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Neurometer^® Painless Carpal Tunnel Syndrome (CTS) Diagnostic Evaluation and Screening

The sensory Nerve Conduction Threshold (sNCT) evaluation and screening for Carpal Tunnel Syndrome (CTS) begins with testing conducted at the distal phalange of the index finger (B).  Early CTS is associated with hyperesthetic CPTs (abnormally low electrical excitability) reflecting inflamed nerves (neuritis) that have not lost their functioning.  Advanced CTS, associated with a loss of median nerve function (neuropathy), is associated with hypoesthetic (abnormally high) CPTs.  The combination of a sensory impairment detected at the distal phalange of the index finger (Site B), combined with normal CPT measures from the ulnar nerve (5th finger, Site E) and palmar branch of the median nerve (Site I, pre-tunnel control site), objectively confirms the clinical diagnosis of CTS. The CPT evaluation can detect CTS in the presence of a polyneuropathy. This electrodiagnostic procedure confirms the recovery of median nerve function following conservative or surgical treatment of CTS.  Screening for CTS in industrial settings results in the prevention of advanced complications and significant financial savings.

 Utilization Guidelines  Focal nerve lesions, such as those induced by a traumatic injury, are evaluated and confirmed by determining a normal sensory function proximal to the suspected lesion and abnormal function distally. For example, evaluation of carpal tunnel syndrome is performed by testing the median nerve proximal and distal to the carpal tunnel - at the palmar cutaneous branch of the median nerve and the distal digital branches of the median nerve, respectively. Upon obtaining measures consistent with the suspected condition, the distal digital branches of the ulnar nerve at the little finger are evaluated to rule out a distal polyneuropathy mimicking or co-existing with carpal tunnel syndrome.
                                                  

Excerpt from Recurrent Nerve Compression: Around the Hand Table: Hand Surgery Quarterly, Winter 2005 pgs. 7-18. A Publication of the American Association for Hand Surgery.

Dr. Van Beek: "Ms. Collins, you use Neurometer screening both for initial assessment and for follow up assessment, has that been a helpful adjunct in advising patients? How do you use those screening Neurometers in the management of the median neuropathies?"

Ms. Collins: "I was actually just going to interject because I think it’s been a very helpful tool for us to have in the clinic. These tests are non-invasive and are very convenient to use. They’re relatively comfortable for the patient and you get objective information that you can use to evaluate the patient’s status. We use it prior to surgery and for follow ups. I think it is particularly helpful for showing the patient how he’s doing during the post-surgery, healing/ rehab period."

The moderator for this discussion is Allen Van Beek, MD, in private practice in Minneapolis, MN, and a professor for the Plastic Surgery training program at the University of Minnesota.

He is joined by: Richard Brown, MD, FACS, Springfield Clinic, Clinical Professor, Division of Plastic Surgery, Southern Illinois University, Springfield, IL; Joan Collins, OTR/L, CHT, Collins Hand Therapy, Minneapolis, MN; Neil Ford Jones, MD, FRCS, Professor and Chief of Hand Surgery, Department of Orthopedic Surgery and Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA; Susan Mackinnon, MD, Shoenberg Professor of Surgery, Chief, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO; and Steven McCabe, MD, MSc, University of Louisville, Louisville, KY.

(Cutaneous nerve illustration on left by Frank Netter, MD)

See a selected bibliography of related publications using Neurometer technology.

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