Abstract
Hough AD, Moore AP, Jones MP. Reduced longitudinal excursion of the median nerve in
carpal tunnel syndrome.
Objective
To determine if longitudinal excursion of the median nerve is reduced in patients
with carpal tunnel syndrome (CTS).
Design
Case-control study.
Setting
University human movement laboratory.
Participants
Nineteen patients with CTS (8 men, 11 women; mean age, 57±15y), and 37 healthy controls
(8 men, 29 women; mean age, 48±10y).
Interventions
Not applicable.
Main Outcome Measures
Longitudinal excursion of the median nerve, and the ratio of nerve to flexor digitorum
superficialis tendon excursion at the carpal tunnel evoked by finger extension. Measurements
were taken using a validated Doppler ultrasound technique, and tests were conducted
with the elbow positioned in extension and flexion.
Results
Mean longitudinal excursion of the median nerve was significantly greater in controls
(11.2±2.8mm) than patients (8.3±2.6mm) with the elbow extended (P=.013), but not with the elbow flexed (controls, 12.5±2.5mm; patients, 10.2±3.1mm;
P=.089). Mean nerve/tendon excursion ratios were significantly greater in controls
(.32±.07) than patients (.23±.06), with the elbow extended (P<.001), and flexed (controls, .36±.06; patients, .28±.10; P=.019). Discriminant analysis identified that 11 (58%) of the 19 patients and 3 (8%)
of the 37 controls showed a nerve/tendon excursion ratio of .25 or less when tested
with the elbow in extension.
Conclusions
Reduced longitudinal excursion of the median nerve at the carpal tunnel was identified
in a substantial proportion of patients with CTS. Further studies are merited to determine
if reduced median nerve excursion at the carpal tunnel is clinically relevant in CTS,
and can be influenced by movement-based interventions.
Key Words
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Identification
Copyright
© 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
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- Reduced Longitudinal Excursion of the Median Nerve in Carpal Tunnel SyndromeArchives of Physical Medicine and RehabilitationVol. 88Issue 11
- PreviewI read with both interest and pleasure this excellent article on the in vivo measurement of longitudinal excursion of the median nerve (or lack thereof) utilizing Doppler ultrasound in carpal tunnel syndrome (CTS).1 Hough et al,1 noting a significant reduction in the longitudinal excursion of the median nerve in patients with CTS, once again calls attention to ischemia rather than only mechanical factors, that is, compression, as a significant potential source of symptoms. Most often, neuroischemia initially induces sensory symptoms of pain and paresthesias before motor signs become evident.
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