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Needle electromyography in carpal tunnel syndrome: is it valuable or predictable?

Abstract

Context

Needle electromyography (EMG) examination is not crucial in establishing the diagnosis of carpal tunnel syndrome (CTS). However, the presence of axonal loss in needle EMG helps clinicians determine a treatment strategy such as surgery.

Aim of the work

The aim of this study was to investigate whether needle EMG in CTS patients is essentially needed or could be predicted using other nerve conduction study (NCS) parameters.

Materials and methods

This study included 100 patients with clinical and NCS-proven CTS, as well as 50 age-matched and sex-matched controls. All individuals were evaluated using electrodiagnostic techniques, including median distal latency, compound muscle action potential (CMAP), forearm motor nerve conduction velocity, median peak latency, sensory nerve action potentials, and sensory nerve conduction velocity. All CTS patients underwent EMG examination of the abductor pollicis brevis muscle, and the presence or absence of spontaneous EMG activity was recorded.

Results

Comparison of the NCS parameters between CTS patients with and without spontaneous EMG activity revealed that the main determinant parameters for spontaneous activity were CMAPs, sensory nerve action potentials, and forearm motor nerve conduction velocities. However, logistic regression analysis showed that CMAP was the most powerful predictor of the presence of spontaneous activity (P = 0.000, odds ratio = 12.154).

Conclusion

It can be concluded that median nerve CMAP amplitudes are the most powerful predictors of the occurrence of spontaneous EMG activity. However, EMG examination is still valuable in some CTS patients and NCS cannot completely replace needle EMG examination in these patients.

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Correspondence to Wafaa S. El-Emary MD.

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El-Emary, W.S., Hassan, M.M. Needle electromyography in carpal tunnel syndrome: is it valuable or predictable?. Egypt Rheumatol Rehabil 43, 41–46 (2016). https://doi.org/10.4103/1110-161X.177426

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Keywords

  • carpal tunnel syndrome
  • needle electromyography
  • spontaneous activity