tunnel syndrome nerve conduction study腕管综合征的神经传导研究课件

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1、CARPALTUNNELSYNDROMENerveConductionStudyKatieDoney–kdoney@med.usyd.edu.auwww.teleemg.comMotorPathwaysVentralHornCNSMotorNeuronMuscleMotorPathwaysPossibleplacesofdysfunctionCNSEEGElectroencephalographyPETPositronEmissionTomographyfMRIFunctionalMagneticResonanceImagingMotorPathwaysPossible

2、placesofdysfunction2.MuscleNeedleEMGElectromyographyCNSEEGElectroencephalographyPETPositronEmissionTomographyfMRIFunctionalMagneticResonanceImagingMotorPathwaysPossibleplacesofdysfunction2.MuscleNeedleEMGElectromyographyCNSEEGElectroencephalographyPETPositronEmissionTomographyfMRIFunctio

3、nalMagneticResonanceImaging3.PeripheralNerveNerveconductionstudyPeripheralNerveMadeupof:SensorynervesMotornervesMyelinGlialcellsMEDIANULNARMedianNervePathologyinCarpalTunnelSyndromeCompressionofthemediannerveresultsinDemyelinationAxonaldegenerationDecreasedbloodsupplyThesemanifestas:-N

4、umbness-Pain-Parasthesiae-Weakness-ProblemswithfinemanipulativeskillsNerveConductionStudyStimulatenerveandrecordoutcome.2maintypes1.Motor(recordcompoundmuscleactionpotential)2.Sensory(recordcompoundsensoryactionpotential)-Orthodromic(stimulateatfinger,recordonelbow/wrist)-Antidromic(stim

5、ulateatelbow/wrist,recordonfinger)-Radial-median(stimulateatwrist,recordonthumb)-Palmar(stimulateatpalm,recordonelbow/wrist)MostsensitiveLeastsensitiveChangestoCMAPinCarpalTunnelSyndromeLatency:Normal<4.9msAmplitude:Normal≥5mVShape:NormalcurveTimeResponseamplitudePathology:-demyelination

6、-axonaldegenerationNerveConductionStudyMeasuresLatencyandAmplitudeLatencyisthetimebetweentheartefactandtheinitiationofthecompoundactionpotentialTheartefactoccurswhenyoupressthebuttontostimulatetheelectrodeLatencyincreasespathologicallydueto:AxonaldegenerationDemyelinationLatencyincreases

7、non-pathologicallydueto:LengthofaxonNerveConductionStudyMeasuresLatencyandAmplitudeTheamplitudeofthecurveshowsthestrengthofthecompoundactionpotentialTheareaunderthecurvedecreasespathologicallydueto:NumberofaxonsinvolvedDiameterofnerveTheareaunderthecurvedecreasesnon-patho