Wrist, Elbow – Digit II

and Mario Di Napoli1



(1)
Neurological Service, S. Camillo de’ Lellis General Hospital, Rieti, Italy

 




Original Settings

Sensitivity, low-frequency filter, high-frequency filter, sweep speed, duration of pulse, rate of pulse, and the machine used were not specified.


Position

This study was performed in the supine position, with the elbow and fingers slightly flexed.


Recording

According to a previous standardized technique [1], the author used the antidromic method [2]. Signals were recorded 14 cm distally from the wrist to a not specified finger (Fig. 1). Probably he recorded sensory potentials from digit II (R), placing the active electrode (A) to the base of the digit and placing the reference (R) 4 cm proximally to the active electrode, slightly distal to the distal interphalangeal joint. Ground (G) electrode position was not specified in the paper; it was probably placed over the midforearm or on the palm of the hand (the figure shows the ground electrode placed on the palm).

A328573_1_En_12_Fig1_HTML.gif


Fig. 1
Antidromic sensory nerve action potentials (SNAPs) recorded to digit II; stimulation of the wrist (upper trace) and at the elbow (lower trace)


Stimulation

Following the method described by Melvin et al. [1], the median nerve was stimulated at the wrist (S1) and at the elbow (S2). At the wrist (S1), the active stimulating electrode (cathode) was applied 14 cm proximal to the active electrode at the base of the digit, over the median nerve at the wrist, between the tendons of the flexor carpi radialis and the palmaris longus muscles (ideally proximal to the distal wrist crease). The anode (+) was proximal. Distal stimulation (S1) determined distal evoked sensory nerve action potentials (SNAPs), while proximal stimulation at the elbow (S2), just above the crease of the antecubital fossa and medial to the biceps tendon at the elbow, allowed determination of forearm mixed nerve conduction velocity. In case of stimulation at the elbow (S2), the authors suggested 2–4-cm separation between the cathode (−) and anode (+), using a pair of standard 0.6-cm-diameter electroencephalograph electrodes mounted on a plastic block for stimulating the nerve. Supramaximal stimulation was used; stimulus in all determinations was at least 30 % greater than that which elicited a maximum response.


Measurements

The author measured the “terminal latency” and calculated “residual latency.” The distal peak latency (ms) was called “terminal latency”; it measured from the beginning of the shock artifact to the peak of the negative deflection of the evoked sensory nerve action potential (SNAP). The sensory nerve conduction velocity (SNCV) was calculated from the nerve using stimulating and recording sites at above the elbow and at the wrist, respectively. From this elbow–wrist conduction velocity, an expected terminal latency from the wrist to finger was calculated and compared with the measured sensory terminal latency. The difference between these values was termed the “residual latency” for the sensory fibers. The temperature of the forearm was determined using a skin surface thermistor thermometer; all forearm temperatures equaled or exceeded 34 °C.

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May 25, 2017 | Posted by in NEUROLOGY | Comments Off on Wrist, Elbow – Digit II

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