Objective Determinations of Sensibility in the Upper Extremity
STEVEN L. WOLF, PhD, FOAD NAHAI, MD, D. MICHAEL BROWN, BS, NANCY JORDAN, BS, and MICHAEL KUTNER, PhD
Distal sensory conduction velocities were determined in 109 normal median nerves. A significant decrease in sensory conduction velocity was noted with increasing age. Latencies increased with age but this relationship was not significant in men. Variables which contribute to the wide range of normal conduction velocities are discussed, and the need for each clinician to establish his own testing procedure is stressed. An additional method for assessing sensory function is suggested.
Accurate evaluations of sensory return following repair of peripheral nerve injuries must depend upon objective and quantitative measurements. Such assessments are particularly important for the patient whose sensory function in the hand has been compromised. In this case, significant decisions hav ing vocational, social, and financial implications may result from the patient's commentary on his sensory status and the clinician's appraisal of sen sory return. Several groups of surgeons 1-4 have stressed the importance of more specific objective measurements of sensation than those established by the Nerve Committee of the British Medical Research Council in 1954. 5 Determinations of sensory nerve conduction ve locities appear to be one way of gathering objective information about peripheral nerve integrity. ReliaDr. Wolf is Assistant Professor, Department of Rehabilitation Medicine, Emory University School of Medicine, and School of Allied Health Professions, and an investigator at Emory University Regional Rehabilitation Research and Training Center, 1441 Clif ton Road, NE, Atlanta, GA 30322. Dr. Nahai is a resident in plastic surgery, Department of Sur gery, Emory University School of Medicine, Atlanta, GA 30322. Mr. Brown is Assistant Chief, Department of Occupational Therapy; and Coordinator, Hand Management Center, Grady Memorial Hospital, Atlanta, GA 30303. Ms. Jordan is a physical therapist on the staff at Grady Memorial Hospital, Atlanta, GA 30303. Dr. Kutner is an Associate Professor, Department of Biometry, Emory University, Atlanta, GA 30322.
Volume 57 / Number 10, October 1977
bility of these measurements is, however, dependent upon many factors which will be addressed in this report. The normal range of sensory conduction velocity values vary as a function of the method. Each clinic should, therefore, establish procedural criteria upon which to base these values. The pur poses of this study are to report distal median nerve sensory conduction latencies and velocities in a nor mal population and to review those variables which may account for the wide distribution of sensory conduction velocities noted in other studies. A sec ond paper will introduce a variant of sensory detec tion theory as a procedure for quantifying sensation in normal subjects. Part III in this series will demon strate the application of objective sensory testing in patients with peripheral nerve lesions and reveal how this technique can enhance the physical thera pist's assessment of sensory return. Inspection of sensory testing data from patients will show that these measurements may be more indicative of im provement in hand sensation than the electrophysio logical measurements discussed in this study. METHODS Distal orthodromic right median sensory nerve conduction velocities were measured in 109 sub jects. None of these individuals had ever experi enced right upper extremity neuromuscular pathol-
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Part I. Median Nerve Sensory Conduction Velocities
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STEVEN L. WOLF, PhD, FOAD NAHAI, MD, D. MICHAEL BROWN, BS, NANCY JORDAN, BS, and MICHAEL KUTNER, PhD
Distal sensory conduction velocities were determined in 109 normal median nerves. A significant decrease in sensory conduction velocity was noted with increasing age. Latencies increased with age but this relationship was not significant in men. Variables which contribute to the wide range of normal conduction velocities are discussed, and the need for each clinician to establish his own testing procedure is stressed. An additional method for assessing sensory function is suggested.
Accurate evaluations of sensory return following repair of peripheral nerve injuries must depend upon objective and quantitative measurements. Such assessments are particularly important for the patient whose sensory function in the hand has been compromised. In this case, significant decisions hav ing vocational, social, and financial implications may result from the patient's commentary on his sensory status and the clinician's appraisal of sen sory return. Several groups of surgeons 1-4 have stressed the importance of more specific objective measurements of sensation than those established by the Nerve Committee of the British Medical Research Council in 1954. 5 Determinations of sensory nerve conduction ve locities appear to be one way of gathering objective information about peripheral nerve integrity. ReliaDr. Wolf is Assistant Professor, Department of Rehabilitation Medicine, Emory University School of Medicine, and School of Allied Health Professions, and an investigator at Emory University Regional Rehabilitation Research and Training Center, 1441 Clif ton Road, NE, Atlanta, GA 30322. Dr. Nahai is a resident in plastic surgery, Department of Sur gery, Emory University School of Medicine, Atlanta, GA 30322. Mr. Brown is Assistant Chief, Department of Occupational Therapy; and Coordinator, Hand Management Center, Grady Memorial Hospital, Atlanta, GA 30303. Ms. Jordan is a physical therapist on the staff at Grady Memorial Hospital, Atlanta, GA 30303. Dr. Kutner is an Associate Professor, Department of Biometry, Emory University, Atlanta, GA 30322.
Volume 57 / Number 10, October 1977
bility of these measurements is, however, dependent upon many factors which will be addressed in this report. The normal range of sensory conduction velocity values vary as a function of the method. Each clinic should, therefore, establish procedural criteria upon which to base these values. The pur poses of this study are to report distal median nerve sensory conduction latencies and velocities in a nor mal population and to review those variables which may account for the wide distribution of sensory conduction velocities noted in other studies. A sec ond paper will introduce a variant of sensory detec tion theory as a procedure for quantifying sensation in normal subjects. Part III in this series will demon strate the application of objective sensory testing in patients with peripheral nerve lesions and reveal how this technique can enhance the physical thera pist's assessment of sensory return. Inspection of sensory testing data from patients will show that these measurements may be more indicative of im provement in hand sensation than the electrophysio logical measurements discussed in this study. METHODS Distal orthodromic right median sensory nerve conduction velocities were measured in 109 sub jects. None of these individuals had ever experi enced right upper extremity neuromuscular pathol-
1121
Downloaded from https://academic.oup.com/ptj/article-abstract/57/10/1121/4558734 by University of Texas at Dallas user on 16 February 2019
Part I. Median Nerve Sensory Conduction Velocities
o%
