Compressive Neuropathies-Dr. Andary - Compressive Neuropathies

Dr. Andary - Compressive Neuropathies

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This document provides a summary of a presentation on the electrodiagnostic evaluation of carpal tunnel syndrome (CTS). The presentation was given by Dr. Michael Andary from Michigan State University College of Osteopathic Medicine. The goals of the session were to develop a differential diagnosis for patients with arm symptoms, develop a plan for nerve conduction studies (NCS) to work up CTS, recognize the results of NCS, and interpret their significance depending on the clinical situation.<br /><br />The presentation started by discussing a case of a 64-year-old patient with arm pain and numbness. The symptoms were most commonly affecting the right thumb and index fingers and had been present for 6-12 months. The patient also experienced neck and periscapular pain, and all fingers could be affected. The strength appeared normal, but there was some weakness around the shoulder. Reflexes were normal and symmetric.<br /><br />The presentation then discussed the initial steps in diagnosing CTS. It emphasized the importance of considering the referring doctor's expectations, conducting a thorough history and physical examination, and developing an electrodiagnostic differential diagnosis. The most likely diagnoses for this patient were right CTS, right C6 radiculopathy, left CTS, brachial plexopathy, polyneuropathy, suprascapular neuropathy, rotator cuff disease, or other hand pathology.<br /><br />The presentation highlighted the importance of conducting multiple NCS tests to establish a clear diagnosis. The tests mentioned included median motor and sensory studies, median-ulnar motor and sensory comparisons, combined sensory index (CSI), and other tests to assess muscle function.<br /><br />The presentation also discussed the reliability of the tests and the challenges posed by cold hands in Michigan. It mentioned that the CSI is more reliable than any single test and emphasized the need for at least two clear, independent tests that agree to make a diagnosis.<br /><br />Needle electromyography (EMG) was also mentioned as a useful tool to assess the severity of CTS and identify other potential problems such as radiculopathy or brachial plexopathy.<br /><br />The presentation concluded by discussing the treatment options for CTS and the impact of nerve conduction studies after carpal tunnel release surgery.<br /><br />Overall, the presentation provided a comprehensive overview of the electrodiagnostic evaluation of CTS, emphasizing the importance of multiple tests and a differential diagnosis approach.

Keywords

electrodiagnostic evaluation

carpal tunnel syndrome

Dr. Michael Andary

Michigan State University College of Osteopathic Medicine

differential diagnosis

nerve conduction studies

NCS

clinical situation

arm symptoms

diagnosing CTS

nerve conduction studies

nerve conduction study

ncs

CTS