[Prevalence of Martin-Gruber anastomosis on motor nerve conduction studies].

Prevalence of median to ulnar anastomosis in the forearm(Martin-Gruber anastomosis; MGA) to the first dorsal interosseous(FDI), abductor digiti quinti (ADQ) and adductor pollicis(AP) was investigated. Subjects contained 106 patients with normal nerve conduction or patients with various neuropathies. Recording electrodes were placed on the motor point of FDI, ADQ and AP. Supramaximal stimulations were given to the median and ulnar nerves at the wrist or above the elbow. The diagnosis of MGA was made by the following criteria; amplitude of compound muscle action potential(CMAP) increased after elbow stimulation as compared with the wrist stimulation in median nerve conduction studies. The corresponding decrease in CMAP amplitude was found after above elbow stimulation as compared with the wrist stimulation in ulnar nerve conduction studies. No MGA was found in 80(75%) out of 106 patients. MGA to FDI was found in all 26 patients who had MGA. MGA to ADQ and AP was found in 11% and 10% of the patients, respectively. Only 8 out of 26 patients had MGA to all 3 muscles. In the presence of MGA median motor nerve conduction studies demonstrate larger CMAP, with a small initial positivity, after elbow stimulation than after wrist stimulation. And moreover, ulnar motor nerve conduction studies reveal a conduction block-like finding in the forearm. In this study MGA was found in 25% of the patient to FDI, in 11% to ADQ and in 10% to AP. Although a very small MGA might be overlooked in our method, such a small MGA doesn't mislead us into erroneous interpretation of motor nerve conduction studies.

[Sensory nerve action potentials in the evaluation of diabetic polyneuropathy].

In order to clarify the suitability of sensory nerve action potential(SNAP) in the evaluation of diabetic polyneuropathy, we studied measurements of SNAPs in the median, ulnar and sural nerves. Subjects were 253 patients with non-insulin dependent diabetes mellitus; 167 men and 86 women, aged 58.2 +/- 12.8(mean +/- SD) years old. Their diabetic history was 10.2 +/- 8.6 years. SNAPs were recorded antidromically from index finger, little finger and lateral to the Achilles tendon, respectively. Twenty-eight patients, in whom any one of the SNAPs couldn't be obtained, were already excluded from this study. The polyneuropathy index (PNI) was calculated from 12 indices concerning to the velocity or long distance latency in motor nerve conduction studies of 4 nerves. The PNI is known to be an excellent index to express the degree of diabetic polyneuropathy. Amplitude and conduction velocity in each nerve was 28.6 +/- 15.6 microV and 46.2 +/- 7.4 m/sec in the median nerve, 26.7 +/- 15.8 microV and 47.0 +/- 6.5 m/sec in the ulnar nerve, 13.1 +/- 6.5 microV and 43.1 +/- 6.0 m/sec in the sural nerve, respectively. The coefficient of correlation of the measurements between median and ulnar nerves was larger than other assortment of nerves. The coefficient of correlation of each measurement with PNI was around 0.40 in the amplitude and around 0.55 in the conduction velocity. Nevertheless, the mean value of the 3 nerves had a higher coefficient of correlation with PNI; 0.48 in the amplitude and 0.60 in the conduction velocity. SNAP measurements of a single nerve are often largely affected by the inter-individual differences, inter-nerve differences or measuring errors. But the mean value of the 3 nerves will be better in exploring the degree of diabetic polyneuropathy. Evaluation of diabetic polyneuropathy by SNAPs will be best achieved by using the mean value of these 3 nerves.

[Sequential nerve conduction studies in a patient with ulnar neuropathy at the elbow treated by night athletic supporter].

Ulnar nerve can be stretched with the elbow flexed position. To avoid elbow flexed position in patients with ulnar neuropathy at the elbow we used an athletic elbow supporter. We herein demonstrate a 31-year-old man with right ulnar neuropathy at the elbow whose neuropathy was resolved by using this supporter only at night. He had complained of weakness and paraesthesia in the ulnar side of his right hand. Nerve conduction studies of right ulnar nerve revealed decrease in the amplitude of compound nerve action potentials and a severe motor nerve conduction block with apparent conduction delay around the ulnar groove. A diagnosis of ulnar neuropathy at the elbow was done and we recommended him to wear an athletic elbow supporter at night. Paraesthesia of his right hand improved in a few days after starting this therapy. Three months later paraesthesia was resolved. One year later grip power of his right hand increased to 35 kg from 20 kg, and the conduction block at the elbow completely disappeared. Compound nerve action potentials, recorded at the segment of wrist to above elbow and wrist to finger, were improved equally. These observations suggest that the conduction block at the elbow entrapment site and the distal axonal degeneration gradually recovered together.

[Analysis of segmental motor conduction in the median and the ulnar nerves: comparison between normal and diabetic individuals].

We investigated characteristics of segmental motor conduction in the median and the ulnar nerves. Subjects were 55 individuals with normal conduction of the upper extremity and 71 patients with diabetes mellitus. Mean polyneuropathy index (PNI), which was determined as a mean percentage of the normal for 6 indices concerning to the conduction velocity in the upper limb, was 99.0% in the normal group and 85.6 % in the diabetic group on the mean. In the normal group distal latency was longer in the median nerve than in the ulnar nerve, and the conduction time between Erb's point and the wrist was longer in the ulnar nerve than the median nerve both in men and women. In the diabetic group these differences were accentuated; that means the distal latency was relatively more prolonged in the median nerve and the conduction time between Erb's point and the wrist was much longer in the ulnar nerve. Prolonged distal latency in the median nerve of women and conduction delay between Erb's point and the wrist in the ulnar nerve of men altogether resulted in the gender difference in the median minus ulnar F-wave latency after wrist stimulation in the diabetic group. Carpal tunnel segment of the median nerve and the elbow segment of the ulnar nerve are known to be common entrapment sites. This phenomenon of accentuated conduction delay in these common entrapment sites might be considered as a sort of 'double crush syndrome'.

[Comparison of nerve conduction studies between conventional and lumbrical/interossei recording methods in diabetics].

Median nerve conduction studies were performed by conventional and lumbrical/interossei recording methods. The former is composed of recordings of compound muscle action potential from abductor pollicis brevis (APB) and sensory nerve action potential from second digit (D) after wrist stimulation. In the latter the recording electrode was placed lateral to the midpoint of the 3rd metacarpal bone, and recorded compound muscle action potential from the 2nd lumbrical (2 L) and sensory nerve action potential from the digital nerve (N) after wrist stimulation. Subjects were 57 healthy individuals and 97 patients with diabetes mellitus. Particularly in diabetic patients values of coefficient of correlation between each measurement were high enough; i.e., r = 0.91 between latencies to 2 L and APB, r = 0.55 between amplitudes of 2 L and APB, r = 0.86 between amplitudes of N and D. Corresponding measurements by conventional method and lumbrical/interossei method were identical in the values of coefficient of correlation between measurements. The characteristics of lumbrical/interossei method are to be able to record compound muscle action potentials and nerve action potential from the same electrode. In this study values obtained by lumbrical/interossei method showed identical correlation between measurements to the corresponding ones by conventional method. In conclusion recordings of APB and D by conventional method can be replaced with the recordings of 2 L and N by lumbrical/interossei method in the evaluation of diabetic neuropathies.

[Isolated extensor digitorum brevis involvement in the population of normal systemic nerve conduction velocities].

To investigate the characteristics of isolated atrophy in extensor digitorum brevis(EDB), we analysed 262 patients whose polyneuropathy index(PNI) was 90% or more than the normal mean value. The PNI was determined as the mean percentage of the normal in 12 indices concerning to the velocity or long distance latency in motor nerve conduction studies. Latencies were adjusted to 160 cm height. Amplitude of compound muscle action potential (CMAP) in EDB showed no correlation with the patient's age. Similar result was obtained as well when studied in 115 patients whose PNI level was 95% or more than the mean normal value. In 18(7%) out of 262 patients CMAP amplitude in EDB was 1 mV or less; larger prevalence(p < 0.05) in women(10%) than in men(4%). The number of motor units which innervate EDB decreases along with the age, but this age-related change could be compensated by the magnification of each motor unit. In Western reports isolated EDB palsy has a predilection for emaciated men. Instead, our results showed the predominance in women. We may have some factors other than in Western countries, for example customs to sit directly on the mat for a long time, in the occurrence of isolated EDB palsy. In conclusion, amplitude reduction in EDB CMAP may reflect the following two factors; neuropathy-related factor and another factor independent of age or neuropathy.

[Inter-examiner reliability of nerve conduction measurements].

A total of 122 patients were performed motor and sensory nerve conduction studies of the upper limb by two examiners (1. doctor, 2. medical technician) to know the inter-examiner reliability of nerve conduction measurements. Subjects contained normal individuals and various types of neuropathy patients. Motor nerve conduction studies were carried out in the median nerve, and antidromic sensory nerve conduction studies were performed in the median and ulnar nerves. F-wave latency of the median nerve and sensory conduction velocity between finger and wrist of the median and ulnar nerves presented the equal mean value between two examiners. A relatively good correlation between two examiners was pointed out in the distal motor latency and F-wave latency. Inappropriate measurements were caused by the differences in the site of placement of stimulating or recording electrodes and effects of submaximum stimuli or stimulus spread to other nerves. In sensory nerve conduction studies, especially in the ulnar nerve, careful attention should be paid to avoid the influence of motor artifact in giving supramaximum stimuli. Amplitude measurements showed larger inter-examiner difference than latency or velocity measurements. We reported the present condition of measurement reliability. We should do our best to minimize the error.