New criteria for sensory nerve conduction especially useful in diagnosing carpal tunnel syndrome

This article reports a technique for determining new standard values for median sensory nerve latencies, amplitudes, and durations. Use of these values should significantly improve the ability to diagnose carpal tunnel syndrome and to reduce the number of false negative results. Forty-five median sensory nerves of 30 neurologically healthy subjects were evaluated with rigid techniques and temperature control at stimulation and recording points. Latencies for antidromic and orthodromic conduction from wrist-to-thumb, wrist-to-index finger, wrist-to-middle finger, and wrist-to-ring finger (all 14 cm distances) are reported. Conduction time for nerve impulses through the transcarpal segment via ulnar and radial nerves was also measured for comparison with median nerve latencies. In addition to latency measurements, characteristics of electrical responses evoked by stimulation were described. These include amplitude of the recorded response measured from baseline to negative peak and from negative peak to positive peak, duration of the negative response wave (from baseline to return to baseline) and duration measured from onset of the negative wave to the positive peak. According to our data, a distal median nerve sensory latency of more than 3.3 ms (the mean of 2.9 ms plus two standard deviation values of 0.18 ms) when measured to the peak of the negative wave is indicative of abnormality.