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Seeking insight on a finding in the evaluation of carpal tunnel evaluations

AANEM Communications3/4/19 9:28 AM (CST)

I am hopeful that I can obtain some insight regarding a particular finding in the evaluation of carpal tunnel evaluations that I am seeing from time-to-time. Specifically, I perform a 14/7 cm antidromic SNAP study and obtain a mid-palm latency of 1.9 ms with an amplitude of 20 uV and a 14 cm SNAP with a latency of 4.4 ms and amplitude of 15 uV. I am comfortable with an assessment of focal slowing of the median sensory fibers to the third digit across the wrist consistent with the diagnosis of the patient’s clinical symptoms of CTS. However, when performing the median CMAP evaluation, I obtain a 8 cm wrist value of 3.8 ms with an amplitude of 7 mV and an antecubital fossa result of 7.7 ms, with a resulting conduction velocity of 46 M/s. The median motor DML appears fine as does the amplitude, but the NCV is low. The temperature over the APB is 34 degrees C, and I have checked and re-checked my distance. What is going on?

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I enjoy participating in the AANEM Connect Forum for a number of reasons. There are very fundamental questions posed on a frequent basis that cause me to pause and ask myself, ‘Why didn’t I think of that?’ Also, I continue to learn new things when others contribute their thoughts and experiences. Connect is an excellent opportunity for members to interact and to address any topic, including those that may not be discussed at an annual meeting or journal article.
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