o to a i o t t n r mei ted u l cu Nak s e oe f h rcc ul sy d o n h o be r sh e sy d o . Am Ha d S r 1990; n r me n ug 9:331340. Crtra M e (1/ 2) i i e t 6: S u c : M e l eS ac . o re di e rh n * ta P Ke i o RC,M e d ws KD,Lo k o RS P e it e Nah n A, nstn ao c wo d . rdci v v leo n r ec n u t nme su e ns a tec r a tn e. M u l au f ev o d ci o a rme t t h ap l u n l sce Nev 1993; re 16:137 7 1382. CrtraM e (3/ 3, 6) S u c : M e l e i i e t 6: 5, o re di n S ac . Ab rc: W e c mp rd te p e it e v le o tre e rh sta t o ae h rdci v au s f h e me su e ns o se so yc n u t no teme inn r ea tec r a a rme t f n r o d ci f h o da ev th ap l tn e (ma i m ltn y dfee c [ LD] 8 c ltn y[ 8] a d u n l xmu ae c ifrn e M , m ae c S , n 14 c ltn y [ 14] i 2334 h n s o id stilwo k r wo k r m ae c S ) n a d f n u ra r es, r es c mp n t n p t ns, a d std ns. Th M LD f r te me in o e sai o ai t n e u et e o h da se so y n r e a r ss te wrstwa d tr n d b te c ni ti n r ev co h i s eemie y h e t rc me tc nq e(ic ig std ). Th trsh l,se si vt,a d sp cfct e h iu n hn u y e h e od n t i n e iii i y y o a n r l is weea f l ws: M LD 0.40 ms,86%,82%,S f b o mai e t r s ol o 8 2.3 ms, %, 67 90% a dS 3.6 ms, n 14 56%, 94%. Nah n P M e d ws KD, yeLS Reain i o a ea d se t ta A, a o Do l . lt shp f g n x o o se so y c n u t n o te me in n r e a te c r a tn e a d n r o d ci o fh da ev t h ap l u n l n a cain o slwe c n u t n wi sy tms. M u l Nev sso it o f o d o d ci o t mpo h sce r e 1988; 11:11491153. CrtraM e (3/ 1, 4) S u c : M e l eS ac . i i e t 6: 2, o re di e rh n Nah n P M e d ws KD,Do l LS S n r se me tlltn y ta A, a o ye . e so y g na ae c v le o te me in n r e f ra p p lt n o n r lidvd as. au s f h da ev o o uai f o ma n iiu l o Arh P y M e Re a i 1988; c hs d h bl 69:499501. Crtra M e (6/ i i e t 6: 1, 3, 5, S u c : M e l eS ac . Ab rc: W i st lt n a l 2, 4, 6) o re di e rh n sta t t i ai t h mu o c itr as a tewrsta d a r ss tec r a tn e a d rc r ig m nev l t h i n co h ap l u n l n e o d n o e te mide fn e,7 n r lh n s a d 54 CTS h n s wee vr h d l ig r 0 o ma a d n ad r e au td f r rlt e se si vt a d sp cfct a 2 lv l o v lae o eai v n ti n i y e iii t y e es f a n r l y At0.5 ms a n r l y te sp cfct wa 97 a d b o mai . t b o mai , h t e iii y s % n se si vt wa 54%. At ms o g e tr tese si vt i r v dt n ti i y s 0.4 r rae, h n t i mp o e o i y 81% a dsp cfct d o p dt 81%. Th p si v p e it ev lea n e iii r p e o y e o t e rdci au t i v 0.5 ms wa 93% a dd ce se t 7 % a te0.4 ms a n r l y s n e ra d o 7 t h b o mai . t Nah n P S iia n H,Do l LS M e d ws KD. Lo ain o ta A, rnv sa ye , a o ct o f i ard se so y c n u t n o te me in n r e i c r a tn e mp ie n r o d ci f h o da ev n ap l u n l sy d o . J Ha d S r Br 1990; n r me n ug 15:8992. Crtra M e (6/ i i e t 6: 1, 3, 5, S u c : M e l e S ac . Ab rc: S i lt n i 1 c 2, 4, 6) o re di e rh n sta t t ai n m mu o se me t a r ss tec r a tn e wa p ro me fo 2 c p o i l g ns co h ap l u n l s ef r d r m m r xma t tedstlwrstce se(DW C) t 6 c dstla d S o h i a i ra o m i a n NAP ltn is ae ce wee rc r e o e te mide fn e i 7 n r la d 217 CTS r e od d v r h d l ig r n 0 o ma n h n s. Th f c l ae s o slwig wee rp re wi te mo ad e o a ra f o n r e o td t h h st c mmo ae o slwig 3 t 4 c dstlt teDW C wi slwig o n ra f o n o m ia o h t o n h p o i loteDW C b igu u a. r xma t h en n su l * u HE, La g B, La g S P e it n o o to Na ne n e . rdci o f uc me o f d c mp e o f r c r a tn e sy d o . J Ha d S r Br e o rssin o ap l u n l n r me n ug 1988; 13:391394. CrtraM e (1/ 3) S u c : M e l eS ac . i i e t 6: o re di e rh n Ne tu a S Gwada A,Ka t AN. M e in t- la se so y sah ri , r jn mah da -o un r n r n r ea t n p tnil mpi d rt a a ee to ig o i a jn t ev ci oe t a l u e ai s n lcr da n st du c o a t o c f rc r a tn e sy d o . Arh P y M e Re a i 1999; 56o ap l u n l n r me c h s d h bl 80:7 7 59. Crtra M e (n r l p p lt n std 3/ 3, 6). S u c : i i e t o ma o uai o u y 6: 4, o re M e l e S ac . Ab rc: Rer sp cie rve o p e iu y di n e rh sta t to e t v e iw f rvo sl o tie NCS d t i 46 n r l o tos t o ti n r t ed t f r ban d aa n o ma c nr l o ban o mai aa o v teme in t- la se so yn r ea t np tnil NAP a l u e h da -o un r n r ev ci oe t (S o a ) mpi d t rt (M US ai o AR) a d t dsc ss te p tnil u o M US n o i u h oe t a se f AR i n da n si o CTS Anir mi me in a d un r S ig o s f . t o c d da n la NAP wee s r rc r e a d te rsp cie M US e od d n h e e t v AR rt s wee c luae . ai o r ac ltd De rpie stt ia a ay s wa c mpee wi te a mpin scit v ai c l n lsi s o ltd t h ssu t st h o ta S h t NAP v le ae n t Ga ssin i dstiuin Th n r l au s r o u a n i rb t . o e o ma M US rn e fo .7 (5t p re t e t 2.5 (95t p re t e Th AR a g d r m 4 h ec ni ) o l h ec ni ). e l M US AR, b ig a ita eso a rt , ma d ce se te fl en n nrp r n l ai o y e ra h ase p si v s a d fl n g t e ta wo l oh r seai wh n u n o t e n ase e ai s h t ud tewi rse e sig i v a soue v le o S b lt au s f NAP a l u e F rh rstde ae n e e t mpi d s. u te u is r e d d o t d tr n te ciia a d a piain o te M US eemie h l c l n p l t n c o fh AR v le t te au o h da n si o CTS ig o s f . 185. Nil nVK. S n r a dmoo n r ec n u t ni teme inn r e ese e so y n tr ev o d ci n h o da ev i n r l be t AcaM e S a d197 194:435n o ma su jcs. t d cn 3; 443. CrtraM e i i e t (n r lp p lt n std 5/ 1, 4, 6) S u c : Bu hh l 197 o ma o uai o u y 6: 3, 5, o re c ta, 4. Ab rc: Orh d o cS sta t to r mi NAP weerc r e o e teme in n r e s r e od d v r h da ev u n n e l ee to e a tewrst n eb w atrst lt no te sig e de lcr d s t h i a d lo fe i ai f h mu o tu a d mide fn es. CM AP wee rc r e wi c n e ti h mb n d l ig r s r e o d d t o c nrc h n e l ee to e pa e i te e d lt z n o te AP atr e de lcr d s lc d n h n pae o e f h B fe st lt n a te wrsta d eb w. NCVs wee d tr n d f r28 i ai t h mu o i n lo r eemie o maea d 20 fmaen r lsu jcs a e 16 t 62 y as. Th r wa l n e l o ma be t g d o er ee s n sinfc n dfee c i NCV b t e maea d fmaesu jcs. o g iia t ifrn e n ewe n l n e l be t Th r wa ad ce sei NCV wi ice sig a e No CTS p t ns ee s e ra n t n ra n g . h ai t e weestde . r u id 186. Oc u ain l se seS r el n e Cap l u n l n r me M M W R c p t a Di a u v i a c . r a tn e sy d o . o l M o b M o tlW ky Re 1989; r ra l p 38:485489. Ba k r u d Reee c c go n frn e S u c : Ba e, o re k r 1990. 187 * o n J Ne l KJ Ru n y J S otn eg J Cap ltn e . Osb r B, wel , d e D, tl b r L. e ra u n l sy d o n r me a n M in soa d na h ge i s. J De t Hy mo g n e t e tl y inst n g 1990; 64(2):7 85. CrtraM e (2/ 1, S u c : M e l eS ac . 9i i e t 6: 2) o re di e rh n 188. P d a L, Lo M o a o M , Vae t EM , To ai P A u f l au nc lne n l A. seu ee to h silgcp rmee f rda n si o c r a tn e sy d o . lcr p y oo i aa tr o ig o s f ap lu n l n r me M u l Nev 1996; sce r e 19:48- CrtraM e (6/ 1, 3, 5, S u c : 53. i i e t 6: 2, 4, 6). o re M e l e S ac . Ab rc: I 43 p t ns (50 h n s) wi ciia di e rh n sta t n ai t e ad t l cl h n ma ie ain o mi - d rt CTS a d 36 h aty v lne r (40 nfstt s f l mo eae o d n el h ou tes h n s),o to r mi se so y n r ec n u t n v lct (S ad rh d o c n r ev o d ci eo i NCV) wa o y s me su e wi su fc ee to e i te me in n r e b t e te a rd t ra e lcr d s n h h da ev ewe n h tid dgta d p l a d b t e tep l a d wrst Th sefg rs hr ii n am n ewe n h am n i . e iu e wee u d t c luae te rt o dstlt p o i lc n u t n r se o ac lt h ai f i a o r xma o d ci o o (dstp o i l ai). Al 90 h n s weeasosu jce t oh rn r e i o r xma rt o l ad r l be td o te ev c n u t n stde u d f r da n si o CTS Al c nr lh n s o d ci o u is se o ig o s f . l o to a d p e ne dstp o i l rt s lss ta 1.0 rfe t g hg e rse td i o r xma ai e o hn elci n ih r c n u t n rts i tep o i lse me t I c nrst 49 o 50 CTS o d ci ae n h r xma g n. n o ta , o f h n s (98%) p e ne rv r drt s (> ad rse td e ese ai o 1.0) idc t gc mp o se n iai o r mi d n p o i lc n u t n Th se si vt o ti tstwa sinfc nl r xma o d ci . o e n t i f hs e i y s g iia t y g e trta ta o oh rmeh d e au td icu ig c mp rt e rae h n h t f te to s v lae , n ldn o aai v stde a d se me tlstd o tep l wrstp rin o teme in u is n g na u y f h am- i o t o fh da n r e S g na std o me in S ev . e me tl u y f da NCV wi c luain o te t ac lt h o fh dstp o i lrt i a se si v tc nq ef rda n si o CTS i i o r xma ai s o n t e e h iu o ig o s f i n p t ns wi n r lfn ig i stn ad n r ec n u t n stde ai t t o ma idn s n a d r ev o d ci e h o u is. Noe Th a to idc tdb c re o d n eta teme n S f r t: e uh r n iae y o rsp n e c h t h a D o teCo to DM L i Ta l 1 sh udra 3.2 0.4 a dn t 0.8 a h nr l n be o l ed n o 3.2 s p bi e . ul d sh 189. P d aL,Lo o a o M ,Grg r B,Vae t EM ,P d aR,To aiP au M nc e oi lne au nl . Ne r p y oo ia ca fc t na dse si vt i 500 c r a tn e u o h silgc l lssiiai n n t i n o i y ap l u n l sy d o h n s. AcaNe r lS a d 199796:211- . CrtraM e n r me a d t uo c n ; 217 i i e d (6/ 1, 3, 5, S u c : M e l eS ac . Ab rc: P o e t estd 6: 2, 4, 6) o re di e rh sta t r sp ci u y n v o 500 h n s (37 p t ns) wi ciia da n si o CTSsy tms. f ad 9 ai t t l c l ig o s f e h n mpo No ma v le fo tesa lb rtr p e iu yp bi e (P d a r l au s r m h me a o ao y rvo sl u l d a u , sh 1996). I te500 CTS p t ns, L wa p oo g d (55%), da nh ai t DM e s r ln e me in o to r mi se so yltn ywa p oo g d(D2, 4%;D3, %). Of rh d o c n r ae c s r ln e 7 67 te rmann 117 p t ns wi n r l DM L a d me in h e iig ai t e t o ma h n da o to r mi se so y stde o e 14 c te me in se so y p l rh d o c n r u is v r m, h da n r amwrstNCV o e 8 c wa a n r li 21% a d te dstp o i i vr m s b o ma n n h i o r xmo rt o teme inp l a ddgt g ns wa a n r ln87 ai f h o da am n ii se me t s b o ma i %. 190. P l y t S Hod nL. Rerco ystde i e ryd tcino c r a al ah K, le i fa tr u is n al ee t o f ap l tn e sy d o . Elcr my g Cl Ne r p y o 1990; u n l n r me e to o r i u o h sil n 30:307 309. CrtraM e (5/ 1, 4, 6) S u c : M e l eS ac . Ab rc: Usig i i e t 6: 3, 5, o re di e rh sta t n n p ie st l a d v rig te itrst ls itr a,te a soue ard i i n ayn h ne- i u nev l h b lt mu mu rfa tr p ro (ARP a d rlt e rfa tr p ro (RRP wee erco y eid ) n eai erco y eid v ), r d tr n d i 10 p t ns wi mi ee to h silgc c a g s eemie n ai t e t h l lcr p y oo i h n e d su g st eo CTS Th yf u dta tese so yRRP wa se si v i ge i f v . e o n h th n r s n t en i da n sige ryCTS ig o n al . 191. * a e G, Ol ir M F M i A, M a ca D. Cl iaP v si i ei v , sk ni i cl n ee to h silgc lc reain i tec r a tn e sy d o . Ia J lcr p y oo ia o rlt s n h ap l u n l n r me tl o Ne r lS i1986;:93- Crtra M e (3/ 2, 5) S u c : M e l e uo c 7 96. i i e t 6: 3, o re di n S ac . e rh 192. P a W S Ca n l CD, J h so EW . M e in t rda ltn y e se , n el on n da o a il ae c dfee c tst i mi c r a tn e sy d o . M u l Nev ifrn e e n l ap l u n l n r me d sce r e 1989; 12:905909. CrtraM e (4/ 1, 5, S u c : M e l eS ac . i i e t 6: 3, 6) o re di e rh n Ab rc: Th f l wigtc nq e weestde : (a a t r mi DS sta t e ol n e h iu s r u id ) ni o c L o d me in rda dfee c s t te tu ,(b a t r mi DS atr da a il ifrn e o h h mb ) ni o c L fe d st lt na tewrst n rc r igfo tetiddgt (c me in i ai t h i a d e o dn r m h hr ii ) da mu o , mi- ama DS c mp rd a a rt o te wrstt mide fn e d p l r L o ae s ai f h o i o d l ig r DS (d me in un r DS ltn y dfee c b t e te un r L, ) da la L ae c ifrn e ewe n h la

17 . 7

17 8.

17 9.

180.

181.

182.

183.

184.

S9 0CTS L 7 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

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S NAP rc r e fo tel t fn e atrst lt na tewrst n e o d d r m h i l ig r fe i ai t h i a d te mu o teme inDS atrst lt na tewrsta drc r igfo te h da L fe i ai t h i n e o dn r m h mu o mide fn e,a d (e me in moo DM L atrrc r ig fo te d l ig r n ) da tr fe e o dn r m h AP atr st lt n a te wrst Th e h n rd tit-h e B fe i ai mu o t h i. re u d e hrytre sy tmai h n s i 262 p t ns wee ii al e au td wi mpo t a d n c ai t e r nt l v lae i y t h su g o p o p t ns wi CTS e au td wi dfee ttst Th b r u s f ai t t e h v lae t ifrn e s. h e me inrda DS dfee c a dme inun rDS dfee c wee da a il L ifrn e n da la L ifrn e r mo l ey t b a n r lf l we b me in DS te tep l st i l o e b o ma ol d y da k o L h n h amt- i DS ltn yrt a dlst teDM L. o wrst L ae c ai n a l h o y P a W S Cu nn h m M L,W ash W E,J h so EW . Deemiig e se , n ig a l on n tr nn n u a rxa i c r a tn e sy d o . Am J P y M e Re a i e rp a i n ap l u n l n r me hs d h bl 1988; :117 119. Crtra M e (5/ 1, 4, 6) S u c : M e l e 67 i i e t 6: 3, 5, o re di n S ac . Ab rc: W i n e l st lt n a tewrsta d mip l e rh sta t t e de i ai t h h mu o i n d am, CM AP wee rc r e o e te AP i 25 CTS p t ns a d 23 s r e od d v r h B n ai t n e h atya mpo t p r n Th yf u dasinfc n dfee c i el h sy tmai eso s. e o n c g iia t ifrn e n tea l u eo teCM AP i teCTS g o pwh nc mp rdt te h mpi d f h t nh ru e o ae o h c nr l r u . Th yp o o ta ti i e ie c f r o d cinbo k o to g o p e r p se h ths s vd n e o c n u t o lc (n u a rxa i CTS e rp a i) n . P a W S Le HH, o n n EW . F ram me in n r ec n u t n e se , e J h so oe r da ev o d ci o v lct i c r a tn e sy d o . Elcr my g Cl Ne r p y o eo i n ap l u n l n r me e to o r i u o h sil y n 1990; 30:299302. CrtraM e (4/ 1, 4, S u c : M e l eS ac . i i e t 6: 3, 5) o re di e rh n Ab rc: Th NCV o te me in n r e i te f ram wa sta t e f h da ev n h o e r s d tr n d b 2 meh d (a st lt n i te f ram a d eemie y to s: ) i ai n h o e r n mu o rc r igten r ea t np tnil t h wrsta d(b st lt na e o dn h ev ci oe t a te i , n ) i ai t o a mu o tewrsta deb w wi rc r igo e teAP i 21 CTS p t ns h i n lo t e o dn v r h h B, n ai t e a d 16 c nr lsu jcs. Th y f u d ta te f ram NCV wa n o to be t e o n h t h oe r s slwe i te CTS g o p u n ete tc nq e Th a to s h v o d n h r u sig i r e h iu . h e uh r a e p o o dta ti su g st h t h r i p o i l ev d sf n t na r p se h t hs g e ta tee s r xma n r e y u ci s o arsut fme inn r ec mp e o i tec r a tn e. e lo da ev o rssin n h ap lu n l * eeso GW , W i AD. Ne r ee to ig o i tc nq e i P tr n l l we lcr da n st e h iu s n c p rp ea n r e ijre Orh p Cl No t Am 1988; eih rl ev nu is. to i n rh 19:1325. CrtraM e (0/ S u c : Naks, i i e t 6) o re r i 1990. * h ln GS Th c r a tn e sy d o : ciia e au t n o 598 P ae . e ap l u n l n r me l c l v lai f n o h n s. Cl Orh p 197 83:29- Ba k r u d Reee c . S u c : ad i to n 2; 40. c go n frn e o re Kaz1990 (JRh u tlg ). t e maoo y * h ln GS Th c r a tn e sy d o : se e te y as P ae . e ap l u n l n r me v ne n e r e p re c i da n si a dte t n o 654 h n s. JBo eJ it u g x ein e n ig o s n rame t f ad n on S r 1966; 48:211228. CrtraM e (1/ 2) S u c : M e es, i i e t 6: o re y r 1989. P ae GS Gad e W J La n e AA. Ne r p ty o te me in h ln , r n r , Lo d u o ah f h da n r e d e t c mp e o b n ah te ta sv r c r a l a n. J ev u o o rssin e e t h rn ese ap l i me t g Bo eJ it u g1950; A:109n on S r 32112. Ba k r u dReee c . S u c : c go n frn e o re Bru , a n 1989. P aaJ Co aaiev leo dfee tee to ig o i meh d i lj . mp rt v au f ifrn lcr da n st c to s n c r a tn e sy d o . S a JRe a iM e 197 3:101ap lu n l n r me c n h bl d 1; 108. Crtra i i e M e (4/ 1, 5, S u c : J y t 1989. Ab rc: Th f l wig t 6: 3, 6) o re o n, sta t e ol n o tc nq e wee stde : (a CM AP p tnil wee rc r e atr e h iu s r u id ) oe t s a r e o d d fe st lt n a tewrsta d rc r igwi c a il e deee to e i ai t h mu o i n e o dn t o xa n e l lcr d s, h (b o to r mi S ) rh d o c NAP wi st lt n o e te id x fn e a d s t i ai v r h n e ig r n h mu o rc r igwi su fc ee to e a tewrst(c n e l EM G u n a e o dn t ra e lcr d s t h i , ) e de h sig c a iln e l,(d ste ghd rt n c r e a d c r n x . F fysi o xa e de ) rn t/u ai u v s n h o a y it- x o c se o CTS a d 20 n r l su jcs wee e au td S n r a s f n o ma be t r v lae . e so y ltn is weemo el ey t b a n r lta teoh rtc nq e ae ce r r i l o e b o ma h n h te e h iu s k me su e . a rd P e o DC, Lo iin EL. Lu rc la d itr sse rc r ig i rstn gga mb ia n neo i e o dn n c r a tn e sy d o [ e c mme t . M u l Nev 1992;15: ap l u n l n r me se o ns] sce r e 12531257 Crtra M e (5/ 1, 4, 6) S u c : M e l e S ac . . i i e t 6: 3, 5, o re di n e rh Ab rc: M e in moo stde ae c mmo l n r l i mi sta t da tr u is r o ny o ma n l d c r a tn e sy d o (CTS Ths rfe t ete te sp rn o ap l u n l n r me ). i elcs i r h h ai g f moo c mp rd t se so y fb r o te ia i t o c n e t n l tr o ae o n r ies, r h n bl y f o v ni a i o stde t d tc a a n r l y A n v la p o c t d mo stae u is o ee t n b o mai . t o e p r a h o e n rt e ry moo fb riv le n i CTS i tepa e n o tesa al tr ie n ov me t n s h lc me t f h me a t e ee to e ltrlt te tid mea ap l alwig rc r ig ci lcr d aea o h hr v tc r a, l n e o dn o fo tese o d lmb ia o ted e e itr sse, e st lt g r m h c n u rc l r h e p r neo i wh n i ai mu n te me in o un rn r e a te wrst rsp ciey W ec mp rd h da r la ev s t h i , e e t l. v o ae tedfee c b t e te ltn is i 51 n r lc nr lh n s t h ifrn e ewe n h se ae ce n o ma o to a d o 107 c n c t e p t n h n s rfre wi sy tms a d sin o se ui ai t a d eerd t mpo v e h n gs su g st e o CTS wh wee su se u nl p o e t h v ge i v f , o r b q et y rv n o a e ee to h silgc CTS b stn ad n r e c n u t n ci ra A lcr p y oo i y a d r ev o d ci o rt i. e p oo g d lmb ia-neo i ltn y dfee c (> r ln e u rc litr sse ae c ifrn e 0.4 ms) wa s f u d t b ase si v idc tro CTS i alp t n g o p I wa on o e n t e n iao f i n l ai t r u s. t s e aso h lf l i p t ns wi c e i e t p ln u o ah , wh r l ep u n ai t e t o xstn oy e r p ty h ee lc l ain o me in n r e p too y a te wrstwa oh r se o ai t z o f da ev ah lg t h i s tewi dfiut ifc l . 201. * rstn DC,Ro M H,Koh r M J P okn GM ,Ve k tsh S Pe o ss tai , lti n ae , Lo iin EL. Th me in un r ltn y dfee c stde ae gga e da - la ae c ifrn e u is r c mp rbei mi c r a tn e sy d o . M u l Nev 1994;17 o aa l n l ap l u n l n r me d sce r e : 1469- 1. CrtraM e (2/ 1, S u c : M e l eS ac . Ab rc: 147 i i e t 6: 3). o re di e rh sta t n Co ae se si vt 159 p t ns o o to r mi p l wrstmie mp rs n t i i y ai t f rh d o c am- i e xd p l rme in un rp a ltn y dfee c wi n r l< ms, ama da - la e k ae c ifrn e t o ma 0.4 h a t r mi wrstD4 se so y me in un ro se ltn y dfee c ni o c i d n r da - la n t ae c ifrn e wi n r l 0.5 ms, n tese o dlmb ia/ tr sse moo wi t o ma < h a d h c n u rc l neo i tr t i h n r l< o ma 0.5 ms. S e dsc ssin o b n ft o tc nq e a d e i u o f e ei f e h iu s n s da rms o ee to epa e ns a d l ed a n s o ee to ea d ig a f lcr d lc me t n i rwig f lcr d n n st ltrpa e n. i ao lc me t mu 202. P e c G. Th efc o st ls itn t i moo ltn yi c r a rswik e fe t f i u ne si n tr ae c n ap l mu y tn e sy d o . J Ne r lNe r su g P c ity 1963; u n l n r me uo u o r sy har 26:398401. Crtra M e (4/ 1, 5, S u c : Lo n , 197 Ab rc: W i i i e t 6: 3, 6) o re og 1. sta t t h st lt n a tewrsta d c a iln e l ee to erc r ig fo i ai t h mu o i n o xa e de lcr d e o dn r m te AP DM Ls wee rc r e a su e- xma st lt n a d h B, r e o d d t p rma i l i ai n mu o trsh l st lt n i 29 CTS h n s fo 25 p t ns a d 25 h e od i ai n mu o a d rm ai t n e c nr lsu jcs. Ov r80% o te p t ns wee ie t id wi a o to be t e f h ai t r d ni e e f t n h a n r l y ete wi su e- xma st lt n o trsh l b o mai i r t t h h p rma i l i ai mu o r h e od st lt n Th e od st lt n wa mo e se si v ta su ei ai . mu o rsh l i ai mu o s r n t e hn pr i ma i l i lt n xma st ai . mu o 203. Re dRL. S rss tst gi n r ec mp e o . Ha dCl 1991;:521a te e i n ev o rssin n i n n 7 526. Crtra M e (1/ 3). S u c : M e l e S ac . Co i i e t 6: o re di n e rh mme t n: Isp cin o te ta ig i te at l idc ts ta te n n n et o f h rcn s n h ri e n iae h t h o c p y ca a to c a g d te swe p sp e a d g i d rn te h siin uh r h n e h e e d n an u ig h rc r ig whc c st d u to tea c rc o tec n lsin a d e o dn s ih a s o b n h c u a y f h o cu o s n c n o n s terp o u ii t o teme su e ns. o f u d h e r d cbl y f h i a rme t 204. Re mo d M D,Rin rM H. F l p si v ee to ig o i tst i d n ve ase o t e lcr da n st e s n i c c r a tn e sy d o . M u l Nev 1988; ap lu n l n r me sce r e 11:511518. CrtraM e i i e t (4/ 1, 5, S u c : M e l e S ac . Ab rc: S v rltc nq e 6: 3, 6) o re di e rh n sta t e ea e h iu s weee au tdi an r l o uainu n l eau en r t a ss r v lae n o ma p p lt o sig i rtr o ms o sse t f rsp cfct i 100 h n s o 50 n r l be t F fe np re to o e iii n y ad f o ma su jcs. ite ec n f te h n s (30% o p o l) e hbtd a a n r lme in t- la h ad f e pe x ii e n b o ma da -o un r se so ya l u ert ,8% o h n s (14% o p o l) h d a n r l n r mpi d ai t o f ad f e pe a b o ma rsiu lltn is,a d 4% o h n s (8% o p o l) h d p oo g d e d a ae ce n f ad f e pe a r ln e me in un r p l t wrst ltn y (8 c da - la am o i ae c m) dfee c s. Th y ifrn e e su g std a mo e c n r aie a n r l y o > ge e r o sev t v b o mai f 0.5 ms b t e t ewe n me in a d un r n r e f r mip l st lt n t a od fl da n la ev o d am i ai o v i ase mu o p si v tst f rCTS NoCTS p t ns weestde . o t ee s o i . ai t r u id e 205. Re e D, Ev n f B, Ama i P d Kr m M , F a ki G, mp l a of do C, e o rn l n F a z luA, a R, r F Ha b r M , ls T, t J P a sk rn ba Gry Ger , g eg Hae Kaz N, rn y G. Co se su ci raf rteca fc t no c r a tn e sy d o n n s rt i o h lssiiai f ap l u n l n r me e o i e ie oo i stde Am J P bi He l 1998; n pd milgc u is. ul c at h 88:1447 1451. S u c : M e l e S ac . Ba k r u d Reee c . Ab rc: Crtra o re di e rh n c go n frn e sta t i i e f r te ca fc t n o c r a tn e sy d o o h lssiiai o f ap l u n l n r me f r u i o se n e ie oo i stde wee d v lp d b me n o a c n n s pd milgc u is r e eo e y a s f o se su p o e Twev me ia rse rh r wi e p re c i c n u t g r c ss. le dc l e ac es t x ein e n o d ci h n e ie oo i stde o c r a tn e sy d o p riiae i te pd milgc u is f ap l u n l n r me at p td n h c p o e Th g o p ra h d a re n o se ea c n e ta i e r c ss. e r u e c e g e me t n v rl o c pu l ssu s. F r , whl tee i n p re t g l stn ad f r c r a tn e ist i h r s o efc od a d r o ap l u n l e sy d o ,te c mbn t n o ee to ig o i std fn ig a d n r me h o iai f lcr da n st u y idn s n o c sy tm c aa trst s wi p o ie te mo a c rt if r t n mpo h rcei i c l r vd h l st c u ae n o mai o f r da n si o c r a tn e sy d o . S c n , u o o l o ig o s f ap l u n l n r me e o d se f ny ee to ig o i std fn ig t da n se CTS i n t lcr da n st c u y idn s o ig o s o rc mme d d F n l , sp cfc c mbn t n o sy tm eo n e. ial y e ii o iai s o f mpo c aa trst s a d p y c le a n t n fn ig ma b u f lt h rcei i n h sia x miai idn s c o y e seu o da n se CTS b tae l ey t rsuti g e trmi lssiiain o ig o u r i l o e l n rae sca fc t k o f p t ns ta tec mbn t no fn igo teciia hstr a dte ai t h n h o iai f idn n h l c l i o y n h e o n rsut o ee to ig o i stde e l f lcr da n st u is. s c 206. Re a i M , To rei F Di Blsi F Un ii A. Ex lsie pc rir , ao , cn cu v ee to h silgc lmoo iv le n i c r a tn e sy d o . lcr p y oo ia tr n ov me t n ap l u n l n r me Cl Ne r p y o 1999;110: 147 147 Crtra M e (2/ 3, i n u o h sil 1- 4. i i e t 6: 5) S u c : M e l eS ac . o re di e rh n 207 Re n e LA,Ad mo AS Bo o iAP Ca r HA,Ki i P . se d a , nn O, sto mad A, F rig er CH, S h l AO. Te o a n w tc nq e f r te o t u ra n c ep st f e e h iu o h da n si o c r a tn e sy d o . J Elcr my g Kie o ig o s f ap l u n l n r me e to o n sil 2000; 10:127 133. CrtraM e (4/ 1, 5, S u c : M e l eS ac . i i e t 6: 3, 6) o re di e rh n Ab rc: S u yo 55 CTSh n s (32 p t ns) c mp rdt 40 n r l sta t td f ad ai t o ae o e o ma h n s (20 n r lsu jcs) o te dfee c b t e te me in ad o ma be t f h ifrn e ewe n h da moo dstlltn y t te se o d lmb ia mu l a d te un r tr i a ae c o h c n u rc l sce n h la moo dstlltn y t te itr sse mu l. Th tstwa mo e tr i a ae c o h neo i sce e e s r se si v t ie t y CTS ta me su e n o te me in moo n t e o d ni i f h n a rme t f h da tr dstlae c t teAP i a ltn y o h B.

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208. Re n e LA,Ale RP Ca r HA,Ki i P F rig er CR, se d vs , sto mad A, o t u ra n S h l AO. S ln p ro i c r a tn e sy d o . Elcr my g c ep i t eid n ap l u n l n r me e to o r e a d Cl Ne r p y 2000; n i n uo h s 40:31- Crtra M e (4/ 1, 5, 36. i i e t 6: 3, 6) S u c : M e l eS ac . Ab rc: Th r wa n c reain b t e o re di e rh n sta t ee s o o rlt o ewe n tesi n p ro atrt n a dtese ei o teCTSi 20 h n s o h l t eid l ai s n h v rt f h e e o y n ad f 20 CTSp t ns c mp rdt 20 n r l be t ai t o ae o e o ma su jcs. 209. * v e M H. Cap ltn e sy d o : a ci q e o n we n r e Rin r r a u n l n r me rt u f e r ev i c n u t n tc nq e I: AAEM 1991 Co r D: F c lp rp ea o d ci e h iu s. n o u se o a eih rl n u o ahe see td tpc Ro h str M N: Ameia Asso it n e r p tis: lce o is. c e e, rc n cai o o Elcr da n st M e iie 1991. CrtraM e (2/ 2, S u c : f e to ig o i c dcn ; i i e t 6: 6) o re AAEM Co sutn 1993. n l t a 210. Ro iso LR, ike nP , a gL. Opi zn ten mb ro tst bn n M c lse J W n t ig h u e f e s mi f r c r a tn e sy d o . M u l Nev 2000; o ap l u n l n r me sce r e 23:18801882. Crtra M e (3/ 3, 6). S u c : M e l e S ac . Ab rc: Th i i e t 6: 5, o re di n e rh sta t e c mbn d se so y id x (CS ),tesu o treltn y dfee c s, o ie n r n e I h m f h e ae c ifrn e me in un ra r ss te p l (p l if me in un rt te rn da - la co h am amdf), da - la o h ig fn e (rn df),a d me in rda t te tu (tu df),h s ig r ig if n da -a il o h h mb h mb if a hg e se si vt a d rl bl y f rCTS ta idvd a tst Th ih r n t i n ei i t o i y a i h n n iiu l e s. e o jcie o ti std wa t d v lp a a p o c ta mii z s be t v f hs u y s o e eo n p r a h h t nmie tst g b tma i z s a c rc . A rto e t estd o 300 h n s ei u n xmie c u a y er sp ci u y f v ad d tr n d ta tee wee e d ons f r idvd a tst ta eemie h t h r r n p it o n iiu l e s h t c n ie t p e itdtersut o teCS ;f rrn e b t e te o fd nl rdce h e l f h y s I o a g s ewe n h se e d ons,f rh rtst g wa rq ie . Th sern e wee p l if n p it u te e i n s e urd e a g s r: amdf 0- ms; ig if0.1- ms; n tu df 0.2- ms. Th rf r,f 0.3 rn df 0.4 a d h mb if 0.7 eeo e i tersut o o eo te tretst e c e e te v le i wa n t h e l f n f h se h e e s x e d d h se au s,t s o s n c ssayt p ro m al h NCSn c ssayt c luaeaCS wi o t e e r o ef r lte e e r o ac lt I t u h lss o se si vt a drl bl y o f n t i n ei i t. i y a i 211. Ro iso LR,M ike n P ,W a g L. S rtge f ra ay ig n r e bn n c lse J n tae is o n lzn ev c n u t n d t: su eirt o a su o d ci aa p ro i f o y mmay id x o e sige tst r n e v r n l e s. M u l Nev 1998; sce r e 21:1166- 1. Crtra M e (5/ 1, 3, 6) 117 i i e t 6: 2, 5, S u c : M e l eS ac . Ab rc: Co ai no trestae is f r o re di e rh n sta t mp rso f h e rtge o da n sig CTS wi NCS u o asigeNCS rsut rq ie n ig o n t h s: se f n l e l e urme t ; ta o e t , rtreo treNCS rsut t b a n r l a du h t n , wo o h e f h e s e l o e b o ma; n se s o asigesu f n l mmay v ra l ic r o aig d t fo tredfee t r aibe n o p rt n aa r m h e ifrn NCS S xyfv h n s o su jcs wi o t ciia CTS wee s. it-ie a d f be t t u l cl h n r c mp rdwi 66 h n s wi ciia CTS Th e ltn ydfee c s o ae t h a d t l cl h n . re ae c ifrn e wee me su e : me in un r (8 c r a rd da - la m) mip l r o to r mi d ama rh d o c (p l if me in un rrn fn e (14 c a t r mi (rn df); amdf); da - la ig ig r m) ni o c ig if d a d me in rda tu n da -a il h mb (10 c a t r mi (tu df). Th m) ni o c h mb if d e c mbn dse so yid x(CS ) wa tesu o te tredfee c s. o ie n r n e I s h m f h se h e ifrn e S n t i f r te tst wa p l if 69.7 e si vt o h e s i y s amdf %, rn df 7 ig if 4.2%, tu df 7 h mb if 5.8%, a d CS 83.1%. S e iii wa 95.4n I p cfct y s 96.9%. Re urn o e t ,o tre o tre tst t b a n r lyed d q iig n , wo r h e f h e e s o e b o ma ile se si vt s o 84.8%, 4.2%, r n t ie f i i 7 o 56.1%, e e t ey b t e iii e rsp ci l, u sp cfct s v i o 92.3%, 98.5%, a d 100%, rsp ciey W e c n ld ta a f n e e t l. v o cu e h t c mbn d id xi r v s da n st ca fc t no e u o sige o ie n e mp o e ig o i lssiiai v r se f n l c o tst e l e rsut s. 212. Rovr jS S rc aia e W ,Ko wo W ,W o g watn n n J jio , iih t p e v wsu n n wi t a o , a Ta mma to gN, e rvp ov r P P e rs i tec r a tn e. A nh n J ea io lan . rssu e n h ap l u n l c mp rso b t e p t ns wi c r a tn e sy d o a dn r l o ai n ewe n ai t t ap lu n l n r me n o ma e h su jcs. JBo e J itS r Br1990;2:516be t n on u g 7 518. Crtra M e (3/ i i e t 6: 1, 6) S u c : M e l eS ac . 3, o re di e rh n 213. Ro ca c J Co k TM ,Big a RC. S n r n r e rc v r se rn e C, o nhm e so y ev e o ey f l wig me in n r e p o o ain i c r a tn e sy d o . ol n o da ev r v c t o n ap l u n l n r me Elcr my g Cl Ne r p y o 199737 e to o r i u o h sil n ; :219229. CrtraM e (6/ i i e t 6: 1, 3, 5, S u c : M e l e S ac . Ab rc: Th ltn y a d 2, 4, 6) o re di n e rh sta t e ae c n a l u e o o to r mi me in S mpi d f rh d o c da NAP fo p l t wrstwee t r m am o i r me su e 5 miue b f r a d a itr as u t 10 miue u t a rd n ts eo e n t nev l p o n ts ni l rc v r atrsu an d ma i lwrstfe in c mbn d wi te e o ey fe stie xma i lxo o ie t h h fn es si l n o sl p ro mig fn e fe in a an rsi a c . ig r mut e u y ef r n ig r lxo g ist e stn e a 35 h n s wi a ciia da n si o CTS weesu dvd d it 24 ad t h l c l ig o s f n r b iie no wi a p oo g d b seie ltn y (+NCS a d 11 wi n r l t h r ln e a l n ae c ) n t o ma h ltn is (- ),a d 25 a mpo t c nr lh n s weestde . ae ce NCS n sy tmai o to a d c r u id F u me su e wee a ay e : dfee c i ltn y a d a l u e o r a rs r n lz d ifrn e n ae c n mpi d t b f r fe in a d a 2 miue atr r , t eo e lxo n t n ts fewad i f r te S me o h NAP a l u e t rc v rt 95% ii a v le a d t f rltn y t mpi d o e o e o t nt l au , n i o ae c o i me rtr t ii a ltn y Th ltn y ice se o l 1- i CTS eu n o nt l ae c . i e ae c n ra d ny 2% n h n s c mp rd t c nr l b ttea l u ed ce se t ag e tr a d o ae o o tos, u h mpi d e ra d o rae t e tn (17 c mp rd t c nr lh n s (2%) a d te a l u e xe t %) o ae o o to a d n h mpi d t rc v r t wa ln e. F rg o p me n rc v r t s wee0.6 e o ey i me s o g r o r u s, a e o ey i me r mi c nr l 2.25 mi CTS (- ) g o p a d p rd xc l ,4.7 n o tos, n NCS r u , n , aa o ial y 4 mi f rCTS (- ) g o p Ampi d rc v r t g e trta n o NCS r u . l u e e o ey i t me rae h n 1.62 mi (a mpo t me n + 2S wa c n d rd a n r lf r n sy tmai c a D) s o siee b o ma o idvd a h n s. W i ti ci ro ,a n r l is wee p e n i n iiu l a d t hs rt in b o mai e h e t r rse t n 7 o ciial sy tmai h n s, n ldn 8 o 11 wi o t te 1% f l c l mpo t a d icu ig f n y c t u oh r h NCS a n r l is. S b o mai e NAP rc v r t ma b c mpi nay t t e o ey i me y e o l tr o me oh rNCSt da n si CTSb t o s n t e lc me ino to r mi te o ig o s u d e o rpa e da rh d o c p l wrst NAPltn yme su e ns t da n seCTS am- i S ae c a rme t o ig o . Ro nI Ne r p y oo ia da n si o tec r a tn e sy d o : se . u o h silgc l ig o s f h ap l u n l n r me e au t n o n u o rp i tc nq e S a d JP a Re o st S r v lai f e r g a hc e h iu s. c n o lst c n r u g Ha d S r 1993; :95n ug 27 101. Crtra M e (4/ 3, 5, S u c : i i e t 6: 4, 6) o re M e l e S ac . Ab rc: Rer sp cie std o 28 p t ns di n e rh sta t to e t v uy f ai t e da n se wi CTS o b si o c mbn t n o ciia,NCS a d ig o d t h n a s f o iai f l c l o n n EM G d t. Th me in moo DM L, rh d o cme in S aa e da tr o to r mi da NCV f r o D1 a d D3,p l r mie me in NCV wee me su e a d te n ama x d da r a rd n h q oin o S u t t f NCV a r ss CT t f ram weec luae i 86 n r l e co o oe r r ac ltd n o ma c nr l a d tersut c mp rd t tesa stde i te28 CTS o tos n h e l o ae o h me u is n h s p t ns. Th p l rmie me inNCV wa su eirt teq oin ai t e e ama x d da s p ro o h u t t e oS f NCV a r ss CT t f ram a dteoh rtst f rteda n si o co o o e r n h te e s o h ig o s f CTS . Ro n egJ Aneiritr sse u me inn r eltn yrt . Arh se b r N. tro neo o s/ da ev ae c ai o c P y M e Re a i 1990;1:228hs d h bl 7 230. Crtra M e (4/ 1, 5, i i e t 6: 3, 6) S u c : M e l eS ac . Ab rc: W i st lt na tea tc btl o re di e rh sta t t i ai t h ne u i n h mu o a f ssa a d si l n o s rc r ig o e te AP a d p o ao o n mut e u e o dn v r h a B n r n tr q a rts (n e l ee to e DM Ls wee d tr n d fo 100 u d au e de lcr d ) r eemie r m a tro itr sse u n r e i 61 n r lv lne r 5 p t ns wi neir neo o s ev s n o ma ou tes, ai t t e h a tro itr sse u sy d o , n 35 p t ns wi CTS Th rsut neir neo o s n r me a d ai t t e h . ee l s sh w a n r l rt s f r b t CTS a d a tro itr sse u o b o ma ai o oh o n neir neo o s sy d o . n r me Ro S Gin iiF P sseo S P rdso C,Bat iiN,Cin R. ssi , a nn , a r , aa i t st i n oi S n r n u a c n u t n o me in n r e fo dgt a d p l e so y e rl o d ci f da ev r m ii n am o s st lt n i c r a tn e sy d o . Elcr e c p ao r Cl i ai n ap l u n l n r me e to n e h lg mu o i n Ne r p y o 1994; u o h sil 93:330334.Crtra M e (4/ 3, 5, S u c : i i e t 6: 4, 6) o re M e l e S ac . Ab rc: A v rain o p l rst lt n wi di e rh n sta t ait o f ama i ai mu o t h mo edstlst lt n o e temea ap p aa g a itr a e so r i a i ai v r h mu o tc r o h ln e l nesp c s ta tec n u t ndstn e wa 1- c ln e ta teu a 8 c h t h o d ci i a c s s 1.5 m o g r h n h su l m o o to r mi p l rc n u t n std . Th mo e dstlst lt n rh d o c ama o d ci o uy e r i a i ai mu o wa p ro me t e au t teme in n r ep l rb a c e t te s ef r d o v lae h da ev ama rn h s o h a jc n su fc s o te id x a d mide fn e (P te mide da e t ra e f h n e n d l ig r 2), h dl fn e a d rn fn e (P a d te un rp l rb a c e t te ig r n ig ig r 3), n h la ama rn h s o h a jc n su fc s o tern a d l t fn e (P Th a to s n td da e t ra e f h ig n i l ig r 4). e uh r oe te ta te se si vt o te mo iid o to r mi p l r std ht h n ti f h i y dfe rh d o c ama u y p rl ld te se si vt o o to r mi me in se so y dgt aal e h e n ti i y f rh d o c da n r ii st lt nstde t da n seCTS Th mo iidp l r i lt n i ai u is o ig o mu o . e dfe ama st ai mu o tc nq e h d te a v na e (1) o fe u nl d mo staig a e h iu a h d a tg s f rq e t e n rt y n me su a l rsp n i CTS p t ns wi st lt n a P wh ra a rbe e o se n ai t t i ai t 3 e h mu o ee s te rsp n wa a se t wi st lt n o D4 a d (2) o h e o se s b n t i ai h mu o f n f d mo staig a a n r l ywh n tersp n wi st lt n a e n rt n n b o mai t e h e o se t i ai t h mu o P wa n r l S n etea to s u dNCS ci rat see t ains 2 s o ma. ic h uh r se rt i o lc p t t e e f rtestd ,teciia se si vt a d sp cfct o temo iid o h u y h l c l n t i n e iii f h n i y y dfe p l rstde c ud n tb c luae ato g te c ud c mp r ama u is o l o e ac ltd l u h h y o l o ae h tese si vt o o estd t a oh r h n t i f n u y o n te. i y S c etDL,S ru S Rih r so W S Ro n eg W ,Ha n s RB. ak t ta s E, c ad n , se b r ye Evd n eb se me iie h w t p a t e a d ta h EBM . Ne ie c - a d dcn : o o rci n e c c w Yo k Ch rhl Liig o e 2000. Ba k r u d Reee c . S u c : r: u c i vn stn : l c go n frn e o re AAEM 2000 CTSTa F reme e. sk o c mb r S lr oDF F a z luA, en rRA, o egM B, msto gTJ aen , rn ba W re Br mb r Ar r n , Ales J . M e in a d un r n r e c n u t n stde a n br W da n la ev o d ci o u is mo g wo k r n r t ev le M u l Nev 1998; r es: o mai au s. v sce r e 21:9991005. Crtra i i e M e: (n r lp p lt n std 4/ 1, 5, S u c : M e l eS ac : t o ma o uai u y 6: 2, 6) o re o di e rh n Ab rc: To d tr n n r t e v le f r NCS a n a t e sta t eemie o mai au s o v mo g ci v wo k r ap o e t eco se t n lstd wa p ro me o a t e r es, r sp ci r ss- ci a u y s ef r d f ci v o v wo k r i c nrstt tetpc lrfrn ep p lt n Th a to s r es n o ta o h y ia eee c o uai s. e uh r o see td asu se o 326 wo k r fo 955 su jcs wh p riiae lce b tf r es r m be t o at p td c i me ia su v y i tewo k lc . Bi trl da (D2) a dun r n dc l r e s n h r pa e l ea me in a n la (D5) a t r mi se so yc n u t nstde o e a14 c c n u t n ni o c n r o d ci u is v r d o m o d ci o dstn e t te wrst wee p ro me atr c e kn mip l iac o h i r ef r d fe h c ig d am tmp rtr t b 32.0 d g e s c nird o g e trwi o wi o t e eau e o e e re e t a e r rae t r t u g h h wamigtel ;l tmp rtrs ween tmo i rn d rn te r n h i mb i e eau e r o mb nt ig u ig h o std (p r n lc mmu iain M e in a d un rS u y eso a o nc t ). o da n la NAP a l u e mpi d t a d ltn y (o se a d p a ) wee me su e . W o k r wi u p r n ae c n t n e k r a rd r es t p e h e te t sy tms,me ia c n i o s ta c ud a v r l afc xrmi y mpo dc l o dt n h t o l d esey fe t i p rp ea n r ef n t n lw h n tmp rtr,o hg l rp t ie eih rl ev u ci , o a d e eau e r ihy e ei v o t jb wee e cu e fo te n r l c h r. Lie r rg e o os r x ld d r m h o ma o o t n a e rssin mo es e pan d v ra c i n r e f n t n wi c v rae o a e d l x lie ain e n ev u ci o t o ait f g , h se , h n tmp rtr, a d a tr p merc fco s a d p o ie x a d e eau e n nh o o ti a tr n r vd

214.

215.

216.

217 .

218.

S9 2CTS L 7 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

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e ie c ta ee to ig o i tst g sh ud c nr l f r to vd n e h t lcr da n st e i c n o l o to o h se rlv n c v rae t i r v da n st a c rc . Th me in un r ee a t o aits o mp o e ig o i c u a y e da - la c p a ltn ydfee c wa teb st a r t u i c re t n ae e k ae c ifrn e s h e me su e o se f o rci s r o n tma e t a c u tf rrlv n c v rae Ho v r te a to s o d o c o n o ee a t o aits. we e, h uh r n td te 95t p re t e a 0.8 ms i a t ewo k r i c nrstt oe h h ec ni t l n ci v r es n o ta o c re t stn ad o 0.4 t 0.5 ms so ta c re t stn ad f r u rn a d r s f o h t u rn a d r s o da n sigCTSa n wo k r a p a tose si v . ig o n mo g r es p e r o n t e i 219. S lr o DF W en r RA,Ales J ,Be k r M P Ar r n TJ aen , re br W ce , msto g , F a z lu A. Reibl y o n r e c n u t n stde a n a t e rn ba l i t f ev o d ci a i o u is mo g ci v wo k r M u l Nev 1999; r es. sce r e 22:137 137 Crtra M e (wo k r 2- 9. i i e t re p p lt n std 4/ 1, 5, S u c : M e l e S ac . Ab rc: o uai o u y 6: 3, 6). o re di n e rh sta t P o e t estd o teitre a n ra ditae a n rrl bl y r sp ci u y f h ne-x mie n nr-x mie ei i t v a i f r te me su e n o a t r mi me in (D2) a d un r (D5) o h a rme t f ni o c da d n la se so yc n u t nfo wrst t c n u t ndstn eo 14 c a d n r o d ci r m i wi o d ci i a c f o h o m n wi o ta ea ig o rsp n s. Th fr r u d o tst g e au td t u v rgn f e o se h e ist o n f e i v lae n itre a n rrl bl yi 158 wo k r b c mp rso o tersut ne-x mie ei i t n a i r es y o ai n f h e l s o NCS p ro me b t dfee te a n r o tesa d y Th f ef r d y wo ifrn x mies n h me a . e se o d r u d o tst g wa p ro me 3 we k ltra d a ay e cn o n f e i n s ef r d e s ae n n lz d d t fo 58 su jcs rtstdb e a n r1 a d7 su jcs rtstd aa r m be t ee e y x mie n 6 be t ee e b e a n r2. M ip l tmp rtr wa rc r e a teb gn ig y x mie d am e eau e s e o d d t h e inn o tst g a d su jcs wi c o h n s weewame t 32 d g e s fe i n n be t t o l a d h r r do e re c nird wh n p ssil; tmp rtr wa n t mo i rd et ae g e o be e eau e s o nt e o c niu u y d rn te tst g Th d t wa a ay e wi a d o t o sl u ig h e i . n n e aa s n lz d t n h wi o t o rcino ltn yme su e ns b 0.3 ms f r a hd g e t u c re t h o f ae c a rme t y o e c e re b lw 35 d g e s c nird . Itre a n rrl bl ya ay s n td eo e re e t a e ne-x mie ei i t n lsi oe g a i (1) me in se so y n r eme su e ns o a l u e o se ltn y da n r ev a rme t f mpi d , n t ae c , t a d p a ltn y wee mo e rl be ta un r me su e ns, n e k ae c r r ei l h n la a a rme t (2) a l u ea dp a ltn yme su e ns weemo erl beta mpi d n e k ae c t a rme t r r ei l h n a o se ltn y me su e ns, (3) te me in un r p a ltn y n t ae c a rme t h da - la e k ae c dfee c h dc n stnl hg rl bl y (4) un r n tae c h d ifrn e a o si e t ih ei i t, y a i la o se ltn y a te p o e rl bl y Itre a n rrl bl y a ay s sh we a h o rst ei i t. ne-x mie ei i t n lsi o d a i a i hg c n r e c b t e e a n r a d te sa p t r o itr ih o g u n e ewe n x mies n h me at n f nee e a n rrsut b t e me ina dun rme su e ns a n tdi x mie e l ewe n da n la a rme t s oe n s te itae a n rrl bl y a ay s d scie a o e Te eau e h nr-x mie ei i t n lsi e rb d b v . mp rtr a i c re t n ma e a smal c a g i rl bl y o un r ltn y o rci o d l h n e n ei i t f la ae c a i me su e ns. Ba do te rsut tea to s rc mme d dta a rme t se n h se e l h uh r e o s, n e ht tesa e a n rp ro m terp ae NCS i ln i dn lstde h me x mie ef r h e e td n o gt ia u is u t mii z itre a n rv ra i t a d u o me in un rp a o nmie ne-x mie aibl y n se f da - la e k i ltn ydfee c s (i a dt nt sh r se me t rh d o cme in ae c ifrn e n d i o o o t g n o to r mi da i n r estde t e au t p t ns f rCTS ev u is) o v lae ai t o e . 220. S n e HW , it C, a d hP Ch k o et S S n t eme in adr Quno S a e B, o r v ry . e si v i da un r moo c mp rt e tc nq e i c r a tn e sy d o . la tr o aai e h iu s n ap l u n l n r me v M u l Nev 1999; sce r e 22:88- Crtra M e (5/ 1, 4, 6) S u c : 98. i i e t 6: 3, 5, o re M e l e S ac . Ab rc: CTS wa da n se i 50 p t ns (7 di e rh n sta t s ig o d n ai t 9) e h n s b se o a c mbn t n o ciia a d ee to ig o i ad a d n o iai o f l c l n lcr da n st n c ci ra(me inp l wrst x dNAP o se ltn yg e trta 1.7 rt i e da am- i mie n t ae c rae h n ms o o se ltn ye c e teisi trl la p l wrst ae c b r n t ae c x e d h p l ea un r am- i ltn y y a mo e ta 0.3 ms a d scie b J c so a d Cl f r i 1988). r hn s e rb d y a k n n i od n f Th e moo c n u t nstde weee au td teme in te a t re tr o d ci u is r v lae : h o da -h n r o un rte a ltn y dfee c (TTLD),teme in te a t un r la-h n r ae c ifrn e h da - h n r o lah p te a ltn y dfee c (THLD),a d te un rt- da F y oh n r ae c ifrn e n h la-o me in wa e ltn y dfee c (F LD). Th a n r lc tfs b se u o v ae c ifrn e W e b o ma uo f a d p n 34 n r lc nr l ae TTLD,0.8 ms;THLD,1.2 ms;F LD,0.6 o ma o tos r: W ms. Th da n st se si vt s wee 95e ig o i n t i e r: c i i 98%, 88%, n 7 7 85a d 5- 8%, rsp ciey i ti CTSp t n g o pwi a n r l da se so y e e t l, n hs v ai t r u t b o ma me in n r e h c n u t nstde a d scie a o e o d ci u is s e rb d b v . o 221. S esa S Hesk vt S Bir P Beg rAR. M e in mie a d c l N, r o i , ei , r e z da xd n se so y n r e c n u t n stde i c r a tn e sy d o . n r ev o d ci o u is n ap l u n l n r me Elcr e c p ao r Cl Ne r p y o 1998; e to n e h lg i n u o h sil 109:268- 3. Crtra 27 i i e M e (6/ 1, 3, 5, S u c : M e l eS ac . Ab rc: Toa ss te t 6: 2, 4, 6) o re di e rh sta t n sse h se si vt s a d sp cfct s o v lct dfee c s b t e me in n t i e n e iii e f eo i ifrn e ewe n da i i i y mie n r ec n u t n a r ss tewrst(M e mx w) a d (I me in x d ev o d ci co h o i d p n ) da mie n r ec n u t ni tef ram (M e mx ) a d(I) p l t D2 x d ev o d ci n h o e r o d f n I am o se so yc n u t n (M e p n r o d ci o d D2),wep o e t eystde 67 l s o r sp ci l u id v i mb f p t ns wi ciial d fnt c r a tn e sy d o ai t e t l c l eii ap l u n l n r me (CTS h n y e ). M e mx a d M e mx w wee p ro me b st lt g te me in d fn d p r ef r d y i ai h mu n da n r e a te eb w a d p l rsp ciey a d rc r ig a te ev t h lo n am e e t l n e o dn t h v p o i l wrst ce se W e aso c mp rd c n e t n l me in r xma i ra . l o ae o v ni a o da se so y(D2- i ) a dmie (p l wrst tst i al ains. Thry n r wrst n x d am- i ) e s n lp t t e it l s o a mpo t su jcs sev d a n r lc nr l a d 21 i mb f sy tmai be t r e s o ma o tos n c l s o su jcs wi oh rn u o ahe sev da dse se c nr l i mb f be t t te e r p tis r e s i a d o tos; h c nr l d t wa c l ce p o e t ey Th se si vt o te o to aa s ol td r sp ci l. e v e n ti f h i y M e p M e mx w dfee c (0.87 wa sinfc nl g e trta d D2- d p ifrn e ) s g iia t rae h n y ta o teM e mx - e mx w dfee c (0.61, < h t fh d fM d p ifrn e P 0.001). Bohtst t es wee si lra d hg l sp cfc (0.98 a d 0.96,rsp ciey Th r mi n ihy e ii a n e e t l). v e M e p M e mx w std i a n temo se si v a d sp cfc d D2- d p u y s mo g h st n t e n i e ii ee to h silgctst f rCTS lcr p y oo i e s o . S h rzM S Go d n J S sh M . S o d n r ec n u t n wi c wat , r o A, wa lwe ev o d ci o t h wrstfe in i c r a tn e sy d o . An Ne r l1980; i lxo n ap l u n l n r me n uo 8:69- 1. 7 Crtra M e (3/ 1, 5) S u c : Godn ,1986. Ab rc: DM Ls i i e t 6: 2, o re lig sta t fo tewrstt AP a d DS fo teid x fn e t tewrst rm h i o B n Ls r m h n e ig r o h i weed tr n d i 32 h n s i 20 p t ns a d 10 c nr lsu jcs. r eemie n ad n ai t n e o to be t Th ltn is wee d tr n d b f r a d atr 2 miue o f l e ae ce r eemie eo e n fe n ts f ul v lnay wrstfe in (P ae s ma e v r Th y f u d ta te ou tr i lxo h ln n u e). e on ht h DS o DM L ice se b g e trta 0.2 ms i 16 o to 32 CTS L r n ra d y rae h n n u f p t ns a dwa n t rae ta 0.1 ms i n r l be t I 2 CTS ai t n e s o g e tr h n n o ma su jcs. n p t ns teo l a n r l ywa teice sei dstlae ce atr ai t h ny b o mai e t s h n ra n i a ltn is fe P ae s ma e v r Te eau e dfee c s b f r a d atrwrst h ln n u e. mp rtr ifrn e eo e n fe i fe inween t e o td lxo r o rp re . S n r HO,Ta i r NF Baa a H,S lu iD. S mp tei skn ee scl a , lb n ec k y ah t c i rsp n i c r a tn e sy d o . Cl Ne r p y 2000; e o se n ap l u n l n r me i u o h s n 111:13951199. Crtra M e (6/ 1, 3, 5, S u c : M e l e S ac . i i e t 6: 2, 4, 6) o re di n e rh Ab rc: P o e t e std o 31 CTS p t ns a d 21 h aty sta t r sp ci v uy f ai t n e el h v lne r o tesy ah t skn rsp n (S R) rc r e fo D2 ou tes f h mp tei i e o se S e o d d r m c a d D5 wi str a st lt n S en lst lt n wa c o n t n t en l i ai . tr a i ai h mu o mu o s h se o eii te S R ista o l l t h S n e d f i st lt n t a od te efc o c mb i ai o v i h fe t f mu o afrn d sf n t n i a l fee t y u ci n o i o te rsut Th S R ltn y mb n h e l s. e S ae c rc r e fo sy tmai l s o CTS ddn tdfe fo n r l e o d d r m mpo t i c mb f i o ifr r m o ma c nr l a dtesa wa tu f rme in t- la rt s o ltn y o tos, n h me s r e o da -o un r ai f ae c , o a l u ea d ae o teS R. Ofasu se o 23 CTS p t ns wh mpi d n ra f h S t b tf ai t o e c mpee a q e in ar,7 o ltd u st n ie 0% o CTS p t ns dd c mpan o o f ai t i o li f e sy ah t sy tms i te sy tmai l s: rd o p r l mp tei mpo c n h mpo t i c mb e r u pe dsc lrt n e c ssie swe t g o feig c l (p r n l i oo ai , x e v o ai , r e l n n od eso a c mmu iain o nc t ). o S r r P Co aaie da n st se si vt s o o to r mi o eo . mp rt v ig o i n t i e f rh d o c r c i i a t r mi se so yic igtst nmi c r a tn e sy d o . Arh ni o c n r n hn e i l ap l u n l n r me c d d P y M e Re a i 2000; 81:442hs d h bl 446. Crtra M e (4/ 1, 5, i i e t 6: 3, 6) S u c : M e l e S ac . Ab rc: P o e t e std c mp rn te o re di e rh n sta t r sp ci u y o aig h v o to r mi ic igtst T) t tea t r mi ic igtst T) i rh d o c n hn e (OI o h ni o c n hn e (AI n d te d mia th n o 20 CTS p t ns wi c nr ld t fo 20 h o nn ad f ai t t o to aa r m e h n r lsu jcs. Th da n si o te20 CTS p t ns wa b se o o ma be t e ig o s f h ai t s a d n e ciia ci raa dc n ime b NCS Tosee t a s o d fnt b t l c l rt i n o fr d y n e . lc c se f eii u e mi CTS teci raf rNCS rsut wa a f l ws: n r l da l d , h rt i o e e l s s s ol o o ma me in moo dstlltn y (< ms),n r lse so y c n u t n v lct tr i a ae c 4.0 o ma n r o d ci eo i o y p l wrst(> m/ a d a n r lme in un rltn ydfee c am- i 45 s), n b o ma da - la ae c ifrn e o tef u t dgt 0.4ms). Te eau ewa me su e a testr o f h o rh ii (> mp rtr s a rd t h at f te std ,b tn tmo i rd c niu u y d rn testd . Th I h uy u o nt e o t o sl u ig h u y e T o n (100% p si v ) wa su eirt teAI (20% p si v ) i te20 CTS o t e s p ro o h T i o te nh i p t ns. ai t e * eo P Co ai n o te dstlmoo ltn y o te fr d r l S rr . mp rso f h i a tr ae c f h ist o sa itr sse u wi a d co p l c s b e i Re o t o 200 c se neo o s t b u tr ol e rvs. h i pr f a s. Elcr my g Cl Ne r p y o 1988; e to o r i u o h sil n 28:341345. CrtraM e (1/ i i e t 6: 1) S u c : M e l eS ac . o re di e rh n S r rP Orh d o c ic ig tsti mi c r a tn e sy d o . eo . to r mi n hn e n l ap l u n l n r me d M u l Nev 1998a21:1206sce r e ; 1208. Crtra M e (4/ 2, 5, i i e t 6: 3, 6). S u c : M e l eS ac . Ab rc: Orh d o cic igtst(OI o o re di e rh sta t to r mi n hn e n T) f teme inn r ea wrst s p ro me o ted mia t i o 80 h da ev t i wa ef r d n h o n n wrst f c nr l a d 100 p t ns wi mi CTS d fn d b tep e n eo o tos n ai t t l e h d eie y h rse c f ciia fau e a d c o n f r std b c u l c l e trs n n h se o u y e a se stn ad adr ee to ig o i tst f r CTS wee n r l(me in moo dstl lcr da n st e s o c r o ma da tr i a ltn y lss ta 4 ms a d p l t- i o to r mi se so y ae c e h n n am-o wrst rh d o c n r c n u t n v lct g e tr ta 45 m/ I c nr l te me n o d ci o eo i rae h n y s). n o tos h a c n u t n d ly p r c ni tr (CD/m) wa 0.184 ms a d wa o d ci o ea e e t e me c s n s sl hl hg e isie ta o t d te c r a tn e;te ma i l i t ih r n d h n usie h ap l u n l h g y xma CD/m (M CD/m) wa n v rg e trta 0.34 ms (me n0.247 Th c c s e e rae h n a ). e M CD/m wa 0.36 ms o mo ei 96 CTS p t ns. Ths a n r l y c s r r n ai t e i b o mai t wa lc td wi i te c r a tn e i 92% o c se Ousie te s o ae t n h ap l u n l n h f a s. td h e ta me tsi CD/m v le rman d n r la d si lrt to nrp n t e c au s e ie o ma n mi o h se a f u d i te c nr l On te wh l, ti rsut i a o eal o n n h o tos. h oe hs e l n n v rl s sp cfct o 100% a dse si vt o 96% f rteOI e iii f y n n ti f i y o h T. S r rP P ae s tsti teda n si o c r a tn e sy d o . J eo . h ln e n h ig o s f ap l u n l n r me Ha d S r 1988; B:383n ug 13385. Crtra M e (3/ 1, 6) S u c : i i e t 6: 2, o re M e l eS ac . di e rh n S r rP S n t i o te v ro s tst f rte da n si o c r a eo . e si vt f h aiu e s o h ig o s f ap l i y tn e sy d o . JHa d S r [ ]1994; 25- 28. Crtra M e u n l n r me n u g Br 19:7 7 i i e t (5/ 1, 4, 6) S u c : M e l e S ac . Ab rc: A p o e t e 6: 3, 5, o re di n e rh sta t r sp ci v

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std o 150 h n s i 96 p t ns su e td o CTS P t ns wee uy f ad n ai t sp ce f e . ai t r e icu e i te std b c u a la o e EDX tstf rCTS wa n ld d n h u y e a se t e st n e o s a n r l p t ns su e td o CTS wi n r lEDX tst wee b o ma; ai t sp ce f e t o ma h es r e cu e fo tea ay s. Th d t wa u dt c mp r terlt e x ld d r m h n lsi e aa s se o o ae h eai v se si vt o nn dfee tEDX tst t da n se CTS Th dstl n t i f ie ifrn i y e s o ig o . e ia moo ltn ywa g e trta 5 ms i 35% o c se a dg e trta tr ae c s rae h n n f a s n rae h n o e u l t 4 ms i 55% o c se Th D3 t wrst (14 c r qa o n f a s. e o i m) o to r mi me in se so yCV wa lss ta o e u lt 45 m/ i rh d o c da n r s e hn r q a o s n 66% o c se Th p l t wrst c o to r mi me inCV wa f a s. e am o i (8 m) rh d o c da s lss ta o e u l45 m/ i 7 e hn r q a s n 6%. Th rmann 24% o c se wee e e iig fa s r a sse b a dt n l sse d y d i o a EDX tst teme in un rltn ydfee c i e s: h da - la ae c ifrn e rc r e fo D4 wa a n r l n21 o termann 24% a dte e od d rm s b o ma i f h e iig n h c ni ti tstwa atrd i al24%. Th me in un rltn y e t rc e me s l e n l e e da - la ae c dfee c i si lrt p ro m ta tec ni ti tsta d i ti ifrn e s mpe o ef r h n h e t rc e n , n hs me std ,teewa o l asmaldfee c i tep re tg o me in u y h r s ny l ifrn e n h ec na e f da n r ea n r l is d tce i CTSsu e t wi te t tst ev b o mai e ee td n t sp cs t h se wo e s. h S r rP Th a o a c r a tn e sy d o . Elcr e c p ao rCl eo . e x n l ap l u n l n r me e to n e h lg i n Ne r p y o 1996b101:197 200. CrtraM e (4/ 1, 5, S u c : u o h sil ; i i e t 6: 4, 6) o re M e l e S ac . Ab rc: F v p t ns wi ciia sy tms o di e rh n sta t ie ai t t l c l mpo e h n f CTSa darsp n t asigec rio eodijcino teCT wee n e o se o n l o t str i ne t c o fh r stde . Ea h p t n h d a n r l ee to ig o i e au t n u id c ai t a e o ma lcr da n st v lai , c o icu ig n e l e a n t n (C5 t C8T1),dstlmoo ltn y n ldn e de x miai o o ia tr ae c , p l t wrsto to r mi se so y c n u t n v lct,a d sp ca am o i rh d o c n r o d ci eo i n o y e il tst me in un r ltn y dfee c o te 4t dgt p l r e s: da - la ae c ifrn e f h h ii ama , c ni ti tc nq e A n w tst i d scie : te o to r mi e t rc e h iu . me e e s e rb d h rh d o c se so y uta dstl st lt n o e c dgt a te p l wi n r l r i a i ai mu o f a h ii t h up t h rc r ig o e te me in n r e a te wrstf rdgt 1, 3, a d e o dn v r h da ev t h i o ii 2, 4 n s o e te un r n r e f r dgt 5. Th tst rv ae a sinfc n v r h la ev o ii e e e e ld g iia t a l u e c a g (60mpi d h n e t 90%) i a la t me in dgt o te n t e st wo da ii f h s sy tmai h n c mp rdt tea mpo t h n itr rtda mpo t a d o ae o h sy tmai a d nep ee s c c a o a lss i te fv CTS p t ns. Th se fn ig ld t te xnlo n h se ie ai t e e idn s e o h p o o l ftetr a o a CTS r p sa o h em x n l . S r rP Ties sin i te da n si o c r a tn e sy d o . J eo . n l g n h ig o s f ap l u n l n r me Ha d S r 198712n ug ; B:364365. Crtra M e (3/ 1, 6) S u c : i i e t 6: 2, o re M e l eS ac . di e rh n S ash kTS e- n wyYM . Th a tro itr sse u n r eltn y hf a , lHia e neir neo o s ev ae c i teda n si o se eec r a tn e sy d o wi u o tia l n h ig o s f v r ap l u n l n r me t n ban be h me in n r e dstlc n u t n Arh P y M e Re a i 1995;7 da ev i a o d ci . c h s o d h bl 6: 47 47 Crtra M e (5/ 1, 4, 6). S u c : M e l e S ac . 1- 5. i i e t 6: 3, 5, o re di n e rh Ab rc: Th a to s c n ld d ta me su e n o te a tro sta t e uh r o cu e h t a rme t f h neir itr sse u n r eltn y (AI wi su fc ee to e h s ar l neo o s ev ae c NL) t ra e lcr d s a h oe i te dfee t lda n si o se ee CTS fo oh r c u s o n h ifrni ig o s f v r a r m te a se f me in n r e p too y Th atr aie i t p ro m n e l EM G da ev ah lg . e l n t s o ef r e de e v e a n t no f ram mu ls in r ae b teme inn r e x miai f o e r o sce n ev td y h da ev . S aai h h n BT, u gRR, ot F M a c b eP Temia ltn yid x Yo n P t , c a e . r n lae c n e s (TLI a d lt rsp n stde i moo n u o dse se (M ND), ) n ae e o se u is n tr e r n i a p rp ea n u o ahe a d e ta me t sy d o s. Aca Ne r l eih rl e r p tis n nrp n n r me t uo S a d197 7 p l cn 9;3(su p):118. CrtraM e (0/ (Ab rc o l) S u c : i i e t 6) sta t ny o re S e e s, tv n 1987 . S e a GL, u rM K, u ryNM . Lu rc litr sse u ltn y h en Ho se M ra mb ia-neo o s ae c c mp rso i te da n si o c r a tn e sy d o . o ai n n h ig o s f ap l u n l n r me Elcr e c p ao rCl Ne r p y o 1995; :285e to n e h lg i u o h sil n 97 289. CrtraM e i i e t (4/ 1, 5, S u c : M e l e S ac . Ab rc: I 66 h n s o 45 6: 3, 6) o re di e rh n sta t n ad f p t ns wi su e tdCTS tese o dlmb ia-neo o s dstl ai t t sp ce e h ,h c n u rc litr sse u i a moo ltn ydfee c (2LIDM L) wa a n r la fe u nl (48 tr ae c ifrn e s b o ma s rq e t y h n s,7 a d 2%) a te me in un ro to r mi mie n r e p l r s h da - la rh d o c x d ev ama v lct dfee c . eo i ifrn e y * h r DG,Bli W F Ba t G. Elcr my g a hc c a g s atr S ur ar , sset e to o rp i h n e fe c r a tn e rla . JHa dS r Am 1986; ap lu n l ee se n ug 11:87 880. CrtraM e 6i i e t (2/ 1, S u c : M e l eS ac . 6: 2) o re di e rh n * i esti B, F n L, S eso D. Ha d wrst dso d r a n S l r en v ie tt n n - i i r es mo g iv st n c st gpa t r es. JHa dS r Am 198712:838n e me t a i ln wo k r n n ug ; 844. CrtraM e (0/ S u c : M e l eS ac . i i e t 6) o re di e rh n S mo i D, en egDH. Temia ltn yid xi tec r a tn e i vc W ib r r n lae c n e n h ap lu n l sy d o . M u l Nev 1997 ; n r me sce r e a20:117 1180. Crtra M e (3/ 8i i e t 6: 3, 5) S u c : M e l e S ac . Ab rc: A rto e t e std 4, o re di n e rh sta t er sp ci v uy e au td teu f le o teme in moo tr n lltn yid x v lae h seun ss f h da tr emia ae c n e (m- ) t da n seCTS Th m- i ad rv d me su eo dstl TLI o ig o . e TLI s eie a r f ia moo c n u t n a d c luae a f l ws: tr n l dstn e / tr o d ci o n ac ltd s ol o emia i a c (p o i l o d cinv lct dstlae c ). Th 132 h n s o 107 r xma c n u t o eo i y i a ltn y e ad f p t ns su e tdo CTS weedvd dit t g o p b se o te ai t sp ce f e r iie no wo r u s a d n h rsut o mie n r ep l rst lt nstde (n r l e l f x d ev ama i ai u is o ma 2.2 ms o s mu o r me in t un rp a ltn ydfee c 0.4 ms.) Gr u Ic nan d da o la e k ae c ifrn e o p o tie p t ns wi a n r lme in p l rp a ltn is (l eyt h v ai t t b o ma da ama e k ae ce i l o a e e h k CTS whl g o p 2 c nan p t ns wi n r lme in p l r ). i ru e o tis ai t t o ma e h da ama p a ltn is (lss l ey t h v CTS Th m- wa lss ta e k ae ce e i l o a e k ). e TLI s e h n 0.34 i alp t ns i Gr u 1 a d e u lo g e trta 0.34 i al n l ai t n o p n q a r rae h n e n l p t ns i Gr u 2. Ths rto e t estd su g st ta temai t n o p e i er sp ci u y g e s h t h v TLI i ada n st tst o CTSp tnil a u f l s teme inp l r s ig o i e f r c oe t l s seu a h ay da ama c n u t nstd (se 1999brfrn e o d ci u y e o eee c ). S mo i D,W en eg DH. Th me in n r etr n lltn yid x i vc ib r e da ev emia ae c n e i c r a tn e sy d o : a ciia c se see t n std . M u l n ap l u n l n r me l cl a n lci o uy sce Nev 1999b22:57 57 . Crtra M e: (6/ 1, 3, 5, S u c : re ; 3- 7 i i e t 6: 2, 4, 6) o re M e l eS ac . Ab rc: Th me intr n lae c id x(TLI i di e rh sta t e da emia ltn y n e n ) s ac luae v led rv d fo tec n e t n lme in moo NCS ac ltd au eie r m h o v ni a da o tr d t. Th TLIi art ta a jst teme in moo dstlltn y aa e s ai h t du s h o da tr i a ae c (DL) f rte tr n lc n u t n dstn e (CD) a d te p o i l o h emia o d ci i a c o n h r xma n r ec n u t nv lct (CV): TLI= tr n l (mm) /p o i l ev o d ci eo i o y emia CD [ r xma CV (m/ DL (ms)] Th rt d ce se a te c n u t n t s) . e ai e ra s s h o d ci i o o me ice se a r ss te c r a tn e. I ti p o e t e std o 66 n ra s co h ap l u n l n hs r sp ci v uy f p t ns t a ss te se si vt o te me in n r e TLIf rte ai t o sse h n t i f h e i y da ev o h da n si o c r a tn e sy d o ig o s f ap l u n l n r me (CTS ciia a d ), l c l n n ee to h silgc le au t n weec mpee b se aae bid d lcr p y oo ia v lai s r o ltd y p rt, l e o n e a n r Ba do ciia da n st ci ra 54 o te66 p t ns x mies. se n l c l ig o i rt i, n c e fh ai t e (54 h n s) weed tr n d t h v CTS (CTS g o p Co to d t ad r eemie o a e r u ). nr l aa wee o tie fo 19 h aty su jcs (38 h n s). Th me n TLI r ban d r m el h be t ad e a wa 0.26 0.04 i teCTSg o pa d0.43 s nh ru n 0.04 i tec nr l r u n h o to g o p (P < 0.001). Th se si vt o teTLIf rteda n si o CTS wa e n t i fh i y o h ig o s f s 81.5%. Th TLIwa mo ese si v t da n seCTS ta teme in e s r n t e o ig o i hn h da moo DL a d me in se so y p a ltn y (P t tese o d dgt tr n da n r e k ae c L) o h c n ii (CD 14 c Th TLIwa awa s a n r l e teme inmie m). e s l y b o ma wh n h da xd n r e p l rltn y wa a n r l I tre c se fo te CTS ev ama ae c s b o ma. n h e a s r m h g o p teTLI s teo l a n r l lcr p y oo ia p rmee. r u ,h wa h ny b o ma ee to h silgc l aa tr S mp n J Elcrc lsin i te da n si o c r a tn e a d i so A. e tia g s n h ig o s f ap l u n l n rltd sy d o s. JNe r lNe r su g P c ity1956; eae n r me u o u o r sy har 19:27 280. 5CrtraM e (2/ 3, S u c : P l y t, i i e t 6: 5) o re al ah 1990. i S t T. Ne rn r e v r s su fc ee to e rc r ig o se so y mi h a- ev esu ra e lcr d e o dn s f n r n r e c n u t n i p t ns wi c r a tn e sy d o . Aca ev o d ci n ai t t ap l u n l n r me o e h t Ne r l c n 1998; 280uo S a d 98: 282. CrtraM e (5/ 1, 4, 6) S u c : i i e t 6: 3, 5, o re M e l e S ac . Ab rc: Co ai n o te rlt e se si vt o di e rh n sta t mp rso f h eai v n ti f i y se so y n r e c n u t n (S n r ev o d ci o NC) rc r e wi n a- ev n e l e o d d t e rn r e e de h ee to e a d S lcr d s n NC rc r e wi su fc ee to e t d mo stae e o d d t ra e lcr d s o e n rt h f c lslwig o te me in n r e c n u t n i CTS p t ns. 82 oa o n f h da ev o d ci n o ai t e c n c t ep t ns wi ciia sy tms a d sin o CTS wee o se ui ai t t l c l mpo v e h n n gs f r stde p o e t ey b te sa u id r sp ci l y h v me ciia n u o h silgst l c l e r p y oo i . n Orh d o cn a- ev rc r igfo dgt 1 a d3, i a me in to r mi e rn r e e o dn r m ii s n dstl da moo ltn y a da t r mi su fc rc r igfo p l t dgt tr ae c , n ni o c ra e e o dn r m am o ii 2 d a d wrst t dgt 2 wee p ro me i al p t ns. Ne rn r e n i o ii r ef r d n l ai t e a- ev rc r ig o te un r n r e wa d n i p t ns wi a n r l e o dn f h la ev s o e n ai t t b o ma e h me in n r ec n u t n Ne rn r eS da ev o d ci . o a- ev NC wa a n r lc mp rd s b o ma o ae t c nr l o dv lct o a se t e o se i 52% o tep t ns o o to (slwe eo i r b n rsp n ) n y f h ai t e fo dgt1 t wrst i 51% fo dgt3 t wrst a d 40% h d a r m ii o i , n r m ii o i , n a p oo g d dstl moo ltn y S ra e a t r mi S r ln e i a tr ae c . u fc ni o c NC wa d s a n r li 49% fo wrstt p l a d i 43% fo wrstt dgt b o ma n r m i o am, n n r m i o ii 2. S ai ia a ay s rv ae n sinfc n dfee c b t e te tt c l n lsi e e ld o g iia t ifrn e ewe n h st n a- ev meh da dtesu fc meh d e rn r e to n h ra e to . S YT,Ole RK,Amio fM J Ev lain o temo rp y i te o ny nf . au t o f h r ga h n h da n si o see td e ta me t n u o ahe (c mme t i ig o s f lce nrp n e r p tis o ns n Ne r lg 1989; u oo y 39:10031005). Ne r lg 1989; u oo y 39:1- CrtraM e 5. i i e t (2/ 1, S u c : M e l eS ac . 6: 2) o re di e rh n * pn lrHA,Deln AL. Nev c n u t n stde a d se sii t S ide l o r e o d ci o u is n n bl y i tst g i c r a tn e sy d o . J Ha d S r 1982;:260e i n ap l u n l n r me n n ug 7 263. CrtraM e (3/ 2, 5) S u c : J r a , i i e t 6: 3, o re o d n 1987 . S eso DS Ales J , i esti BA, of RA. Efe t o a e se , tt n , b r W S l r en v W le fcs f g , x a d a tr p merc fco s o n r e c n u t n me su e M u l n nh o o ti a tr n ev o d ci o a rs. sce Nev 1992; re 15:10951104. (n r lp p lt n std 5/ 1, 4, 6) o ma o uai o u y 6: 3, 5, S u c : Bu h a h r 1999. S u y o 105 h aty a mpo t o re sc b c e td f e l , sy tmai h c a ut wi o t hstr o h n -ne sie o c p t n l a t i e dl s t u i o y f a d itn v c u ai a ci t s. h o vi Heg t a d fn e cru ee c wa n g t ey a cae wi ih n ig r ic mfrn e s e ai l sso itd t v h se so y a l u e o me in un r a d su a n r e Heg twa n r mpi d f da , la n t rl ev s. ih s p si v l a cae wi me in un r a d su a se so y dstl o t ey sso itd t i h da , la n rl n r i a ltn is. Eq ain u n a e h ih a d fn e cru ee c f r ae ce u t s sig g , eg t n ig r ic mfrn e o o p e it n o n r lv le ae p e ne . F i r t a jstn r l rdci f o ma au s r rse td al e o du o ma o u n r e c n u t n v le f rte fco s d ce se te da n st ev o d ci au s o h se a tr e ra s h ig o i o c sp cfct a dse si vt o n r ec n u t nstde e iii n n t i f ev o d ci u is. y i y o S e e s J AAEE M ii n g a h # tv n C. nmo o rp 26: Th ee to ig o s o e lcr da n si f

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S9 4CTS L 7 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine

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c r a tn e sy d o . M u l Nev 198710:99ap l u n l n r me sce r e ; 113. CrtraM e i i e t (3/ 3, 6) S u c : M e l eS ac . Ab rc: Th a to p e ns (1) 6: 5, o re di e rh sta t e uh r rse t n te ee to ig o i fn ig i 505 c se o CTS e au td a te h lcr da n st idn s n c a s f v lae t h M a oCl i fo 1961y i c rm n 1980, n r l au s f rme ina dun r (2) o ma v le o da n la se so ya dmoo c n u t n (3) a EDX p oo o f re au t no n r n tr o d ci , o n r tc l o v lai f o CTS a d(4) ap oo o t ie t yM at - u e a a o si ,n r tc lo d ni f ri Gr b r n stmo s. n S e e s J S t BE, e v rAL, sc EP De nHG J, i e s tv n C, mi h W ae Bo h , e rW l n k J S mpo o 100 p t ns wi ee to o rp ial v rfe A. y tms f ai t t lcr my g a hc l eiid e h y c r a tn e sy d o . M u l Nev 1999; ap l u n l n r me sce re 22:14481456. Ba k r u d Reee c . S u c : M e l e S ac . Ab rc: To c go n frn e o re di n e rh sta t d tr n tesy tms o c r a tn e sy d o (CTS sce nn eemie h mpo f ap l u n l n r me ), re ig e au t n weep ro me i 244 c n c t ep t ns wi se so y v lai s r ef r d n o o se ui ai t t n r v e h sy tms i te h n a d u e uv c lslwig o me in n r e mpo n h a d n n q io a o n f da ev c n u t na tewrst Ths yed d100 p t ns to g tt h v n o d ci t h i . i ile o ai t h u h o a e o e e pa ain oh rta CTS f rteru p rl c mpans. Th se x ln t o te h n o hi p e i mb o lit e p t ns c mpee ah n sy tm da rm (HS a dq e in ar ai t o ltd a d mpo ig a e D) n u st n ie o (HS a o ttersy tms. CTS sy tms weemo c mmo l Q) b u h i mpo mpo r st o ny rp re i me in a d un rdgt f l we b me in dgt o l e o td n da n la ii ol d y da ii ny s, o s a d a go edstiuin Un su lse so y p t r s weerp re b n lv i rb t . o u a n r at n e r e o td y so p t ns. Ba do teHS p rste a o p i p o i lote me ai t e se n h Q, ae h sis r an r xma t h wrsto c re i 36.5% o h n s. Th u f le o te HS a d i c u rd n f ad e seun ss f h D n HS f r da n si wa d tr n d b a ig tre p y ca s, Q o ig o s s eemie y skn h e h siin bid d t teda n si t rt tel eio do CTS i tep t ns l e o h ig o s, o ae h i l o f n k h n h ai t e wi CTS a d i 50 p t ns wi oh rc u s o u p re te t t h n n ai t t te a se f p e xrmi e h y p rste a Th se si vt s o te id p n e tistu ns rn e ae h si. e n t i e f h n e e d n n r me t a g d i i fo 54.1% t 85.5%. Ba do tec mbn distu n rt g te rm o se n h o ie n r me t ai s,h n se si vt ice se t 7 n t i n ra d o 9.3% t 93.7 i y o %. S e e s J S n S Be r CM ,OF l n W M ,Ku ln LT. Cap l tv n C, u , ad al o ra d ra tn e sy d o i Ro h str M in soa 1961u n l n r me n c e e, n e t, 1980. Ne r lg u oo y 1988; 38:134138. Ba k r u dReee c . S u c : M e l eS ac . c go n frn e o re di e rh n S e r J Ei nA. Ties sina dtec r a tn e sy d o . Br twad D, se n l g n h ap l u n l n r me M e J 197 2:1125d 8; 1126. Crtra M e (1/ 3) S u c : Godn , i i e t 6: o re lig 1986. S a oRM , lema RH, mikM P S n bl ytst gi p t ns zb Geb r n Di c . e sii t e i n ai t i n e wi c r a tn e sy d o . J Bo e J itS r 1984; t ap l u n l n r me h n on u g 66A:6064. CrtraM e (1/ 1) S u c : Bo g 1988. i i e t 6: o re r , Ta k n W ,Ka se HE,M a u HG. Co ai n o o to r mi c ma n e r gn mp rso f rh d o c a da t r mi se so yn r ec n u t nv lct me su e n i te n ni o c n r ev o d ci eo i d o y a rme t n h c r a tn e sy d o . J Ne r l1981; ap l u n l n r me uo 224:257 266. Crtra M e i i e t (6/ 1, 3, 5, S u c : Un ii 1989. Ab rc: Usig rn 6: 2, 4, 6) o re cn, sta t n ig ee to e o te mide fn e a d su d r l ee to e a te lcr d s n h d l ig r n b ema lcr d s t h mip l a dwrst o to r mi a da t r mi S d am n i , rh d o c n ni o c NAPltn is wee d ae ce r rc r e fo 56 h n s fo 50 CTS p t ns a d32 h n s fo 32 e od d rm a d rm ai t n e a d rm h atysu jcs. Th yrp r n sinfc n dfee c s i ltn is o el h be t e e o t o g iia t ifrn e n ae ce f o to r mi a d a t r mi rc r ig a d ta p l rltn is ae rh d o c n ni o c e o dn s n h t ama ae ce r d mo el eyt b a n r lnCTSta dgtae ce r i l o e b o ma i k h n ii ltn is. Ta k n W , h nHJ Reaierfa tr p ro o me inn r e c ma n Le ma . lt erco y eid f da ev v se so y fb r i te c r a tn e sy d o . Eu Ne r l n r ies n h ap l u n l n r me r uo 197 12:3094; 316. CrtraM e (4/ 1, 4, S u c : P l y t, i i e t 6: 2, 5) o re al ah 1990. i Ab rc: W i st lt n o teid x fn e a d rc r ig a te sta t t i ai n h n e ig r n e o dn t h h mu o wrst te rlt e me in n r e rfa tr p ro wa d tr n d i , h eai v da ev erco y eid s eemie wi p ie st l i 11 h n s o eg t t ard i i n h mu a d f ih CTSp t ns a d12 h n s o ai t n e ad f eg th atyc nr l Th yf u dterlt erfa tr p ro mo e ih e l h o tos. e o n h eai erco y eid r v l ey t b p oo g d i p t ns wi CTS a o p se t n r l i l o e r ln e n ai t t k e h s p o d o o ma su jcs. be t * ri S P sc ai C, M eal o I P p p to o ls T. Eal Tezs , a h l s tl n s C, a a er p uo i ry da n si o c r a tn e sy d o : c mp rso o se so y ig o s f ap l u n l n r me o ai n f n r c n u t n stde o f u fn es. M u l Nev 1998;21: 1543o d ci o u is f o r ig r sce r e 1545. Crtra M e (3/ 3, 6) S u c : M e l e S ac . Ab rc: i i e t 6: 5, o re di e rh n sta t S n r stde o f u fn es wee p ro me o 7 p t ns wi e so y u is f o r ig r r ef r d n 2 ai t t e h e ry (dstlmoo ltn y < ms) c r a tn e sy d o (CTS al i a tr ae c 4.2 ap l u n l n r me ) a d o 43 c nr lsu jcs. Re l d mo staeta se so y stde n n o to be t sut e n rt h t n r u is s o dgt4 yed tehg e se si vt (88%) f rda n si o e ry f ii ils h ih st n t i i y o ig o s f al CTS Th se si vt o dgt1,dgt2,a d dgt3 wa 61%,22%, . e n t i f ii i y ii n ii s a d50%, e e t ey n rsp ci l. v Th ma J La etEH, u KA. Elcr da n st a e t o te o s E, mb r Cse z e to ig o i sp cs f h c c r a tn e sy d o . Arh Ne r l196716:635ap l u n l n r me c uo ; 641. CrtraM e i i e t (3/ 3, 6) S u c : Na , 6: 5, o re u 1988. Th ma P M oo n r e c n u t n i c r a tn e sy d o . o s K. tr ev o d ci n ap l u n l n r me o Ne r lg 1960; u oo y 10:10451050. Crtra M e (5/ 1, 3, 6) S u c : i i e t 6: 2, 5, o re W id r ot 197 Ab rc: W i c a iln e l rc r ig o e te e eh l , 0. sta t t o xa e de e o dn v r h h AP st lt n a tewrst eb w,a d a i a CM AP a d DM Ls B, i ai t h mu o i , lo n xl , l s n wee rc r e o e te AP i 95 CTS p t ns a d 50 c nr l r e od d v r h B n ai t n e o to su jcs. Th DM L wa p oo g di a p o i tl t -hr s o te be t e s r ln e n p r xmaey wo tid f h CTSp t ns. ai t e Tr jb r W ,Grwa RP W eme LH,S eifP Vau o ltn y oa o g e l , i r h rf . le f ae c me su e ns t te smal p l mu ls c mp rd t oh r a rme t o h l am sce o ae o te c n u t n p rmees i tec r a tn e sy d o . M u l Nev o d ci aa tr n h ap l u n l n r me o sce r e 1996; 19:243245. Crtra M e (5/ 1, 3, 6). S u c : M e l e i i e t 6: 2, 5, o re di n S ac . Ab rc: S u y o 17 h n s o 105 p t ns wi ciia e rh sta t td f 0 a d f ai t t l c l e h n da n si o CTS Th r wa a a n r l lmb ia-neo u ig o s f . ee s n b o ma u rc litr sse s ltn y dfee c i 83% o h n s wh ra teewa a a n r l ae c ifrn e n f ad ee s h r s n b o ma me in se so y c n u t n v lct fo te tu t te wrsti da n r o d ci eo i r m h h mb o h o y i n 93% o h n s. Th a to s c n ld d ta telmb ia-neo u f ad e uh r o cu e h t h u rc litr sse s ltn ydfee c wa e e il u f lnc n imigCTSi p t ns ae c ifrn e s sp cal seu i o fr n y n ai t e wi a se c o teme inS t b n e fh h da NAPo AP moo rsp n o b t. r B tr e o se r oh Un iiA,DiM u i A,Awa J M a e t G,Tau o M ,Ga iD. cn zo d , n ne fr mb S n t i o treme in t- la c mp rt etst i da n si o e si vt f h e i y da -o un r o aai e s n ig o s f v mi c r a tn e sy d o l ap l u n l n r me [ e c mme t . M u l Nev d se o ns] sce re 1993; 16:1366- 3. CrtraM e (6/ 1, 3, 5, S u c : M e l e 137 i i e t 6: 2, 4, 6). o re di n S ac . Ab rc: S u y o 193 h n s o 113 p t ns wi ciia e rh sta t td f ad f ai t t l c l e h n da n si o CTS c mp rdt rfrn ep p lt no 7 h n s o 47 ig o s f o ae o eee c o uai f 2 a d f o v lne r Nieyfv (49%) h n s h d n r lme in DM L (4.2 ou tes. n t-ie a d a o ma da ms) a dn r l rb r el eme inS n o ma o o d ri n da NCV fo dgt st lt n r m ii 2 i ai mu o (45 m/ I ti su p p lt n o 95 h n s,tea to s p ro me s). n hs b o uai f o a d h uh r ef r d tre me in t un r c mp rt e tst (1) dfee c b t e he da o la o aai e s: v ifrn e ewe n me in a d un rdstlmoo ltn is rc r e fo te se o d da n la i a tr ae ce e o d d r m h c n lmb ia a d itr sse mu ls (2L-NT);(2) dfee c b t e u rc l n neo i sce I ifrn e ewe n me in a d un rse so y ltn is fo dgt4 st lt n (D4M da n la n r ae ce r m ii i ai mu o D4U);a d (3) dfee c b t e me in a d un rmie n r e n ifrn e ewe n da n la x d ev ltn is fo p l rst lt n (P - U). Th 2L-NT dfee c ae ce r m ama i ai mu o M P e I ifrn e wa g e trta o e u l o0.6 ms i 10 (10%) o tesu p p lt n s rae h n r q a t n f h b o uai o o 95 h n s. P - U a dD4M f ad M P n D4U weeg e trta o e u l o0.5 r rae h n r q a t ms i 53 (56%) a d 7 (7 %) o te su p p lt n o 95 h n s, n n 3 7 fh b o uai f o ad rsp ciey I e c o te tre stde weea n r li te98 e e t l. f a h f h se h e u is v r b o ma n h h n s wi a n r lme in DM L o me in D2S te ma i m ad t b o ma h da r da ,h xmu se si vt f rtetretst wo l b (10 + 98 = 108)/ = 56%, n t i o h he e s i y ud e 193 (53 + 98 = 151)/ = 7 193 8%,a d (7 + 98 = 17 193 = 89%. Th n 3 1)/ e c mp rso o me in a d un rse so y c n u t n a r ss te CT o ai n f da n la n r o d ci co h o wa mo e se si v ta c mp rso o me in a d un r moo s r n t e h n o ai n f da n la i tr c n u t n a r ss te CT. Th se si vt o D4M o d ci co h o e n ti f i y D4U mih b gt e e pan d b te f nc lr tp g a h a d c n q e t g e tr x lie y h u iua o o rp y n o se u n rae su e t i t t c mp e o o te c tn o s fb r fo tetid sc pi l y o o rssin f h ua e u ies r m h hr bi itr a ewhc , t h dstl ap lu n laecu e su efcal nesp c ih a te i a c r a tn e, r lmp d p riil y i te v lrun r p rin o te me in n r e jst b n ah te n h oa- la o t o f h da ev u e e t h ta sv r l a n. rn ese i me t g Un iiA,La g DJ S lmo M ,S l e B,M e rJ Lo ea eRE. cn n e , oo n oi n v e , v lc Rigfn e tst gi c r a tn e sy d o : A c mp rt estd o n ig r e i n ap lu n l n r me n o aai u y f v da n st ui t (c mme t i M u l Nev 1990; ig o i t i o c ly ns n sce r e 13:560). M u l sce Nev 1989; 35- 41. CrtraM e (4/ 1, 3, S u c : M e l e re 12:7 7 i i e t 6: 2, 5) o re di n S ac . Ab rc: W i st lt na tewrst n rc r igo e te e rh sta t t i ai t h i a d e o dn v r h h mu o rn fn e, te me in a d un r DS ltn y dfee c s wee ig ig r h da n la L ae c ifrn e r rc r e i 43 h n s o 33 n r l a d42 h n s i 32 p t ns wi e od d n ad f o mas n ad n ai t t e h mi CTS a d fn d b ee to ig o i ci ra S a d r DM L l d s eie y lcr da n st rt i. tn ad c e fo wrstt AP a d me in DS fo wrstt id xfn e wee r m i o B, n da L r m i o n e ig r r aso d tr n d Th y f u d ta teme in un rdfee c t te l eemie . e o n h t h da la ifrn e o h rn fn e wa mo el eyt b a n r lh nteDM L a dDS ig ig r s r i l o e b o ma ta h k n L. * l J Lln s J . Orh d o c std o te se so y fb r Val , a a M s to r mi u y f h n r ies in r aig te f u t fn e. M u l Nev 1988; n ev t n h o rh ig r sce re 11:546552. CrtraM e (3/ 1, 5) S u c : M e l eS ac . i i e t 6: 3, o re di e rh n Val S l J Alae R, n zM . Li tdln i dn l iigo te l oe , v rz Nu e smi o gt ia sl n f h e u d me in n r ei p t ns wi c r a tn e sy d o . M u l Nev da ev n ai t t ap l u n l n r me e h sce r e 1995; 18: 7 7 . Crtra M e (4/ 1, 5, S u c : M e l e 61- 67 i i e t 6: 3, 6) o re di n S ac . Ab rc: Du ign r l v me t o c a g s i p si o o e rh sta t rn o ma mo e ns r h n e n o t n f i tel s,n r estu trs mu a c mmo aetersut g c a g s h i mb ev r cu e st c o d t h e ln h n e i i ln t o te n r e p t. I p t ns wi CTS we mo i rd n e gh f h ev ah n ai t t e h , nt e o ee to h silgc l te ln i dn l a jst n o te me in lcr p y oo ial h o gt ia du me t f h y u da n r e t p si o s o e te fe in a d e te e tn o o te ev o o t n f xrme lxo n xrme xe sin f h i wrsta d eb w, yme su igtedfee c s id c di teltn y i n lo b a rn h ifrn e n u e n h ae c o teS f h NAP rc r e i tef ram a d u p ram. I p t ns, h e o d d n h o e r n p e r n ai t te e ltn y dfee c wa sinfc nl sh re ta i n r lsu jcs ae c ifrn e s g iia t y o tr h n n o ma be t (0.196 0.084 ms v 0.088 0.059 ms i tef ram, n 0.485 s. n h oe r a d 0.122 ms v 0.129 0.086 ms i te u p ram). Th se rsut s. n h pe r e e l s idc t ta te dspa e n o te so re o te me in n r e n iae h t h i lc me t f h uc f h da ev S NAP wi mo e ns o fe ina de tn o i l tdi p t ns t h v me t f lxo n xe sin s i e n ai t mi e wi c r a tn e sy d o . S n e te ltn y c a g s i CTS t ap l u n l n r me ic h ae c h n e n h

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245.

246.

247 .

248.

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250.

257 .

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252.

Muscl & Nerve Sup l e pement X 2 0 S9 5 02 7

Practice Parameter: Carp Tunnel ndrome al Sy

p t ns wee lss ta b twi i te rn e o ltn y c a g s i ai t r e h n u t n h a g f ae c h n e n e h n r lc nr l te p o e u e c n o b u d t dst g i CTS o ma o tos, h r c d r a n t e se o i i ush n p t ns fo c nr l Ho v r te a n r l y n td ma b a ai t r m o tos. e we e, h b o mai oe t y e ma ie ain o te p to h silg o e ta me t sy d o s: nfstt o f h ah p y oo y f nrp n n r me l tdln i dn l iigo n r e i e ta me t e r p tis. i e o gt ia sl n f ev s n nrp n n u o ahe mi u d Ve nx M J Hish DD,Cho - n F Ro CD. P e it g a ue ni , r iu Ta Y, ssi rdci c t n d n r ain i c r a tn e sy d o . Arh P y M e Re a i e ev t o n ap l u n l n r me c hs d h bl 1998;9:3067 312. Crtra M e (3/ 3, 6) S u c : M e l eS ac . i i e t 6: 4, o re di e rh n Ab rc: Rer sp ciestd o 1590 p t ns da n se wi me in sta t to e t v uy f ai t ig o d t da e h n u o ah a te wrst b se o te rsut o NCS ao e t e r p ty t h i a d n h e l f s ln o d tr n terlt n i o e ie c o a ued n r aino n e l eemie h eai shp f vd n e f c t e ev t o o n e de EM G o te AP t p t n a e g n e, a d NCS p rmees f h B o ai t g , e d r n e aa tr icu ig me in se so y p a ltn y a d a l u e a d me in n ldn da n r e k ae c n mpi d , n t da moo dstl ltn y a d a l u e Lo i i rg e o a ay s tr i a ae c n mpi d . t gst e rssin n lsi c ie t id g n e,me in moo dstlltn y a d me in moo d ni e e d r da f tr i a ae c , n da tr a l u e (al p .008) a c nrb t g t te p e it n o mpi d t l s o tiui n o h rdci o f d n r ain Ne de EM G o te c se wi a me in CM AP e ev t . o el f h a s t h da a l u e < mV d tce 95.3% (141/ mpi d 7 t ee td 148) o al c se wi f l a s t h d n r ain Ho v r temo e i n ta pia l f rp e it g te e ev t . o we e, h d l s o p l be o rdci h c n p e n eo d n r aini teidvd a p t n. rse c f e ev t n h n iiu l ai t o e Veg e J Gaa o o luAS Hesk vt S Auo o cd sf n t n r h se , ln p uo , r oi . z tn mi y u ci o i iip ti c r a tn e sy d o . M u l Nev 2000; n do ahc ap l u n l n r me sce r e 23:12091213. Crtra M e (5/ 1, 4, 6) S u c : AAEM CTS Ta F re i i e t 6 3, 5, o re sk o c 2000 me e. Ab rc: A p o e t e std o a tn mi mb r sta t r sp ci v u y f uo o c dstr a c s i 139 l s o 7 CTS p t ns da n se o teb si i ub n e n i mb f 6 ai t ig o d n h a s e o ciia a d se so y a d moo NCS a n r l is. Auo o c f l cl n n n r n tr b o mai e t tn mi dstr a c s weeie t ida f l ws: swel go tefn es (39%), i u b n e r d ni e s ol f o l n f h ig r i d yp l (33%), y a d p e o n n(32%) a dba c igo te r ams Ra n u s h n me o n ln hn f h h n (32%), ig rt uc rt n (0%) a dn i c a g s (0%). Cod ad fn e i leai s p o n al h n e l se sain o tefn et s (to n n sp cfc a d e c ssieswe t g n t o f h ig ri o o - e ii) n x e v p ai n (n t e o tdi ap ei n r su v y ween t n ld d S mp tei o rp re n rl ay r e ) r o icu e . y ah t mi c S i Re o se (S R) a n r l is (ltn y > 2 ms o a se t kn sp n S b o mai e ae c 1.7 t r b n rsp n ) wee n td i 24% (33 o 139) sy tmai h n s a d e o se r oe n f mpo t a d n c weemo ec mmo i h n s wi a tn mi sy tms (34%;26 o r r o n n a d t uo o c mpo h f 7 h n s). Co ae t c nr l ains, h S R h dasp cfct o 6 ad mp rd o o to p t t te S a e e iii f y 89%. W a g AK,Ra n rEM ,Blm AS Ruk v S He tse si vt o n yo u , to e B. a n ti f i y se so y fb r i c r a tn e sy d o [ e c mme t . M u l n r ies n ap l u n l n r me se o ns] sce Nev 1999; re 22:37 42. Crtra M e (5/ 1, 4, 6) S u c : M e l e i i e t 6: 3, 5, o re di n S ac . Ab rc: CTS u d a amo e t std teefc o h a o e rh sta t se s d l o u y h fe t f e t n n r e wi f c ld my l ain se o d r t c r nc c mp e o . ev s t o a e ei t h n o c n ay o h o i o rssin M e inS da NAP a l u ea dae d ce se mo ei 12 CTSp t ns mpi d n ra e ra d r n t ai t e ta i 12 n r lc nr l a 42 d g e C c mp rd t b seie hn n o ma o tos t e re o ae o a l n me su e ns a 32 d g e s c nird . I i h p te z d ta te a rme t t e re e t a e t s y oh sie h t h se g rd cin i rsp n a l u eaese o d r t teo c re c o e u t s n e o se mpi d r c n ay o h c u rn e f o t h a-n u e c n u t nbo ki d my l ae se so yn u o s. e tid c d o d ci lc n e ei td n r e r n o n W en rRA,Ales J . Reain b t e n e l ee to o rp y re br W lt o ewe n e de lcr my g a h a dn r ec n u t nstde i p t ns wi c r a tn e sy d o . n ev o d ci u is n ai t t ap lu n l n r me o e h Arh P y M e Re a i 1995;6:246c hs d h bl 7 249. Crtra M e (2/ 3, i i e t 6: 6) S u c : M e l eS ac . Ab rc: Rer sp ciestd o 480 c se o re di e rh n sta t to e t v uy f a s o ee to ig o ial c n ime CTS rve d t d tr n i te f lcr da n st l o fr d c y e iwe o eemie f h fn ig o NCS c udp e ittep e n eo a se c o fb i ain idn s n o l rdc h rse c r b n e f irl t l o p tnil o moo u i c a g s o ten e l EM G o teAP Two oe t s r tr nt h n e n h e de a fh B. h n rd tit- n CTS p t ns h da a n r l e deEM G e a u d e hryo e ai t a n b o ma n e l e xm d fn d b p e n e o fb i ain a t i (105 p t ns) a do eie y rse c f irl t l o ci t vy ai t n /r e a n r lM UAP c n iu ain M oo a d se so y e o e p tnil b o ma o fg rt . o tr n n r v k d oe t a ltn is wee te mo i o tn p e itr o a a n r ln e l ae ce r h st mp ra t rdco s f n b o ma e de EM G e a n t n x miai . o W en rRA,Bi C,Ar r n TJ Re eseP ae s ma e v ra a re r msto g . v r h ln nu e s n ad i da n sig c r a tn e sy d o . Arh P y M e Re a i i n ig o n ap l u n l n r me c h s d h bl 1994;5:7 7 7 83- 86. Crtra M e (6/ 1, 3, 5, S u c : M e l e i i e t 6, 2, 4, 6) o re di n S ac . Ab rc: Die t nrc r a c n l rssu eme su e ns i 5 e rh sta t rc ita ap l a a p e r a rme t n su jcs d mo stae ta a rv r P ae s ma e v r(wrsta d be t e n rtd h t e ese h ln nu e i n fn e e tn o ) rsut i a sinfc nl hg e ita ap lc n l ig r xe sin e l n s g iia t ih r nrc r a a a y h d o ai p e r c mp rdt ata i o a P ae s (wrstfe in y r stt rssu e o ae o rdt n l h ln c i i lxo a dfn e e tn o ) o amo iidP ae s ma e v r(wrstfe in n ig r xe sin r dfe h ln nu e i lxo whl pn hn a fa o jc b t e tetu a d tid dgt 31 i ic ig lt be t ewe n h h mb n hr ii e ). idvd as wi aciia da n si o c r a tn e sy d o a d20 n iiu l t l c l ig o s f ap lu n l n r me n h n n r lc nr l wee e au td t d tr n te efc te rv r o ma o tos r v lae o eemie h fe t h e ese P ae s ma e v rwo l h v o a t r mi me inse so yltn y h ln n u e ud a e n ni o c da n r ae c d a d a l u e me su e wi te wrst a d h n i te n url n mpi d t a rd t h h i n a d n h e ta p si o . Bohg o p d mo stae sl h (1o t n t r u s e n rtd i t 4%) p oo g t no te i g r ln ai f h o p a ltn ya drd cini tea l u eo teme inS e k ae c n e u t n h mpi d f h o t da NAPatr fe 1 miue o ti ma e v r Th c nr lg o p h d a me n p a n t f hs n u e. e o to r u a a ek ltn y p oo g t n o 0.05 ms (1.6% o te me n a d a me n ae c r ln ai f o fh a) n a a l u erd cin o 1.5 mir v l (2.6% o teme n c mp rd mpi d e u t t o f co ot s fh a ) o ae t 0.13 ms (3% o teme n a d0.9 mir v l (4% o teme n i o fh a) n co ot s fh a) n te c r a tn e sy d o g o p Ony tec a g i p a ltn y h ap l u n l n r me r u . l h h n e n e k ae c me su e ns b t e tet g o p wa sinfc n a ap = 0.05 a rme t ewe n h wo r u s s g iia t t lv l Ad i o a stde wi ln e p ro s o manan d wrst e e. dt n l u is i t o g r eid f itie h i e tn o weerc mme d d t e au t ti tc nq et da n se xe sin r e o n e o v lae hs e h iu o ig o CTS . 263. W en r RA, F a z lu A, Ales J , Ar r n TJ M e in re rn ba br W msto g . da mo o e r p tya n a t ewo k r aeteedfee c s b t e n n u o ah mo g ci v r es: r h r ifrn e ewe n sy tmai a d a mpo t wo k r Am J Id M e mpo t c n sy tmai c r es? n d 1998; 33:37 37 CrtraM e: (wo k rp p lt nstd 3/ 1, 6). 4- 8. i i e t r e o uai u y 6: 3, o S u c : M e l e S ac . Ab rc: A p o e t e co se t n l o re di n e rh sta t r sp ci v r ss- ci a o std o 7 a t e wo k r ie t id 184 wi me in n u o ah u y f 00 ci v r es d ni e f t h da e r p t d fn da ap oo g t no teme inS eie s r ln ai f h o da NAPp a ltn yc mp rd e k ae c o ae t teun rS o h la NAPp a ltn yb a la 0.5 ms, nir mi stde e k ae c y te st a t o c u is, d c n u t n dstn e 14 c e c t D2 a d D5. Co lh n s wee o d ci i a c s o m ah o n o ad r wame b f r tst g b ttmp rtr wa n tmo i rd i e ey r d eo e e i u e eau e s o n nt e n v r o c sed rn tetst g A rve o sefrp re sy tms o p i, a u ig h e i . n e iw f l-e o td mpo f an n mb e t gig a d b r ig i teh n s o fn es lst g mo e u n ss, i l n n n u nn n h a d r ig r a i n r ta 1 we k o o c re 3 o mo et s a teo tesce nn wa hn e r c u rd r r i me t h f h re ig s u dt ie t ysy tmai wo k r W o k r wh c mpan do se o d ni f mpo t c r es. r es o o lie f sy tms wee mo e l ey t b fmae t h v jb wi hg e mpo r r i l o e e l, o a e o s t ih r k h h n rp t in lv l t h v hg e rt g o jb se u i ,n tt a d e ei o e es, o a e ih r ai s f o c rt o o t n y h v a hstr o da ee t u mo ef rei terjb wi mo e a e i o y f ib ts, o se r o c n h i o t h r a n r lp strs o terwrsta d fn es,a d t h v a te d b o ma o u e f h i i n ig r n o a e rn twad amo ep oo g d me in se so ydstlltn y As n td b o r r r ln e da n r i a ae c . oe y te a to s,te std i l td b c u i i co se t n la d h uh r h u y s i e e a se t s r ss- ci a n mi o c n o a swe ma y o te q e in ri d a ln i dn lstd a n t n r n f h u st s ase : o o gt ia u y u wo l b n c ssayt d tr n teicd n ea dn trl i o yo ud e e e r o eemie h n ie c n au a hstr f me inmo o e r p tya n a t ewo k r da n n u o ah mo g ci v r es. 264. W ht J Ha se S J h so RK. A c mp rso o EM G i C, n n R, o n n e o ai n f p o e u e i te c r a tn e sy d o r c d rs n h ap l u n l n r me wi ciia- G t l c lEM h n c reain M u l Nev 1988; o rlt s. o sce r e 11:117 7 1182. Crtra M e (3/ i i e t 6: 1, 3) S u c : M e l eS ac . Ab rc: Two h n rd o eh n s i 2, o re di e rh n sta t u de n a d n 122 p t ns wee e au td wi se ea tc nq e f rCTS Th ai t r v lae e t v rl e h iu s o h . e a mpo t h n s o 43 o te p t ns sev d a c nr l Th sy tmai a d f c f h se ai t r e s o tos. e e f l wigtc nq e weee au td (a DM L fo wrst oAP (b ol n e h iu s r v lae : ) o rm i t B, ) DS fo wrstt id x fn e,(c moo ic ig stde a r ss te L r m i o n e ig r ) tr n hn u is co h wrst oAP (d se so yic igstde a r ss tewrst oteid x i t B, ) n r n hn u is co h i t h n e fn e,(e ic ig stde t telmb ia,(f p l t- i me in ig r ) n hn u is o h u rc l ) am-o wrst da ltn y (g c mp rso o me in a d rda DS a d (h tr n l ae c , ) o ai n f da n a il Ls, n ) emia ltn yid x M oo ic igstde weemo l eyt b a n r l ae c n e . tr n hn u is r st i l o e b o ma k i b t te CTS g o p a d a mpo t g o p M oo ic ig n oh h r u n sy tmai r u . c tr n hn stde wee a n r li 92% o mi CTS h n s a d 7 o te u is r b o ma n f l d a d n 2% f h a mpo t h n s. Al o testde h dhg rts o a n r l y sy tmai a d c l f h u is a ih ae f b o mai t i a mpo t h n s v rigfo 9% t 7 n sy tmai a d ayn r m c o 2%. 265. W id r otW C. M e in n r ec n u t n v lct i se so yfb r e eh l da ev o d ci eo i n n r ies o y tr u h c r a tn e. Arh P y M e Re a i 197 51:328h o g ap l u n l c h s d h bl 0; 330. Crtra M e (n r l p p lt n std 5/ 1, 4, 6) S u c : i i e t o ma o uai o u y 6: 3, 5, o re M a lo , ce d 1987 Ab rc: W i st lt no e temidefn e a d . sta t t i ai v r h d l ig r n h mu o rc r ig dstla d p o i lt te c r a tn e,se so y NCVs e o dn i a n r xma o h ap l u n l n r weed tr n d a r ss tec r a tn e a d p o i lt tec r a r eemie co h ap l u n l n r xma o h ap l tn e i 30 n r la ut S n r NCV wa fstrp o i lt te u n ln o ma d l e so y s. s a e r xma o h c r a tn e ta a r ss te c r a tn e. No CTS p t ns wee ap l u n l h n co h ap l u n l ai t r e stde . u id 266. W i o r AJ Elcr da n si o pe o ahe I: Amio f M J l u n : e to ig o s f lx p tis. n b nf , e i r Ne r lgcciis: sy o u o ee to ig o s. Vo 3, dt . u oo i l c mp sim n lcr da n si o n l No 3:511529. P i d lha W B S u d r 1985. p . 512hl ep i: a a n es; p 516. Crtra i i e M e: Ba k r u dS u c : AAEM Co sutn 1993. t c g o n o re n l t a 267 W i o r AJ La et EH. Th f ram me in t- la n r e . l u n , mb r b e oe r da -o un r ev c mmu iain ee to ig o i a e t (a sta t Ne r lg o nc t ; lcr da n st o c sp cs b rc). u oo y 197 6:26:368. Ba k r u dS u c : AAEM Co sutn 1993. c g o n o re n l t a 268. W i n J M e in mie n r ec n u t n stde i tef ram: l so R. da x d ev o d ci o u is n h o e r e ie c a an rto rd d my l aini c r a tn e sy d o . vd n e g ist er g a e e ei t n ap l u n l n r me n o J Cl Ne r p y o 1998; i n u o h sil 15:541546. Ba k r u d Reee c . c go n frn e S u c : M e l e S ac . Ab rc: M oo c n u t n v lct (CV) o re di e rh n sta t tr o d ci eo i o y me su e ns so t s sh w c n u t n v lct slwig i te a rme t mei me o o d ci eo i o n n h o y f ram se me t o te me in n r e i c r a tn e sy d o oe r g n fh da ev n ap l u n l n r me (CTS Ths slwig o moo n r e c n u t n i to g tt b ). i o n f tr ev o d ci s h u h o e o c u d b ete rto rd d my l ain i te f ram o a se y i r er g a e e ei t h n o n h oe r r

258.

259.

260.

261.

262.

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c n u t nbo ko tefststfb r wi i tec r a tn e. Die t o d ci lc f h a e ies t n h ap l u n l rc o h me su e n o tef ram se me to teme inn r eweema e a rme t f h o e r g n f h da ev r d t dst g i b t e te t p ssii t s. M e in moo o i i ush ewe n h se wo o bl i n ie da tr c n u t n stde a d mie n r e a t n p tnil (M NAP o d ci o u is n x d ev ci o oe t a ) rc r ig wee p ro me o te f ram se me to te me in e o dn s r ef r d n h o e r g n fh da n r ei p t ns (n = 32 l s,a e 24 t 7 a d c nr l (n = 15 ev n ai t e i mb g d o 6) n o tos l s, g d33 t 7 Th rsut sto gysu p r teh p te s ta i mb a e o 6). e e l r n l p o t h y oh si h t s teslwigse n i tef ram i c u db c n u t nbo ko te h o n e n h o e r s a se y o d ci lc f h o fstst o d cigfb r wi i tec r a tn e a di n t a se b a e c n u t ies t n h ap lu n l n s o c u d y n h rto rd d my l ain er g a e e ei t . n o 269. * in F J,Kre EF J. A rg e o mo e f r c r a tn e W n J r ig r e rssin d l o ap l u n l sy d o . P o S c Ex BilM e 1989; n r me r c o p o d 192:161165. Crtra M e i i e t (2/ 1, S u c : M e l eS ac . 6: 2) o re di e rh n 27 W ot n HW . Ne rt a cae wi a r me ay Arh Ne r l 0. l ma u i s sso itd t co g l. i h c uo P c ity 1941; sy har 45:680682. Ba k r u d Reee c . S u c : c go n frn e o re Geb r n , lema n 1980. 27 W o g m P J h so EW , en r nJ Cap l u n l n r me 1. n sa E, o n n W iema D. r a tn e sy d o : u o p l rst lt n o se so yfb r Arh P y M e Re a i se f ama i ai f n r ies. c h s mu o d h bl 1983; 64:1619. Crtra M e (3/ 3, 6) S u c : P a , 1989. i i e t 6: 5, o re e se Ab rc: W i st lt n a te wrsta d mip l a d rc r ig sta t t i ai t h h mu o i n d am n e o dn wi rn ee to e o e temidefn e, Ls weeo tie fo t ig lcr d s v r h d l ig r DS h r ban d r m teme inn r ea d100 h n s fo 50 n r l be t 15 p t ns h da ev n a d rm o ma su jcs, ai t e wi e ry CTS a d 6 wi da ee mel u a d su ei o d t al h , n t ib ts h l ts n i p rmp se me in n r e e ta me t Ampi d s a d d rt n o te S da ev nrp n. l u e n u ai s f h NAP t o wee aso rp re . Ths tc nq e i rp re a u f l i te r l e o td i e h iu s e o td s seu n h da n si o CTSa du d ryn mi p rp ea n u o ah . ig o s f n n elig l eih rl e r p ty d 27 Yo H, S mmo s Z, F ev ls A, Koh r M J Nad S 2. u i n riad t ai , iu H. Reain is b t e ciia sy tm se ei sc ls a d n r e lt shp ewe n l c l mpo o n v rt ae n ev y c n u t n me su e i c r a tn e sy d o . M u l Nev o d ci o a rs n ap l u n l n r me sce r e 1999; 22:497 501. Crtra M e (5/ 1, 4, 6). S u c : M e l e i i e t 6: 3, 5, o re di n S ac . Ba k r u d Reee c . Ab rc: Ths std e a n d te e rh c go n frn e sta t i u y x mie h se ei o sy tms i c r a tn e sy d o (CTS i rlt n t v rt f mpo n ap l u n l n r me y ) n eai o o n r e c n u t n me su e o te me in n r e S g iia t ev o d ci o a rs f h da ev . infc n rlt n is ie t id a n te ciia sc ls rsutd i a eai shp d ni e mo g h l c l ae e l o f n e n dc oo u sy tm ca fc t n sc e it p i r sy tms ih tmo s mpo lssiiai o h me no rmay mpo mo e sp cfc f r n r e ijr (n mb e t gig n cu n l r e ii o ev nu y u n ss, i l , o tr a n n sy tms) a d se o d r sy tms (p i,we k e cu n ss). mpo n c n ay mpo an a n ss, lmsie Th r wee sinfc n rlt n is b t e sy tm se ei a d ee r g iia t eai shp ewe n mpo o v rt n y n r e c n u t n a n r l y a d te p i r sy tm sc l ev o d ci o b o mai , n h rmay mpo t ae c reae mo esto gywi teee to ig o i me su e o n r e o rltd r r n l t h lcr da n st h c a rs f ev ijr ta ddtese o d r sy tm sc l. nu y h n i h c n ay mpo ae 27 Za h r RB. Th n rp l d et c mp e o o teme inn r ei 3. c ay e a asy u o o rssin f h da ev n tec r a tn e. S r Gy e o Ob e 1945; h ap lu n l u g n c l stt 81:213- . Ba k r u d 217 c g o n Reee c . S u c : Geb r n , frn e o re lema n 1980.

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S9 8CTS L 7 iterature Review 2 0 American Association of El 02 ectrodiagnostic Medicine