Sensibility testing in peripheral-nerve compression syndromes. An experimental study in humans

Abstract

Sensibility testing in peripheral-nerve compression syndromes was investigated in an experimental study in humans. Twelve volunteer subjects had controlled external compression of the median nerve at the carpal tunnel at a level of forty, fifty, sixty, or seventy millimeters of mercury. The subjects were then monitored for thirty to 240 minutes with four sensory tests: two-point discrimination, moving two-point discrimination, Semmes-Weinstein pressure monofilaments, and vibration. Sensory and motor conduction, subjective sensations, and motor strength were also continuously tested. The threshold tests (vibration and Semmes-Weinstein monofilament testing) consistently reflected gradual decreases in nerve function in both subjective sensation and electrical testing, while the innervation density test (two-point discrimination and moving two-point discrimination) remained normal until nearly all sensory conduction had ceased. Decreased muscle strength occurred late, and not until changes had already occurred in each of the sensory tests. Threshold tests of sensibility correlated accurately with symptoms of nerve compression and electrodiagnostic studies, and are being evaluated for clinical use in a variety of peripheral-nerve compression syndromes.