Ann Rehabil Med.  2024 Aug;48(4):259-270. 10.5535/arm.240015.

Reference Standard of Median Nerve Conduction Study in Korea

• Lee JH
• Kim E
• Shim HS
• Kang MG
• Kim K
• Lee SY
• Lee GJ
• Lee SU
• Lim JY
• Chung SG
• Oh BM

• KMID: 2558732
• DOI: http://doi.org/10.5535/arm.240015

Abstract

Objective
To establish the reference standard of the median nerve conduction study (NCS) in Korea.
Methods
A total of 648 median motor and 602 median sensory NCSs from 349 Korean healthy volunteers were tested and analyzed prospectively. Equipment calibration, assessment of intraand inter-rater reliability, and the NCSs per se were conducted according to a predetermined protocol. A reference standard was established from uncertainty components for the following parameters: the onset and peak latencies; the baseline-to-peak and peak-to-peak amplitudes; the area and duration of the negative wave; and the nerve conduction velocity. The effects of sex, age and stimulation intensity were analyzed.
Results
Each measured value of 648 median motor and 602 median sensory nerves were obtained and presented with both mean and expanded uncertainties, as well as mean and standard deviations. The cut-off values with expanded uncertainty were determined for different age and sex groups. After adjusting for anthropometric covariates, all parameters except duration were affected by age, and sex appeared to influence both duration and area. While stimulation intensity significantly affected some parameters including latencies, the effect sizes were negligible.
Conclusion
We propose the median NCS reference standard using the largest Korean dataset ever available. The use of the traceable and reliable reference standard is anticipated to promote more accurate and dependable diagnosis and appropriate management of median neuropathies in Korea.

Keyword

Nerve conduction studies; Reference values; Reference standards; Median nerve; Uncertainty

Figure

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  Fig. 1. Demonstration of the waveform of action potentials obtained from median motor (A) and sensory (B) nerves stimulation. a, initial point of negative deflection; b, peak point of negative deflection: c, the point that negative potentials turn into the iso-electrical line; d, peak point of positive deflection; Lonset, onset latency which is time from initial point to marker a; Ampb-p, baseline to negative peak amplitude which is vertical distance from marker a to b; Ampp-p, negative peak to positive peak amplitude which is vertical distance from marker b to d; Aneg, negative spike area which is shaded; Dneg, negative spike duration which is time from marker a to c; Lpeak, peak latency which is time from initial point to marker b.

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  Fig. 2. Schematic illustration of the motor (A) and sensory (B) median nerve conduction studies. (A) Distal and proximal stimulation sites on the median motor nerve and recording electrodes attached to the abductor pollicis brevis muscle. (B) Stimulation site on the median sensory nerve and recording electrodes attached to the index finger. G1, active electrode; G2, reference electrode; Ground, ground electrode; Cathode, cathode of stimulator.

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