Median Nerve Conduction Study Through the Carpal Tunnel Using Segmental Nerve Length Measured by Ultrasonographic and Conventional Tape Methods Dong-Wook.

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Median Nerve Conduction Study Through the Carpal Tunnel Using Segmental Nerve Length Measured by Ultrasonographic and Conventional Tape Methods Dong-Wook Rha, MD, PhD, Sang Hee Im, MD, Seong-Kyun Kim, MD, Won Hyuk Chang, MD, Ki Jung Kim, MD, Sang Chul Lee, MD, PhD Archives of Physical Medicine and Rehabilitation Volume 92, Issue 1, Pages 1-6 (January 2011) DOI: 10.1016/j.apmr.2010.09.012 Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 Two hyperechogenic metal bars were placed at the point of the proximal wrist crease and the point 5cm distal from the proximal crease along the expected course of the median nerve. The third hyperechogenic metal bar was placed between the above 2 points. Archives of Physical Medicine and Rehabilitation 2011 92, 1-6DOI: (10.1016/j.apmr.2010.09.012) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 Longitudinal ultrasonographic findings of the median nerve (arrow). Using a hyperechogenic metal bar as a marker (arrowhead), we obtained 2 separate ultrasonographic images under the 5-cm segment. Distal (A) and proximal (B) parts of the median nerve beneath the carpal tunnel were depicted. Abbreviations: S, scaphoid; T, trapezium. Archives of Physical Medicine and Rehabilitation 2011 92, 1-6DOI: (10.1016/j.apmr.2010.09.012) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 Two hyperechogenic metal bars were placed at the same points as used in live subjects before dissection (A). After dissection, the actual nerve length between 2 needles was measured with a tape (B). Archives of Physical Medicine and Rehabilitation 2011 92, 1-6DOI: (10.1016/j.apmr.2010.09.012) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 Antidromic median SNAP was obtained by stimulating the median nerve across the palm-to-wrist segment. The proximal crease of the wrist was stimulated to obtain the proximal latency, and the point 5cm distal from the proximal crease was stimulated for obtaining the distal latency. The active electrode was located slightly distal to the metacarpophalangeal joint of the third digit, and the reference electrode was located 4cm distal from the active electrode. Archives of Physical Medicine and Rehabilitation 2011 92, 1-6DOI: (10.1016/j.apmr.2010.09.012) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 The schema of ultrasonographic measurement technique. The nerve length measured by ultrasound was longer than the actual nerve length, which might be caused by an overlapping area (arrows) of ultrasonographic beam. Abbreviations: M, median nerve; P, probe of ultrasonography. Archives of Physical Medicine and Rehabilitation 2011 92, 1-6DOI: (10.1016/j.apmr.2010.09.012) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions