Temperature effect on antidromic and orthodromic sensory nerve action potential latency and amplitude

The measurement of sensory nerve action potential (SNAP) latency and amplitude is often necessary to accurately diagnose disorders of peripheral nerves. The sensory evoked response can be obtained using either the antidromic (AD) or orthodromic (OD) technique. In a previous study we demonstrated that in healthy subjects the AD SNAP distal latency of median and ulnar nerves at 14 cm distance is approximately 0.2 msec slower than the OD SNAP distal latency at 32C. The AD SNAP amplitude was also two times greater than the OD SNAP amplitude. In this study we observed that these differences between the AD and OD SNAP latency and amplitude varied significantly as temperature changed. The AD median nerve SNAP distal latency was delayed by .06 msec/degree with cooling. The OD median nerve SNAP distal latency was delayed by .03 msec/degree with cooling. These values represent less of a slowing per degree centigrade cooling than has been previously noted in the literature. The median nerve SNAP amplitude was found to increase with upper extremity cooling with the AD and OD technique by 3.5 microV and 0.5 microV per degree, respectively. For accurate interpretation of SNAP latency and amplitude, the electromyographer must be familiar with the technique used and the differing effect of the temperature with each technique.