KR20030069734A - TenElectrodes, A newly developed stimulator for carpal tunnel syndrome and ulnar neuropathy - Google Patents

Abstract

PURPOSE: An electrical stimulation device is provided to diagnose a carpal tunnel syndrome or ulnar neuropathy in a rapid and accurate manner. CONSTITUTION: An electrical stimulation device comprises a spring or electrode units having an elasticity similar to the elasticity of the spring, and a circuit for controlling operations of the electrode units. The spring is a coil type spring, and electrodes of the electrode units are arranged at the spacing of 1cm, to thereby allow the electrical stimulation device to give a stimulation to the user along the curvature of the skin of the user.

Description

TenElectrodes, A newly developed stimulator for carpal tunnel syndrome and ulnar neuropathy for effective diagnosis of carpal tunnel syndrome and ulnar neuropathy

Development of stimulator and its use that can perform electric stimulation easily, comfortably and accurately in a short time when conducting inching method during nerve conduction test.

The present invention relates to a special electrical stimulator that can easily, easily and accurately perform the inching method, which is a method of accurately measuring the position and extent of nerve lesions. Conventional electric stimulators consist of a pair of electrodes with a 2 cm spacing. When performing the inching method using this, the pens were marked at intervals of 1 cm on the skin where the nerves were expected to travel, and each stimulation point was stimulated with a stimulator. However, this method is very cumbersome and time consuming when marking stimulus points using tape measure on the surface of the skin rather than on a plane and moving each stimulus point. It is not commonly used to diagnose peripheral nerve lesions such as ulnar neuropathy.

Carpal tunnel syndrome is a disease characterized by desensitization, tingling, and atrophy of the medial nerve due to compression of the median nerve in the carpal tunnel, and outside of the first, second, and third resins. The disease was named by Carer Tunnel Syndrome for Moersch's spontaneous compression of the median nerve, and Phalen et al. Described Kremer's overall clinical picture. However, there are many limitations in the diagnosis of carpal tunnel syndrome based on clinical manifestations and treatment of conservative or surgical methods. Therefore, objective electrodiagnostic tests are needed to confirm the diagnosis. It is also necessary for differential diagnosis of peripheral neuropathy, cervical 6th or 7th neuromyopathy, median nerve proximal capture neuropathy, and severity or prognosis of carpal tunnel syndrome. Due to the usefulness and necessity of such an electric diagnosis, many studies have been conducted on the electric diagnosis of carpal tunnel syndrome. In particular, Simpson identified local delays in the conduction velocity of median nerves at the hip joint, and other researchers have proved this, and in order to diagnose carpal tunnel syndrome, normal values of median nerve action potentials have been established. A lot of research has been done. However, when carpal tunnel syndrome is diagnosed only by the movement of the median nerve and the speed or amplitude of the sensory nerve, mild cases are often included in the normal category. Therefore, many studies have been conducted to increase the sensitivity of the electric diagnosis. These methods can be used to compare median and ulnar nerve movements, transients and amplitudes of sensory nerve dislocations in the same hand, and to briefly compare two nerves caused by median sensory nerves and ulnar sensory nerve stimulation in the palm of the hand using the directivity or reversal method. The retrograde method was used to compare median and radial sensory nerve transients in the first resin, and the exact location of the lesion was studied through inching between the palmar and arm joints. However, the use of the inching method in carpal tunnel syndrome has a lot of problems with its accuracy due to distance measurement, movement of electrical stimulation points, and sliding phenomenon in the joint area.

Ulnar neuropathy that develops around the elbow is the next most common compression neuropathy after carpal tunnel syndrome. Knowing the exact location of the lesion is very important in selecting treatment. For this purpose, Seror devised an inching method called short segment incremental stimulation (SSIS) and was able to detect more than 80% of the ulnar neuropathy compression site in the elbow joint. However, this method was very time consuming and difficult to use.

In this way, the inching method has very high sensitivity and specificity in diagnosing carpal tunnel syndrome and ulnar neuropathy and finding the location of the lesion, but it was not easily used due to the measurement problems and the moving and stimulating problems encountered during the examination. Therefore, we invented a special electric stimulator with 10 electrodes that can make inching method easy, convenient and accurate in a short time. Diagnosis of carpal tunnel syndrome and ulnar neuropathy and precisely find the site of the lesion help surgical treatment. Now.

The above object of the present invention is achieved by fabricating an electrical stimulation device (TenElectrodes) having a plurality of electrodes for the inching method, and using the special electrical stimulation device to reveal the degree and exact location of the lesion in the carpal tunnel syndrome and ulnar neuropathy It was.

[Object of use of the invention]

It can be useful for the diagnosis of carpal tunnel syndrome or ulnar neuropathy, which is the main cause of handicap.

1 is a block diagram of a stimulation device of the electrical stimulator

2 is a circuit diagram of a control device of the electrical stimulator;

3 is a view of the actual stimulator and the adjusting device

4 is a real stimulator applied to the wrist joint

5 is a real stimulator applied to the wrist joint

The present invention includes the steps of developing and manufacturing an electric stimulator (TenElectrodes) that can effectively perform the inching method in carpal tunnel syndrome or ulnar neuropathy; TenElectrodes were used to identify the extent and location of carpal tunnel syndrome and ulnar neuropathy.

The usage of TenElectrodes is explained step by step.

Step 1: Arrange 10 electrodes in a row so that eight pairs of electrical stimulators are in contact with the curved surface of the median nerve running on the wrist or the site of the ulnar nerve driving on the elbow.

Second step: The switch of the switch barrel containing the electric circuit is adjusted to give 8 electric stimuli from the proximal to the lower side of the stimulator.

Step 3: Record the potentials for each stimulus and analyze the momentary differences between each potential.

Hereinafter, the embodiment using the specific configuration of the present invention will be described in detail, but the rights of the present invention are not limited only to these embodiments.

Example 1: Fabrication of TenElectrodes

TenElectrodes produced in the present invention is composed of a switch box with a switch and a circuit for controlling the stimulator and electrical stimulation. As shown in Fig. 1, the magnetic pole was made by inserting ten cylindrical iron cores with 10 springs and a spring attached to the holder of the plastic material, and each magnetic pole electrode stimulated the electrical stimulation generated by the EMG machine through the wire. Made to deliver. The springs attached to each stimulation electrode made it possible to make contact with the curvature of the skin with which the stimulator contacts. The switch barrel is composed of an electric circuit and a switch so that electrical stimulation can be sequentially transmitted to the electrodes of the stimulator by the operation of eight switches. Between the switch passing electric stimulator there is a cable (cable), which is a multi-wire connecting the stimulation electrode and the switch.

Example 2: Diagnosis of Carpal Tunnel Syndrome Using TenElectrodes

The subjects of this study were patients who visited the Department of Rehabilitation Medicine, Ansan Hospital, Korea University College of Medicine from March 2000 to June 2001, and those who had no symptoms of medical illness or dizziness. The patients with carpal tunnel syndrome were diagnosed with carpal tunnel syndrome by electromyography, and we used TenElectrodes to find out which part of the carpal tunnel was affected by dizziness.

There were 21 patients with carpal tunnel syndrome and the mean age was 47.4 years (range, 40-69 years). There were 4 men and 17 women. The mean age of normal subjects was 42.9 years (range, 30-71 years). There were 18 men and 28 women.

The results are summarized in Table 1.

[Table 1] Characteristics of Target Patients

TenElectrodes was applied to the hip joint to stimulate 8 parts of the median nerve at 1 cm intervals from 1 cm above the distal fold to 7 cm downward. The peak moments of the median sensory nerve potentials obtained at each stimulus point were measured, and the peak delay difference between each point was calculated as the conduction delay of each section. Segment 1 is between the distal folds of the distal fold 1 cm and distal folds, Segment 2 is between the distal folds and 1 cm below the distal folds and Segment 3 is between 1 cm and 2 cm below the distal folds. It was.

The average time of conduction delay between each stimulus point was 0.20 msec (range, 0.17-0.27 msec) in normal subjects. The most significant difference in conduction time was between 3 cm and 4 cm in the distal crease of the hip. There was a conduction delay of 0.27 ± 0.09 msec (mean ± standard deviation). In carpal tunnel syndrome, the mean conduction time between each stimulus point was 0.31 msec (range, 0.17-0.56 msec). The most significant difference in conduction time was between 2 cm and 3 cm in distal pleural humerus and 0.56 ± 0.3 msec (mean ± standard deviation). The conduction delay times for each section of 1 cm in normal and carpal tunnel syndrome patients are shown in Table 2.

In normal subjects, the maximum conduction delay time was 0.4 msec. In carpal tunnel syndrome, there was a conduction delay of at least 0.5 msec in the carpal tunnel.

Table 2. Conduction delay time for each section of 1 cm in normal and carpal tunnel syndrome patients

When the patients with carpal tunnel syndrome were stimulated with TenEelctrodes but no response was obtained, the average conduction delay time was 0.42 msec (range, 0.34-0.52 msec) in the normal subjects. The 2 cm section was between 2 cm and 4 cm in the distal crease of the hip and showed an average delay of 0.52 ± 0.11 msec (mean ± standard deviation). In carpal tunnel syndrome, the mean conduction delay time in the 2 cm section was 0.66 msec (range, 0.44 to 1.04 msec). The greatest difference in the conduction time was between 2 cm and 4 cm in distal folds of the arm and was 1.04 ± 0.41 msec (mean ± standard deviation). The conduction delay times for each section of 2 cm in normal and carpal tunnel syndrome patients are shown in Table 3.

Table 3. Conduction delay time for each section of 2 cm in normal and carpal tunnel syndrome

Example 3 Diagnosis of Elbow Joint Ulnar Neuropathy Using TenElectrodes

The subjects of this study were those who visited the Department of Rehabilitation Medicine, Department of Rehabilitation Medicine, Ansan Hospital, Korea University College of Medicine from March 2001 to December 2001. Normal subjects were asymptomatic. TenElectrodes were used to evaluate the nerve damage in elbow joints of elbow joint neuropathy patients.

There were 13 patients with elbow ulnar neuropathy with an average age of 51.9 years (range, 24-68 years), 9 males, and 4 females. The average age was 41.2 years (range, 19-71 years). There were 32 males and 22 females.

In the measurement method, the elbow joint was extended and stimulated between the medial epicondyle and the olecranon, with the fourth stimulation electrode of TenElectrodes on the line connecting the medial epicondyle and the olecranon. The conduction delay time of 1cm section was calculated by calculating the time difference between each stimulus point as in carpal tunnel syndrome.

The measurement result showed that the average conduction delay time between each stimulus point in the normal subject was 0.19 msec (range, 0.14-0.23 msec). Elbow ulnar neuropathy is usually pressed at three sites, such as the medial and retroepicondylar area, humeroulnar arcade, and flexor carpi ulnaris, and the first of these is medial and posterior. It is known to be the most. In this study, 14 patients with periarticular ulnar neuropathy were diagnosed. Among them, medial upper and rear 35.7%, humerus iliac arch 35.7%, and medial upper and rear and humerus vertebrae were 28.6%.

As described above, for example, the present invention has a inching method as a method of finding a nerve compression site in a short section such as carpal tunnel syndrome or ulnar neuropathy, but it is inconvenient with the existing inching method. Because it is not used well due to inaccuracy and inaccuracy, it is effective to measure the lesion site of carpal tunnel syndrome or ulnar neuropathy easily and quickly by using inching method using TenElectrodes. It is a useful invention in the diagnostic industry and treatment business because it can provide accurate information without surgery.

Claims (3)

Multi-electrode stimulators with spring-loaded or similar elastic electrodes and circuitry to control them. A method for objectively measuring the location of a lesion in a patient with peripheral compression neuropathy, such as carpal tunnel syndrome or ulnar neuropathy, using the apparatus of claim 1. 2. The device of claim 1, wherein the spring is characterized by a coiled spring and each electrode is fixed at an interval of 1 cm, so that the device can be stimulated at regular intervals along the curvature of the skin contact surface.