title: [Initial positive deflection of the compound muscle action potential in the median nerve conduction studies can be originated from lumbrical muscles in patients with carpal tunnel syndrome].
abstract: In motor nerve conduction studies we sometimes encounter a small initial positive deflection (IPD) of the compound muscle action potential (CMAP). This potential represents a volume conduction from nearby muscles other than the objective muscle. We demonstrated recordings of motor nerve conduction studies from two patients with carpal tunnel syndrome (CTS). In patients with CTS IPDs can be recorded from a surface electrode above the abductor pollicis brevis when intense stimuli to the median nerve provoked a stimulus spread to the ulnar nerve. However, without this stimulus spread to the ulnar nerve, IPDs can be observed by contraction of median nerve innervated muscles. In the CTS thenar branch of the median nerve is apt to be more severely damaged than lumbrical branch. In such an occasion volume conduction from the lumbrical muscles is relatively large, which gives rise to the IPD in the CMAP recorded from abductor pollicis brevis. We reported two cases of IDPs originated from lumbrical muscles. The peak latencies were identical between IDP of abductor pollicis brevis recording and negative potential of lumbrical recording. These potentials didn't change by median nerve stimulation at the elbow 3 msec after the ulnar nerve stimulation at the wrist (collision technique). Finally, we repeat that IPDs in the median nerve conduction studies can be originated from not only the stimulus spread to the ulnar nerve but also the median nerve innervated lumbrical muscles in patients with CTS.
authors.affiliation: Department of Neurology, Kawanami Hospital, Fukuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: O
authors.initials: O
authors.lastname: Hasegawa
mesh_terms: D000200:Action Potentials; D000368:Aged; D000818:Animals; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology*; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology*; D009431:Neural Conduction