Electrodiagnostic Testing for Carpal Tunnel Syndrome When Routine Median Sensory and Thenar Motor Responses Are Absent.

PURPOSE The cardinal symptoms of carpal tunnel syndrome (CTS) include pain in the affected hand(s). The median/second lumbrical nerve (Med2ndL) seems relatively preserved in severe CTS, with previous small studies suggesting its value in electromyogram to localize a median neuropathy to the wrist when both initial routine sensory and thenar motor responses are absent. METHODS This is a retrospective analysis of 208 hands in 183 patients with electrophysiologically markedly severe CTS (absent routine sensory and thenar motor median responses) who underwent stimulation of both the Med2ndL and ulnar/second dorsal interosseous (Uln2ndDIn) motor nerves. A Med2ndL distal latency of ≥ 0.5 milliseconds when compared with the Uln2ndDIn supported the diagnosis of CTS. The presence or absence of hand pain was recorded if these data were available. RESULTS Some 83.7% of hands (172/208) in 183 patients with markedly severe CTS had preservation of the Med2ndL meeting criteria for CTS. In those with pain data available, 77.1% (81/105) of hands had no pain. Of those 105 hands, 87 had preservation of the Med2ndL with 79.3% (69/87) demonstrating no pain. CONCLUSIONS This is a large study that demonstrates the relative preservation of the Med2ndL response in markedly severe CTS. Assessment of the Med2ndL should be considered to electrophysiologically support CTS when routine sensory and thenar motor responses are absent. In addition, most patients with electrophysiologically markedly severe CTS had no pain.