Changes in motor axon recruitment in the median nerve in mild carpal tunnel syndrome

Objective To determine whether patients with mild carpal tunnel syndrome (CTS) and conventional electrodiagnostic evidence of selective involvement of sensory conduction show changes in motor axon recruitment in the median nerve. Methods Wrist-to-abductor pollicis brevis (APB) motor axon conduction was studied by analysing the relationship between the intensity of electrical stimulation and the size of motor response (input–output curve) in 30 CTS patients with conventional electrodiagnostic evidence of selective involvement of sensory conduction. Parameters (threshold, slope and plateau) of input–output curves were compared with those obtained in 30 controls. Results The slope of the input–output curve of CTS patients was less steep than that of controls. For stimulus intensity above M-wave threshold (MTh), fewer motor axons were recruited in patients than controls. Conclusions Motor fibres are affected in CTS when conventional electrodiagnostic tests show normal motor conduction. Altered recruitment of motor axons could mainly be due to impairment of energy-dependent processes which affect temporal dispersion of the compound volley or axonal conduction block. Significance In mild CTS, motor fibres are more often affected than was originally thought. The sensitivity of wrist-to-APB motor conduction studies may be increased by using submaximal stimulus intensities