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J Brachial Plex Peripher Nerve Inj 2009; 04(01): e36-e42
DOI: 10.1186/1749-7221-4-7
Research article
Shibuya et al; licensee BioMed Central Ltd.

Neurophysiological study to assess the severity of each site through the motor neuron fiber in entrapment neuropathy[*]

Ryoichi Shibuya
1   Department of Rehabilitation, Osaka Rosai Hospital, Sakai, Japan
,
Hideo Kawai
2   Department of Orthopaedic Surgery, Hosigaoka Kouseinenkin Hospital, Hirakata, Japan
,
Kouji Yamamoto
3   Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
› Author Affiliations
Subject Editor:
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Publication History

14 January 2009

17 June 2009

Publication Date:
18 September 2014 (online)

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Abstract

Background The double crush hypothesis (DCH) that had been widely accepted seems to have been dismissed recently. Prior to the DCH, retrograde changes in the proximal median nerve in carpal tunnel syndrome (CTS) were reported. There has been no report of quantitative analyzing about the effect of one site’s compression on another site all through the same peripheral nerve in CTS patients.

Methods We measured the central motor conduction time (CMCT), motor conduction latency of the cervical root region (CRL), peripheral path latency from the rootlet to the wrist (PL) and motor distal latency (MDL) in the median nerve and ulnar nerves, respectively in CTS patients.

Results MDL, PL and CRL were prolonged selectively in the median nerve, but not in the ulnar nerve of CTS patients. And in the median nerve measurement, MDL was high (r = 0.59, p < 0.0001) while PL showed a significant (r = -0.28, p < 0.05) relationship with CRL. MDL was large (r = 0.58, p < 0.0001) and showed a close (r = 0.59, p < 0.0001) relationship with the amplitude of CMAP. There was no significant difference between the amplitude of the normal CRL group and that of the prolonged CRL group. This quantitative analysis showed a linear relationship among MDL, CRL and CMAP amplitude.

Conclusion Dual entrapment lesions did not unexpectedly exaggerate the vulnerability or total damage. The vulnerability and the damage were proportional to the severity of each lesion. If the DCH term presented to an unexpectedly exaggerated degree, the cases of double crush symdrome in the CTS patients were rare, but if the term DCH refers to only this linear relationship, the DCH should not be dismissed.

*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.