Changes in motor axon recruitment in the median nerve in mild carpal tunnel syndrome

• Published in: Clinical neurophysiology 2006-11, Vol.117 (11), p.2467-2472
• Main Authors: Ginanneschi, F., Mondelli, M., Dominici, F., Rossi, A.
• Format: Article
• Language: English
• Subjects: Action Potentials - physiology; Adult; Axons - physiology; Biological and medical sciences; Carpal tunnel syndrome; Carpal Tunnel Syndrome - physiopathology; Conduction blocks; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Electrodiagnosis; Electrodiagnosis. Electric activity recording; Electromyography; Energy Metabolism - physiology; Female; Humans; Input–output properties; Investigative techniques, diagnostic techniques (general aspects); Male; Median Nerve - physiopathology; Medical sciences; Middle Aged; Motor Neurons - physiology; Nerve Fibers - physiology; Nervous system; Nervous system (semeiology, syndromes); Neural Conduction - physiology; Neurology; Recruitment, Neurophysiological - physiology; Surveys and Questionnaires; Ulnar Nerve - physiopathology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2006.08.002

To determine whether patients with mild carpal tunnel syndrome (CTS) and conventional electrodiagnostic evidence of selective involvement of sensory conduction show changes in motor axon recruitment in the median nerve. Wrist-to-abductor pollicis brevis (APB) motor axon conduction was studied by analysing the relationship between the intensity of electrical stimulation and the size of motor response (input–output curve) in 30 CTS patients with conventional electrodiagnostic evidence of selective involvement of sensory conduction. Parameters (threshold, slope and plateau) of input–output curves were compared with those obtained in 30 controls. The slope of the input–output curve of CTS patients was less steep than that of controls. For stimulus intensity above M-wave threshold (MTh), fewer motor axons were recruited in patients than controls. Motor fibres are affected in CTS when conventional electrodiagnostic tests show normal motor conduction. Altered recruitment of motor axons could mainly be due to impairment of energy-dependent processes which affect temporal dispersion of the compound volley or axonal conduction block. In mild CTS, motor fibres are more often affected than was originally thought. The sensitivity of wrist-to-APB motor conduction studies may be increased by using submaximal stimulus intensities.