Since the 1950s, researchers have primarily focused attention to the techniques of the median motor nerve conduction studies across the carpal tunnel to make the tests more sensitive and specific for the detection of compression of the median nerve in the carpal tunnel. The scientific literature regarding the median nerve it is a journey that started many years ago, from the pilot studies on peripheral nerve conduction in humans during the 1950s to the most recent scientific evidence, through the first motor conduction studies of the 1960s, the techniques of motor nerve conduction to the abductor pollicis brevis (APB) muscle with added palm stimulation firstly described in the second half of the 1970s, the studies of the flexor carpi radialis (FCR) muscle introduced in the 1980s, the median-ulnar nerve motor comparative techniques proposed in the 1990s, and the more recent conduction studies described since the early 2000s to today.
The main attention we have given to techniques that have shown higher sensitivity and specificity in the diagnosis of the carpal tunnel syndrome (CTS) and for this reason are widely used in cinical practice like the comparison of latencies of motor responses from the second lumbrical (2L) and interosseous (INT) muscles by stimulation at the wrist. More than 40 techniques are described in this text-atlas including methods from the original rationale and variants and organized according to practical criteria for easy reference; all of the tests are presented by facilitated pictures in order to make it easy to understand and follow a reproduction of every method.
There have been reports of the parameters and settings used by the authors and the normative and pathological values cited in the entries and present in subsequent articles in order to enrich and update the evidence. With particular attention, it has been reproduced in every test in the laboratory so as to present iconographically the signals acquired in the normal subject; an effective diagnostic utility of each test was then evaluated in several diseases and in varying degrees of the same pathology as in the CTS.
All traces acquired, both in normal and pathological subjects, are shown with different settings to adapt easily and be more accessible to the different situations that may arise in clinical practice.
The execution of the techniques described in the manuals of electroneurography on the market is not always able to provide a complete answer to the many clinical questions. The nonuse of the correct technique because it is not known, incorrect use of a technique, and the absence of normative and pathological values represent all factors that can alter the diagnostic power of the electroneurographic examination.
From this premise volume was born a systematic monograph of motor electroneurographic techniques focusing on the median nerve with the aim to validate the various methods described in the literature since the early articles of the 1950s to the present in order to defi ne the feasibility, reproducibility, and actual usefulness in the diagnostic field. Some of these techniques, abandoned over the years, still show their worth and deserve to be known in the clinical setting, still not having found the right recognition in any of the manuals on the market.
This text-atlas, which is the result of over 5 years of hard work, comes from our daily neurophysiopathological experience; we have described in detail the technique, standardization, and normal and pathological values derived from the original articles and the subsequent literature as never seen in any other work before.
We therefore hope that “The Median Nerve – Motor Conduction Studies (SPRINGER, 2015)“, which is useful to both the novice and the experienced specialist, is always in a laboratory of electromyography as a valid means of ease of reference for the study on the field.