Disclosures: James J. Ying, MD: Nothing to disclose

Objective: To describe the use of palmar stimulation of recurrent median nerve for diagnosis of carpal tunnel syndrome (CTS) in patients with diabetic peripheral polyneuropathy.

Design: Case series.

Setting: Electrodiagnostic lab at tertiary care university hospital.

Participants: 3 subjects with clinical CTS and diabetic peripheral polyneuropathy.

Interventions: Palmar stimulation of the recurrent median nerve, in addition to wrist and elbow stimulations of the median nerve, was performed during nerve conduction study.

Main Outcome Measures: Compound muscle action potential (CMAP) amplitudes after wrist, palmar, and elbow stimulations; conduction velocities (CV) across the carpal tunnel, distal forearm, and entire forearm.

Results: Nerve conduction study showed electrodiagnostic evidence of CTS in 4 limbs. Mean forearm CV was 46 m/s (standard deviation (SD) 5.8). Mean transcarpal CV was significantly lower at 15 m/s (SD 6.6). Mean CMAP amplitudes were similar, 4.4 mV (SD 2.2) at the wrist and 4.4 mV (SD 2.8) at the palm. 1 limb received an additional stimulation 1 cm proximal to the wrist crease that allowed the calculation of distal forearm CV (50 m/s) in addition to forearm (54 m/s) and transcarpal (11 m/s) CV, further supporting a focal demyelination of the median nerve across the carpal tunnel and a diagnosis of CTS.

Conclusions: Palmar and short segment wrist stimulations can provide important electrodiagnostic evidence to further support a diagnosis of CTS, especially in patients with confounding peripheral polyneuropathy.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/utilities-of-short-segment-median-motor-nerve-testing-in-patients-with-diabetic-peripheral-polyneuropathy-and-clinical-carpal-tunnel-syndrome-a-case-series/