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Use of thenar electromyography in the evaluation of carpal tunnel syndrome
Society proceedings/
Elecrroencephalography
in which it was studied, including 2 cases where semitendinosus was abnormal. In S- 1 radiculopathy, the lateral gastrocnemius was involved in 7/8, median gastrocnemius 6/8, BFSH 5/6, abductor digiti quinti 5/6, paraspinals 2/8 aud the H-reflex 6/8. Conclusions: L-3, L-4, L-5.. and S-1 radiculopathies presented with stereotyped EMG patterns. In L-5 radiculopathy, proximal muscle involvement was patchy. BFSH was normal in L-5 radiculopathy, but almost invariably involved in Sl radiculopathy. R.A. Bodner, Junior Member Recognition Award.
153. Neurological assessment of children with acquired foot deformities. - C. Adams and M.J. Wilson (Alberta Children’s Hospital, Calgary, Canada)
Introduction: In children with acquired foot deformities, it is not certain if clinical neurological fmdings are useful in determining a neurological etiology. Value of clinical fmdings was assessed in those investigated. Methods: Children referred ito a pediatric neurology clinic with foot deformity were assessed by history, examination, nerve conduction study, electromyography, neuroimaging, and molecular genetic studies. Results: Sixteen children were assessed at a mean age of 9.4 years. Symptoms were: difficulty walkrng or running, IO; leg pain, 7; sphincter disturbance, 2; asymmetry, 6. Signs were: pes planus, 4, footdrop, 3; pes cavus, 7; toe walking, 5; shortened Achilles tendon, 9; dorsiflexion weakness, 7; absent ankle jerks, 3; sensory loss, 1. Diagnosis was hereditary motor sensory neuropathy (HMSN) type IA in 2, HMSN type 2 in 2, vincristine neuropathy in I, possible chronic inflammatory demyelinating polyneuropathy in I, tethered cord in 2; and no etiology in 8. Conclusions: Foot deformity, heel walking difficulty, asymmetry, and sensory testing were not diagnostically helpful. Seven of the 8 with a proven underlying etiology had clinical weakness, 6 had a progressive course and 3 had absent ankle reflexes. These findings were not present in those with no underlying cause and were the most useful clinical indicators of a neurological etiology. The degree of clinical abnormality dictated the extent of investigation, so investigation may not be considered complete.
154. Use of thenar electromyography in the evaluation of carpal tunnel syndrome. - A. Mazur and J.J. Wertsch (Medical College of Wiionsln, Milwaukee, WI)
Objective: The purpose of this study was to examine the prevalence and rationale for thenar EMG in the electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Methods: In December 1993, 110 surveys were mailed (71 responded) to a random sample of Fellows of the American Association of Elcctrodiagnostic Medicine. The survey questioned when they would do thenar EMG in the evaluation of CTS and how they would use the information. Results: The majority of respondents (74%) incorporated thenar EMG in their routine CTS evaluations. Of these, 79% felt that thenar EMG helped determine severity, 46% felt it helped determine prognosis and 19% felt thenar EMG was not helpful in determining severity or prognosis. Of those routinely performin thenar EMG, 54% felt it helped them decide between surgical versus conservative management, 17% to evaluate neutipraxia versus axonal loss., 19% to rule-out radiculopathy. Fifteen percent indicated that they “rely mostly on nerve conduction studies but include EMG of the abductor pollicis brevis if referral is from a surgeon,” while 10% responded “to be complete.” Conclusion: These results suggest that although many electromyographers routinely do thenar EMG in the evaluation of CTS, there does not appear to be a consistent rationale nor a consistent way of using the information. A. Mazur, Junior Member Recognition Award.
and clinical Neurophysiology
98 (1996) 8P-40P
39P
155. Survey of electrodiagnostic practice patterns in carpal tunnel syndrome. - A. Mazur and J.J. Wertsch (Medical College of Wisconsin, Milwaukee, WI) Objective: The purpose of this survey was to explore practice patterns with stratification by years in practice, specialty, and geographic region. Methods: Surveys were distributed via a randomized mailing to I IO Fellows (71 returned) of the American Association of Electrodiagnostic Medicine (AAEM) and at the AAEM 1994 fall meeting (57 responses). The survey explored “false negative” rate, which electrodiagnostic tests were used and which were considered most sensitive in evaluating carpal tunnel syndrome. Results: Sixty-five neurologists, 61 physiatrists and 2 “other” completed surveys; 63% were 2 IO years in electrodiagnostic practice. Median motor studies were done “usually or always” by 98%. and ulnar motor studies by 84% of all respondents. Index linger sensory studies were done by 63% overall. Long finger sensory studies were done by 51% of respondents 2 10 years practice and by 26% in practice < IO years. Transcarpal studies (done by 50% overall) were believed to be the “most sensitive” tests by 73% of northern midwest aud northwest respondents compared to approximately 30% for the rest of the country. Conclusion: Most believed the “false negative” rate for conduction studies is < 10%. Which studies are done and believed to be most sensitive varied by geographic region and years in practice with little difference between neurologists and physiatrists. 156. Referral patterns for EMG evaluation of carpal tunnel syndrome: a Positive reflection of the future?. - K.J. Bottesi, L.B. Schneider and B.K. Ahmad (Henry Ford Hospital, Detroit, MI) Introduction:As efficiency of healthcare delivery is scrutinized, resurgence of the primary care physician (PCP) as coordinator for health maintenance is anticipated. Carpal tunnel syndrome (CTS) is the most common EMG diagnosis made at the Henry Ford Health Sciences Center, one of the largest managed-care multispecialty centers in the country. Objectives: Compare the yield of diagnostic EMG in CTS for 3 physician groups: PCP (including subspecialists with board certification in Internal/Family medicine), neurologists and surgeons (including all who treat CTS surgically). Methods: Retrospective review of 3740 EMGs performed between January and December 1994 revealed 1156referrals for CTS (31%). These were grouped by ordering physician, number of CTS + (%I studies, and number of CTS + studies which diagnosed other conditions. Results: PCP ordered 586 EMGs; 389 (66%) CTS + . Neurologists ordered I I9 EMGs; 85 (71%) CTS + . Surgeons ordered 451 EMGs; 300 (67%) CTS + . Neurologists had the most referrals with CTS + plus coexisting conditions. Conclusions: Yield of CTS + examinations is approximately the same for 3 physician groups. Specialist evaluation before ordering EMG for
CTS is not warranted. K.J. Bottesi, Junior Member Recognition Award. 157. Comparison of different parts of quadriceps muscle for patellar tendon reflex study. - G.-Y. Jo ‘, D. Kweon ‘, I. Park-K0 a and S.-H. Kim b (” Inje University Pusan Paik Hospital, Pusan, South Korea; b Seoul City University, Seoul, South Korea) Objectives: We investigated the differences of patellar tendon reflex responses (PTRRs) of vasNS medialis, vastus lateralis aud recNs femoris muscles because the differences of its responses to different parts of the quadriceps muscle are expected.
Methods: PTRRs of the vastus medialis, vastus lateralis and recNS femoris were evaluated in 10 healthy adult subjects. The PTRRs were evoked with an electric hammer with an average of 5 times and recorded on motor points.
Elecrroencephalography
in which it was studied, including 2 cases where semitendinosus was abnormal. In S- 1 radiculopathy, the lateral gastrocnemius was involved in 7/8, median gastrocnemius 6/8, BFSH 5/6, abductor digiti quinti 5/6, paraspinals 2/8 aud the H-reflex 6/8. Conclusions: L-3, L-4, L-5.. and S-1 radiculopathies presented with stereotyped EMG patterns. In L-5 radiculopathy, proximal muscle involvement was patchy. BFSH was normal in L-5 radiculopathy, but almost invariably involved in Sl radiculopathy. R.A. Bodner, Junior Member Recognition Award.
153. Neurological assessment of children with acquired foot deformities. - C. Adams and M.J. Wilson (Alberta Children’s Hospital, Calgary, Canada)
Introduction: In children with acquired foot deformities, it is not certain if clinical neurological fmdings are useful in determining a neurological etiology. Value of clinical fmdings was assessed in those investigated. Methods: Children referred ito a pediatric neurology clinic with foot deformity were assessed by history, examination, nerve conduction study, electromyography, neuroimaging, and molecular genetic studies. Results: Sixteen children were assessed at a mean age of 9.4 years. Symptoms were: difficulty walkrng or running, IO; leg pain, 7; sphincter disturbance, 2; asymmetry, 6. Signs were: pes planus, 4, footdrop, 3; pes cavus, 7; toe walking, 5; shortened Achilles tendon, 9; dorsiflexion weakness, 7; absent ankle jerks, 3; sensory loss, 1. Diagnosis was hereditary motor sensory neuropathy (HMSN) type IA in 2, HMSN type 2 in 2, vincristine neuropathy in I, possible chronic inflammatory demyelinating polyneuropathy in I, tethered cord in 2; and no etiology in 8. Conclusions: Foot deformity, heel walking difficulty, asymmetry, and sensory testing were not diagnostically helpful. Seven of the 8 with a proven underlying etiology had clinical weakness, 6 had a progressive course and 3 had absent ankle reflexes. These findings were not present in those with no underlying cause and were the most useful clinical indicators of a neurological etiology. The degree of clinical abnormality dictated the extent of investigation, so investigation may not be considered complete.
154. Use of thenar electromyography in the evaluation of carpal tunnel syndrome. - A. Mazur and J.J. Wertsch (Medical College of Wiionsln, Milwaukee, WI)
Objective: The purpose of this study was to examine the prevalence and rationale for thenar EMG in the electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Methods: In December 1993, 110 surveys were mailed (71 responded) to a random sample of Fellows of the American Association of Elcctrodiagnostic Medicine. The survey questioned when they would do thenar EMG in the evaluation of CTS and how they would use the information. Results: The majority of respondents (74%) incorporated thenar EMG in their routine CTS evaluations. Of these, 79% felt that thenar EMG helped determine severity, 46% felt it helped determine prognosis and 19% felt thenar EMG was not helpful in determining severity or prognosis. Of those routinely performin thenar EMG, 54% felt it helped them decide between surgical versus conservative management, 17% to evaluate neutipraxia versus axonal loss., 19% to rule-out radiculopathy. Fifteen percent indicated that they “rely mostly on nerve conduction studies but include EMG of the abductor pollicis brevis if referral is from a surgeon,” while 10% responded “to be complete.” Conclusion: These results suggest that although many electromyographers routinely do thenar EMG in the evaluation of CTS, there does not appear to be a consistent rationale nor a consistent way of using the information. A. Mazur, Junior Member Recognition Award.
and clinical Neurophysiology
98 (1996) 8P-40P
39P
155. Survey of electrodiagnostic practice patterns in carpal tunnel syndrome. - A. Mazur and J.J. Wertsch (Medical College of Wisconsin, Milwaukee, WI) Objective: The purpose of this survey was to explore practice patterns with stratification by years in practice, specialty, and geographic region. Methods: Surveys were distributed via a randomized mailing to I IO Fellows (71 returned) of the American Association of Electrodiagnostic Medicine (AAEM) and at the AAEM 1994 fall meeting (57 responses). The survey explored “false negative” rate, which electrodiagnostic tests were used and which were considered most sensitive in evaluating carpal tunnel syndrome. Results: Sixty-five neurologists, 61 physiatrists and 2 “other” completed surveys; 63% were 2 IO years in electrodiagnostic practice. Median motor studies were done “usually or always” by 98%. and ulnar motor studies by 84% of all respondents. Index linger sensory studies were done by 63% overall. Long finger sensory studies were done by 51% of respondents 2 10 years practice and by 26% in practice < IO years. Transcarpal studies (done by 50% overall) were believed to be the “most sensitive” tests by 73% of northern midwest aud northwest respondents compared to approximately 30% for the rest of the country. Conclusion: Most believed the “false negative” rate for conduction studies is < 10%. Which studies are done and believed to be most sensitive varied by geographic region and years in practice with little difference between neurologists and physiatrists. 156. Referral patterns for EMG evaluation of carpal tunnel syndrome: a Positive reflection of the future?. - K.J. Bottesi, L.B. Schneider and B.K. Ahmad (Henry Ford Hospital, Detroit, MI) Introduction:As efficiency of healthcare delivery is scrutinized, resurgence of the primary care physician (PCP) as coordinator for health maintenance is anticipated. Carpal tunnel syndrome (CTS) is the most common EMG diagnosis made at the Henry Ford Health Sciences Center, one of the largest managed-care multispecialty centers in the country. Objectives: Compare the yield of diagnostic EMG in CTS for 3 physician groups: PCP (including subspecialists with board certification in Internal/Family medicine), neurologists and surgeons (including all who treat CTS surgically). Methods: Retrospective review of 3740 EMGs performed between January and December 1994 revealed 1156referrals for CTS (31%). These were grouped by ordering physician, number of CTS + (%I studies, and number of CTS + studies which diagnosed other conditions. Results: PCP ordered 586 EMGs; 389 (66%) CTS + . Neurologists ordered I I9 EMGs; 85 (71%) CTS + . Surgeons ordered 451 EMGs; 300 (67%) CTS + . Neurologists had the most referrals with CTS + plus coexisting conditions. Conclusions: Yield of CTS + examinations is approximately the same for 3 physician groups. Specialist evaluation before ordering EMG for
CTS is not warranted. K.J. Bottesi, Junior Member Recognition Award. 157. Comparison of different parts of quadriceps muscle for patellar tendon reflex study. - G.-Y. Jo ‘, D. Kweon ‘, I. Park-K0 a and S.-H. Kim b (” Inje University Pusan Paik Hospital, Pusan, South Korea; b Seoul City University, Seoul, South Korea) Objectives: We investigated the differences of patellar tendon reflex responses (PTRRs) of vasNS medialis, vastus lateralis aud recNs femoris muscles because the differences of its responses to different parts of the quadriceps muscle are expected.
Methods: PTRRs of the vastus medialis, vastus lateralis and recNS femoris were evaluated in 10 healthy adult subjects. The PTRRs were evoked with an electric hammer with an average of 5 times and recorded on motor points.