Over the past 50 years, clinical research efforts have mainly refined the techniques of the median sensory 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. Scientific literature has come a very long way, from the pilot studies on peripheral nerve conduction in humans during the 1950s to the most recent scientific evidence, through the first sensory segmental conduction studies of the 1960s, the many sensory orthodromic nerve conduction techniques mostly used until the first half of the 1970s, the various comparative orthodromic and antidromic studies of the sensory conduction of the median-ulnar and median-radial nerves introduced in the 1980s, the various special techniques proposed in the 1990s, and the sensory and mixed nerve conduction studies described since the early 2000s to today.
This volume represents a chronological path that allows the reader to move from pilot studies on the peripheral nerve conduction in humans during the 1950s to the most recent scientific evidence. 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 clinical practice: the comparative studies of the median-radial sensory conduction to the first finger, the median-ulnar comparative studies of mixed conduction in the palm-wrist segment, or the sensory conduction to the fourth finger. More than 50 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 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 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 define 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 – Sensory 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 study on the field.