Magnetic stimulation F-responses

We used the 9 cm Cadwell magnetic coil, stimulating at the wrist, to obtain simultaneous median and ulnar nerve F-responses. Surface recording was performed from conventional thenar and hypothenar sites. It is known that with this type of coil it is difficult to accomplish selective supramaximal stimulation of the median or ulnar nerve individually. We found it possible, however, to record a compound muscle action potential of supramaximal or near supramaximal amplitude, as well as F-responses, in both thenar and hypothenar muscles simultaneously. We assessed this technique for F-response latency determination in controls and patients with carpal tunnel syndrome. In controls, there was no significant difference in the F-minimal latency or the F-minimum-maximum range obtained by the two methods. In patients with carpal tunnel syndrome, with median F-responses very delayed or absent on conventional testing, magnetically elicited thenar F-responses were of shorter latency, similar to F's recorded in the hypothenar muscles, suggesting they were recorded from ulnar innervated thenar muscles. Although magnetic stimulation allows simultaneous determination of median and ulnar F-latencies, sparing patients several painful stimuli, and shortening the electrophysiologic examination, magnetic stimulation in patients with carpal tunnel syndrome may elicit thenar recorded F-responses that are not of median origin. Use of this technique is limited by the lack of focality of the stimulus, which has been the major limiting factor in its use on peripheral nerves.