Descripción electrofisiològica del síndrome de túnel carpiano según edad en pacientes adultos / Electrophysiological severity of carpal tunnel syndrome according to age in adult patients

Background: Carpal tunnel syndrome (CTS) represents 90% of entrapment neuropathies. Severity may be greater in older patients. Aim: To describe the electrophysiological findings in adult patients with CTS and determine if severity is related to age. Material and Methods: Descriptive and retrospective study of electrophysiological findings in patients over 18 years of age with clinical suspicion of CTS, studied between January 2011 and December 2015. Neurophysiological severity was classified in 3 grades, comparing them by age, gender and laterality. Results: Of 1156 patients subjected to electrophysiological studies due to a clinical suspicion of CTS, 690 (60%) had electrophysiological features of the disease. In 274 patients (24%) the compromise was mild, in 162 (14%) it was moderate and in 254 (22%) it was severe. There was a positive association between age and CTS severity (p < 0.01). Severity was significantly greater in males than females (p < 0.01). Bilateral CTS was present in 471 patients (68%), which was associated with increased age and severity (p < 0.01). Conclusions: Electrophysiological severity in CTS increases with age. Other factors associated with higher severity are male gender and bilateral disease.

New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.

Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands / Síndrome do tunel do carpo: estudo evolutivo de parâmetros de condução nervoso em 261 mãos

OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) <46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) >4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8 percent were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8 percent and 1.9 percent, respectively. In the second/last exam, SCV worsened in 54.2 percent, remained unchanged in 11.6 percent and improved in 34.2 percent. SNAP amplitude worsened in 57.7 percent, remained unchanged in 13.1 percent and improved in 29.2 percent. DML worsened in 52.9 percent, remained unchanged in 7.6 percent and improved in 39.5 percent. Overall, NCS parameters worsened in 54.9 percent, improved in 34.3 percent and remained unchanged in 10.8 percent. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

OBJETIVO: Comparar evolutivamente parâmetros de condução nervosa (CN) na síndrome do túnel do carpo (STC) em mãos não submetidas à cirurgia. MÉTODO: Foram selecionadas retrospectivamente 261 mãos (166 pacientes) com STC sintomática confirmadas por CN e que posteriormente realizaram exame controle com intervalo >12 meses; foram excluídos casos com polineuropatia. Os parâmetros eletrodiagnósticos anormais foram: velocidade de condução sensitiva (VCS) <46,6 m/s, segmento pulso-II dedo, e latência distal motora (LDM) >4,25 ms, segmento pulso-APB (8 cm). RESULTADOS: 92,8 por cento eram mulheres; a média de idade foi 49 anos (20-76); o tempo médio entre os exames foi 47 meses (12-150); 9,8 por cento e 1,9 por cento não apresentaram potenciais de ação do nervo sensitivo (PANS) e potenciais de ação muscular compostos, no primeiro exame. No segundo exame a VCS piorou em 54,2 por cento, ficou igual em 11,6 por cento e melhorou em 34,2 por cento; a amplitude do PANS piorou em 57,7 por cento, ficou igual em 13,1 por cento e melhorou em 29,2 por cento; a LDM piorou em 52,9 por cento, ficou igual em 7,6 por cento e melhorou em 39,5 por cento. Incluindo todos os parâmetros eletrofisiológicos, houve piora em 54,9 por cento, melhora em 34,3 por cento e permaneceram sem alterações 10,8 por cento. CONCLUSÃO: As anormalidades da CN na STC podem oscilar ao longo do tempo e aparentemente independem da sintomatologia clínica, dificultando a correlação e prognóstico; idade mais avançada, sexo masculino e PANS ausentes no primeiro exame foram as variáveis que tiveram menor percentual de melhora evolutiva, independentemente do intervalo entre os exames.

Correlación entre estudio ultrasonográfico (US) y estudio electromiográfico (EMG) en el diagnóstico del síndrome del túnel carpiano (STC) / Correlation between ultrasonographic (US) and electromyographic study (EMG) in the diagnosis of carpal tunnel syndrome (CTS)

Objetivo y método: Evaluar la correlación entre la electromiografía (EMG) y la ultrasonografía (US) de 19 pacientes con síndrome del túnel carpiano (STC) clínico. Resultados: Debieron ser descartados dos pacientes por presentar nervios medianos bíjidos. Se hallaron 15 nervios medianos con US alterada y18 nervios medianos con electromiografía alterada. Se encontró correlación positiva entre US y electromiografía en 12/24 túneles carpianos, y se observó una concordancia de lateralidad entre el tamaño del nervio y su alteración electrofisiológica en cinco pacientes. Se detectó sinovitis de muñeca en seis túneles carpianos (dos pacientes con artritis reumatoide, uno con osteoartritis erosiva). Conclusión: La US músculo-esquelética es una herramienta complementaria a la electromiografía en el estudio del STC en el paciente reumático, aportando información adicional con relación a la patología de base.

Objective: Compare high-resolution ultrasonography (US) and electromyography (EMG) of 19 patients with carpal tunnel syndrome (CTS) Results: Two patients were ruled out because of bifid median nerves. We found 15 median nerves with abnormal US appearance and 18 median nerve with abnormal EMG. We found a positive correlation between US and EMG in 12/24 carpal tunnels, and lateral agreement between nerve size and EMG alteration in 5 patients. Wrist synovitis was detected in six carpal tunnels (two patients with rheumatoid arthritis and one with osteoarthritis). Conclusion: Musculoskeletal ultrasound is a complementary tool to electromyography in the CTS study of rheumatologic patients, thus providing additional information in relation to the basal pathology.

A comparative study of median nerve somatosensory evoked potential in the totally blind and normal subjects.

The totally blind individuals are often considered to be compensated for their visual loss by augmentation in the auditory and tactile perceptions as against the normal sighted individuals. The objective of the present work was to study the somatosensory evoked potentials (SEPs) after median nerve stimulation in the wrist of totally blind and normal sighted individuals. SEPs were recorded after median nerve stimulation in the wrist of 15 Braille reading totally blind females and compared with 15 age matched normal sighted females. Latency and amplitudes of SEPs (N9, N13, and N20) were measured and analyzed statistically. Amplitude of N20 SEP was significantly larger in the totally blind than in normal sighted individuals (P < 0.05). The amplitudes of N9 and N13 SEPs and the latencies of all SEPs showed no significant differences. The congenitally blind individuals have larger N20 amplitude, suggestive of greater somatosensory cortical representation than normal sighted individuals.

Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome / Influência do resfriamento nos parâmetros de condução nervosa mista do mediano e ulnar na síndrome do túnel do carpo

Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU) in electrodiagnosis of carpal tunnel syndrome (CTS). Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands). Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands). PMU was obtained at the usual temperature, >32°C, and after wrist/hand cooling to <27°C in ice water. After cooling, there was a significantly greater increase in PMU and mixed ulnar palmar latency in patients versus controls. We concluded that cooling significantly modifies the PMU. We propose that the latencies of compressed nerve overreact to cooling and that this response could be a useful tool for incipient CTS electrodiagnosis. There was a significant latency overreaction of the ulnar nerve to cooling in CTS patients. We hypothesize that subclinical ulnar nerve compression is associated with CTS.

Temperatura é uma variável comum e importante que modifica os parâmetros de condução nervosa na prática eletrodiagnóstica. Neste trabalho nós estudamos o efeito do esfriamento na diferença de latências palmares entre o nervo mediano e ulnar (PMU), segmento palma-pulso, utilizada rotineiramente para o eletrodiagnóstico da síndrome do túnel do carpo (STC). Foram estudados 22 controles (19 mulheres, média de idade 42,1 anos, 44 mãos) e 25 pacientes (25 mulheres, média de idade 46,6 anos, 34 mãos) com diagnóstico de STC leve. PMU foi obtida em temperatura usual (>32°C), e após resfriamento de mão/pulso em água com gelo (<27°C). Após o resfriamento houve aumento significativo na PMU e na latência mista palmar do nervo ulnar nos pacientes quando comparados aos controles. Nós concluímos que o resfriamento modifica significativamente a PMU e propomos que as latências obtidas em nervos submetidos à compressão reagem de maneira mais acentuada ao frio e isso poderia ser uma arma útil para o eletrodiagnóstico da STC incipiente. Da mesma forma, houve reação mais acentuada ao frio no estudo da latência mista palmar do nervo ulnar nos pacientes mas não nos controles, que poderia levantar a hipótese de compressão subclínica do nervo ulnar.

The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy.

BACKGROUND: Conventional methods in the diagnosis of carpal tunnel syndrome (CTS) in patients with polyneuropathy (PNP) are insufficient. AIMS: We suggest that the comparison of the conduction of the median nerve with that of the neighboring peripheral nerves may be more beneficial in the diagnosis of entrapment neuropathy. SETTING AND DESIGN: The median nerve sensory conduction in healthy volunteers, in cases of CTS, PNP cases without CTS and in cases of PNP in whom clinical findings point to CTS, were compared by palmar cutaneous nerve (PCN) sensory conduction. MATERIALS AND METHODS: Comparative parameters were difference of PCN-1st digits' nerve conduction velocities (NCV), PCN/1st digit NCVs ratio, difference of 5th-2nd digits' NCVs and 5th/2nd digits' NCVs ratio. STATISTICAL ANALYSIS: The statistical analysis was performed by the SPSS package for statistics. Student t test and receiver operating characteristic were used. RESULTS: Although the ratio of PCN-1st digit did not differ significantly between the control group and the polyneuropathy group, there was a significant difference between CTS and PNP+CTS groups and the control group ( P < 0.001 and P < 0.001, respectively). The ratio of PCN-1st digit nerve conduction velocity was also significantly different between polyneuropathy and PNP+CTS groups ( P < 0.001). CONCLUSION: To diagnose CTS on a background of polyneuropathy in mild cases in which sensory conduction is preserved, the ratio of sensory nerve conduction velocities of the palmar cutaneous nerve and the median nerve 1st digit-wrist segment may be a criterion.

Early nerve damage in leprosy: an electrophysiological study of ulnar and median nerves in patients with and without clinical neural deficits.

BACKGROUND: Peripheral nerve trunk involvement in leprosy is very common. However, by the time it becomes clinically manifest, the damage is quite advanced. If the preclinical nerve damage can be detected early, the deformities and disabilities can be prevented to a large extent. AIMS: To assess the electrophysiological functions of the ulnar and median nerve trunks in cases of clinically manifest leprosy with and without manifest nerve damage at different durations of nerve damage. MATERIALS AND METHODS: Electrophysiological functions of ulnar and median nerves were studied in leprosy patients, both normal and at different stages of disease and damage. PB cases, having disease for six months or less, without neurological symptoms and clinically normal appearing nerve. STATISTICAL METHODS: Mean was taken of different values. The changes in values of different parameters were expressed as percentage change with reference to the control values (increase or decrease). RESULTS: Reduced nerve conduction velocities and changes in latency and amplitude were observed. Changes in sensory nerve conduction were more pronounced. Sensory latencies and amplitude changes were more severe than motor latencies and amplitudes in cases with manifest muscle palsies. Changes in MB cases were less marked. CONCLUSIONS: Further studies are needed to identify parameters likely to be helpful in the diagnosis of early nerve damage.

Association between chronic exposure to arsenic and slow nerve conduction velocity among adolescents in Taiwan.

The association between chronic exposure to arsenic and peripheral neuropathy has been controversial in previous studies, which may be due to the influence of factors, such as age, gender, chronic diseases, occupational injuries, and arsenic exposure. To clarify the question of this association, a cross-sectional study was designed. In total, 130 junior high school students aged 12-14 years were included and examined for the motor and sensory nerve conduction velocity of peripheral nerves in their right-upper and lower limbs. Concentrations of arsenic in well-water and history of drinking well-water were retrieved from a baseline database created in 1991. After adjustment for gender and height, a significant odds ratio of 2.9 (95% confidence interval [CI] 1.1-7.5) was observed for the development of slow nerve conduction velocity of the sural sensory action potential (SAP) among the study subjects with a cumulative arsenic dosage of>100.0 mg. In addition, a borderline statistical significance with odds ratio of 7.8 (95% CI 1.001-69.5) for the development of slow nerve conduction velocity of sural SAP was also observed among the study subjects who drank well-water containing arsenic concentrations of >50.0 microg/L and with a cumulative arsenic dosage of >100.0 mg. The study found that chronic exposure to arsenic might induce peripheral neuropathy. It also found that the slowing of the nerve conduction velocity of sural SAP might be an early marker of chronic arsenic neuropathy.

Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo / Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm) e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC), submetidos a estudos de condução nervosa (ECN). As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN) e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (p<0,05), bem como entre a TNAm e os três grupos definidos pela alteração eletrofisiológica (r s=+0.437, p=0,002). Valores de TNAm foram significantemente maiores nos braços com diagnóstico eletrofisiológico (p=0,007). Sugere-se que a TNAm tem participação na fisiopatologia da STC, indicando o uso de procedimentos terapêuticos que diminuam ou previnam a tensão neural.

MR Imaging and Electrophysiological Evaluation in Carpal Tunnel Syndrome

The objective of this study was to compare the MRI findings of wrists in patients diagnosed with CTS with those of the healthy controls, and to evaluate the correlation between the MRI differences and the electrophysiological findings in the patient group. This study involved 55 wrists, 30 of which were clinically and electrophysiologically diagnosed with CTS and 25 healthy controls. These 55 wrists were evaluated electrophysiologically, and in terms of median nerve diameter, ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level, the flexor retinaculum bulging ratio and the median nerve intensity by MRI. When the patient group, which were clinically and electrophysiologically diagnosed with CTS, and the healthy control group were compared, a significant difference (p 0.05). According to the data obtained from the study, we believe that the MRI examination of structural changes that occur in the carpal tunnel, neighboring structures and the median nerve would be useful in the diagnosis of CTS, especially in cases with suspected clinical and electrophysiological diagnosis.

Comparison of nerve conduction techniques in 95 mild carpal tunnel syndrome hands

Electrodiagnosis of carpal tunnel syndrome (CTS) were prospectively studied in 95 hands. The following techniques were studied in all hands when at least one abnormal value was found (onset-measured), it was included on results: 1. wrist-index finger latency (WIF), abnormal = 2.8 ms, 140 mm; 2. palm-wrist latency (PW), abnormal = 1.8 ms, 80 mm; 3. comparison median/ulnar palm-wrist latency (CPW), abnormal = 0.4 ms; 4. comparison median/ulnar latency, wrist-ring finger (CMU), abnormal = 0.5 ms, 140 mm; 5. comparison median/radial latency, wrist-thumb (CMR), abnormal = 0.4 ms, 100 mm. All 95 CTS hands selected have the WIF = 3.5 ms (mild CTS). We found the CMR (97.8 per cent) technique the most sensitive for mild CTS electrodiagnosis and the only comparative method with all potentials recordable when compared to CPW (88.4 per cent). PW (84.2 per cent), CMU (72.6 per cent) and WIF (68.4 per cent).

Motor terminal latency index in carpal tunnel syndrome

We determined the motor terminal latency index [MTLI] of the median nerve across the carpal tunnel in 41 upper extremities of 31 patients with carpal tunnel syndrome. Changes in motor nerve conduction velocity [MNCV], motor terminal latency [MTL], sensory action potential and the amplitude of the compound muscle action potential recorded from the abductor pollicis brevis muscle were all suggestive of proximal and distal segment involvement of the nerve across the carpal tunnel. There was no correlation between forearm MNCV and MTL [r = 0.40], although MTLI was correlated with MTL [r = 0.67] but not with MNCV, indicating a disproportionate conduction across the carpal tunnel

Two objective "archivable" tests for voluntary muscle testing in ulnar and median nerve paralysis.

Two tests are proposed for assessment of ulnar and median nerve function for use under field conditions: (i) "flap flexion" of fingers for ulnar nerve, and, (ii) tip-to-tip thumb opposition to the fourth finger for median nerve. These tests, which are a part of a series of simple clinical tests proposed for rapid neurological evaluation of the function of the nerves involved in leprosy, are simple, objective and easy to do. Because these tests depend on the strength of muscles tested, they might spare its direct assessment. In fact, it is difficult to assess and grade the strength of the little muscles of the hand and that is very much dependent on the examiner's own experience. Therefore, it is rather subjective. The tests described here may also be used for evaluating the results of corrective surgery of the hand. Whenever possible, making photographic records of these two tests, to be archived in the forms where everyone can see and compare them, seems to be easier and more objective than the subjective transcription of the feelings of an examiner assessing the strength of the small muscles of the hand. These two tests seem to be most objective for a scientific prospective study with a long term follow up. So, they could be used in assessing the results of leprosy neuritis by medical treatment, or, by medical treatment completed (when necessary only and not routinely) by surgical decompression of nerves and also of corrective surgery of claw hand, or, loss of opposition of the thumb.

Carpal tunnel syndrome: a clinical and electrophysiological study of 220 consecutive cases at King Fahd hospital of the university, Al-Khobar

To study the clinical and electrophysiological profile of patients with clinically diagnosed carpal tunnel syndrome [CTS] in the Eastern Province of Saudi Arabia. Neurology service at the King Fahd Hospital of the University [KFHU], Al-Khobar, Saudi Arabia. Two hundred and twenty consecutive patients [181 female, 39 male, mean age 37 and 44 years respectively], referred with a clinical diagnosis of CTS to the neurodiagnostic laboratories of KFHU between August 1991 and August 1995, formed the study group. They all had clinical evaluation and standardized nerve conduction studies [390 hands] performed by the same examiner. A control group of 64 normal subjects [31 females, 33 males, mean age 37 and 43 years respectively] were concurrently studied. Carpal tunnel syndrome was confirmed in 265 hands [68%]. The mean distal sensory peak latency [DSL] in milliseconds [ms +/- standard deviation [SD] was 4.61 +/- 1.54 ms [227 hands, 58.2%]. The mean distal motor latency [DML] was 5.87 +/- 1.5 ms [195 hands, 50%]. In 38 hands [9.7%] no sensory responses were recordable. Of these 4 hands [1%] had no motor responses as well. Seventy four percent of the patients were below 45 years of age. The main presenting symptoms were numbness [88.7%], pain in the hands [69.8%] and weakness [35.5%]. Sixty percent of the patients presented to hospital within one year of onset of symptoms. The frequency of associated conditions was highest for diabetes mellitus in 13.1% of the patients. The clinical and electrophysiological patterns of CTS in Saudi Arabia are similar to those reported from developed countries

Electrophysiological findings in newly diagnosed non-insulin-dependent diabetics: a prospective study

This study reports the electrophysiological findings in patients with newly diagnosed non-insulin-dependent diabetes mellitus [NIDDM] studied in the Neurodiagnostic Laboratory of the King Fahd Hospital of the University [KFHU], Al-Khobar, Saudi Arabia. Twenty-nine patients [22 males, 7 females, mean ages 47 and 37 years, respectively] were studied within four weeks of establishing the diagnosis. They were all given nerve conduction studies by the same examiner. Comparison was made with data from a group of 64 normal control subjects. In the study patients, the mean distal sensory peak latency in milliseconds [ms] +/- standard deviation [SD] was 3.5 +/- 0.41 ms in 35 median nerves, 3.2 +/- 0.72 ms in 35 ulnar nerves, 1.9 +/- 0.34 ms in 23 superficial radial nerves and 3.5 +/- 0.61 in 36 sural nerves. The mean distal motor latency +/- SD was 4.6 +/- 0.95 ms in 39 median nerves, 3.5 +/- 0.58 ms in 38 ulnar nerves, 4.8 +/- 1.02 ms in 44 tibial nerves and 6.0 +/- 1.08 ms in 36 peroneal nerves. The electromyogram examination was performed on 24 patients and showed evidence of denervation and/or chronic reinnervation in seven [29%]. The frequency of abnormalities in the studied peripheral nerves was 60% for median, 63% ulnar, 33% peroneal, 16% tibial and 8% sural

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

Leprosy neuropathy: correlation of clinical and electrophysiological tests.

This report describes the neurological and electrophysiological examination of 35 subjects with leprosy (average duration of symptoms 3.4 years, average time since diagnosis 7.5 months). Clinical examination in the distribution of non-dominant median and ulnar nerves was performed with the following clinical methods: touch sensation with 0.05 gm. Monofilament nylon, thermal sensation with a thermal sensitivity testing device, voluntary muscle testing and nerve palpation. At least one abnormality was found in 22 ulnar and 13 median nerves (63% and 37%, respectively). Nerve palpation was the most frequent clinical abnormality, while the other methods had similar frequencies of abnormality. Electrophysiological studies were performed on the ipsilateral side of the leprosy subjects and on 32 age-matched normal subjects. Electrophysiological responses from the leprosy subjects were evaluated by criteria established from normal subject data. Abnormal or absent responses were found in 21/35 ulnar sensory, 12/35 ulnar motor, 9/35 median sensory and 6/35 median motor responses among the leprosy subjects. The most important electrodiagnostic findings were: (i) low sensory amplitudes and (ii) drops in amplitude and NCV over the across-elbow segment of the ulnar nerve. Both clinical and nerve conduction abnormalities were positively associated with duration of leprosy symptoms. The four clinical methods were compared for concordance with nerve conduction data by cross-tabulation. The two sensory measures, monofilaments and the thermal sensitivity device, had the highest concordances. Usefulness of clinical tests for nerve damage in leprosy may vary depending on whether the purpose is for diagnosis, patient education or clinical follow-up.