***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Orthodromic SNAPs were recorded over the median nerve using needle electrodes at the wrist and elbow after stimulation of the thumb and middle fingers . CMAPs were recorded with concentric needle electrodes placed in the endplate zone of the APB after stimulation at the wrist and elbow . NCVs were determined for 28 male and 20 female normal subjects aged 16 to 62 years . There was no significant difference in NCV between male and female subjects . There was a decrease in NCV with increasing age . No CTS patients were studied . 186 . Occupational Disease Surveillance . Carpal tunnel syndrome . MMWR Morb Mortal Wkly Rep 1989;38:485 - 489 . Background Reference Source : Baker , 1990 . 187 . * Osborn JB , Newell KJ , Rudney JD , Stoltenberg JL . Carpal tunnel syndrome among Minnesota dental hygienists . J Dent Hyg 1990;64(2):79 - 85 . Criteria Met ( 2/6 : 1,2 ) Source : Medline Search . 188 . Padua L , Lo Monaco M , Valente EM , Tonali PA . A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome . Muscle Nerve 1996;19:48 - 53 . Criteria Met ( 6/6 : 1,2,3,4,5,6 ) . Source : Medline Search . Abstract : In 43 patients ( 50 h and s ) with clinical manifestations of mild-moderate CTS and 36 healthy volunteers ( 40 h and s ) , orthodromic sensory nerve conduction velocity ( SNCV ) was measured with surface electrodes in the median nerve between the third digit and palm and between the palm and wrist . These figures were used to calculate the ratio of distal to proximal conduction ( distoproximal ratio ) . All 90 h and s were also subjected to other nerve conduction studies used for diagnosis of CTS . All control h and s presented distoproximal ratios less than 1.0 reflecting higher conduction rates in the proximal segment . In contrast , 49 of 50 CTS h and s ( 98 % ) presented reversed ratios ( > 1.0 ) indicating compromised proximal conduction . The sensitivity of this test was significantly greater than that of other methods evaluated , including comparative studies and segmental study of the palm-wrist portion of the median nerve . Segmental study of median SNCV with calculation of the distoproximal ratio is a sensitive technique for diagnosis of CTS in patients with normal findings in st and ard nerve conduction studies . Note : The author indicated by correspondence that the mean ± SD for the Control DML in Table 1 should read 3.2 ± 0.4 and not 3.2 ± 0.8 as published . 189 . Padua L , LoMonaco M , Gregori B , Valente EM , Padua R , Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome h and s. Acta Neurol Sc and 1997;96:211 - 217 . Criteria Med ( 6/6 : 1,2,3,4,5,6 ) Source : Medline Search . Abstract : Prospect i ve study of 500 h and s ( 379 patients ) with clinical diagnosis of CTS symptoms . Normal values from the same laboratory previously published ( Padua , 1996 ) . In the 500 CTS patients , DML was prolonged ( 55 % ) , median orthodromic sensory latency was prolonged ( D2 , 74 % ; D3 , 67 % ) . Of the remaining 117 patients with normal DML and median orthodromic sensory studies over 14 cm , the median sensory palmwrist NCV over 8 cm was abnormal in 21 % and the distoproximo ratio of the median palm and digit segments was abnormal in 87 % . 190 . Palliyath SK , Holden L. Refractory studies in early detection of carpal tunnel syndrome . Electromyogr Clin Neurophysiol 1990;30:307 - 309 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : Using paired stimuli and varying the inter-stimulus interval , the absolute refractory period ( ARP ) and relative refractory period ( RRP ) , were determined in 10 patients with mild electrophysiologic changes suggestive of CTS . They found that the sensory RRP was sensitive in diagnosing early CTS . 191 . * Pavesi G , Olivieri MF , Misk A , Mancia D. Clinical electrophysiological correlations in the carpal tunnel syndrome . Ital J Neurol Sci 1986;7:93 - 96 . Criteria Met ( 3/6 : 2,3,5 ) Source : Medline Search . 192 . Pease WS , Cannell CD , Johnson EW . Median to radial latency difference test in mild carpal tunnel syndrome . Muscle Nerve 1989;12:905 - 909 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Medline Search . Abstract : The following techniques were studied : ( a ) antidromic DSL median radial differences to the thumb , ( b ) antidromic DSL after stimulation at the wrist and recording from the third digit , ( c ) median mid-palmar DSL compared as a ratio of the wrist to middle finger DSL , ( d ) median ulnar DSL latency difference between the ulnar Practice Parameter : Carpal Tunnel Syndrome Muscle & Nerve Supplement X 2002 S971 SNAP recorded from the little finger after stimulation at the wrist and the median DSL after stimulation at the wrist and recording from the middle finger , and ( e ) median motor DML after recording from the APB after stimulation at the wrist .  Three hundred thirty-three symptomatic h and s in 262 patients were initially evaluated with subgroups of patients with CTS evaluated with different tests . The median radial DSL difference and median ulnar DSL difference were most likely to be abnormal followed by median DSL then the palmto-wrist DSL latency ratio and lastly the DML . 193 . Pease WS , Cunningham ML , Walsh WE , Johnson EW . Determining neurapraxia in carpal tunnel syndrome . Am J Phys Med Rehabil 1988;67:117 - 119 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : With needle stimulation at the wrist and midpalm , CMAPs were recorded over the APB in 25 CTS patients and 23 healthy asymptomatic persons . They found a significant difference in the amplitude of the CMAP in the CTS group when compared to the control group . They propose that this is evidence for conduction block ( neurapraxia ) in CTS . 194 . Pease WS , Lee HH , Johnson EW . Forearm median nerve conduction velocity in carpal tunnel syndrome . Electromyogr Clin Neurophysiol 1990;30:299 - 302 . Criteria Met ( 4/6 : 1,3,4,5 ) Source : Medline Search . Abstract : The NCV of the median nerve in the forearm was determined by 2 methods : ( a ) stimulation in the forearm and recording the nerve action potential at the wrist , and ( b ) stimulation at the wrist and elbow with recording over the APB , in 21 CTS patients and 16 control subjects . They found that the forearm NCV was slowed in the CTS group using either technique . The authors have proposed that this suggest that there is proximal nerve dysfunction as a result of median nerve compression in the carpal tunnel . 195 . * Peterson GW , Will AD . Newer electrodiagnostic techniques in peripheral nerve injuries . Orthop Clin North Am 1988;19:13 - 25 . Criteria Met ( 0/6 ) Source : Narkis , 1990 . 196 . * Phalen GS . The carpal tunnel syndrome : clinical evaluation of 598 h and s. Clin Orthop 1972;83:29 - 40 . Background Reference . Source : Katz 1990 ( J Rheumatology ) . 197 . * Phalen GS . The carpal tunnel syndrome : seventeen years ’ experience in diagnosis and treatment of 654 h and s. J Bone Joint Surg 1966;48:211 - 228 . Criteria Met ( 1/6 : 2 ) Source : Meyers , 1989 . 198 . Phalen GS , Gardner WJ , LaLonde AA . Neuropathy of the median nerve due to compression beneath the transverse carpal ligament . J Bone Joint Surg 1950;32-A:109 - 112 . Background Reference . Source : Braun , 1989 . 199 . Plaja J. Comparative value of different electrodiagnostic methods in carpal tunnel syndrome . Scan J Rehabil Med 1971;3:101 - 108 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Joynt , 1989 . Abstract : The following techniques were studied : ( a ) CMAP potentials were recorded after stimulation at the wrist and recording with coaxial needle electrodes , ( b ) orthodromic SNAPs with stimulation over the index finger and recording with surface electrodes at the wrist , ( c ) needle EMG using a coaxial needle  , ( d ) strength/ duration curves and chronaxy .  Fifty-six cases of CTS and 20 normal subjects were evaluated .  Sensory latencies were more likely to be abnormal than the other techniques measured . 200 . Preston DC , Logigian EL . Lumbrical and interossei recording in carpal tunnel syndrome [ see comments ] . Muscle Nerve 1992 ; 15 : 1253 - 1257 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : Median motor studies are commonly “ normal ” in mild carpal tunnel syndrome ( CTS ) . This reflects either the sparing of motor compared to sensory fibers , or the inability of conventional studies to detect an abnormality . A novel approach to demonstrate early motor fiber involvement in CTS is the placement of the same active electrode lateral to the third metacarpal , allowing recording from the second lumbrical or the deeper interossei , when stimulating the median or ulnar nerves at the wrist , respectively . We compared the difference between these latencies in 51 normal control h and s to 107 consecutive patient h and s referred with symptoms and signs suggestive of CTS , who were subsequently proven to have electrophysiologic CTS by st and ard nerve conduction criteria . A prolonged lumbrical-interossei latency difference ( > 0.4 ms ) was found to be a sensitive indicator of CTS in all patient groups . It was also helpful in patients with coexistent polyneuropathy , where localization of median nerve pathology at the wrist was otherwise difficult . 201 . * Preston DC , Ross MH , Kothari MJ , Plotkin GM , Venkatesh S , Logigian EL . The median-ulnar latency difference studies are comparable in mild carpal tunnel syndrome . Muscle Nerve 1994 ; 17 : 1469 - 1471 . Criteria Met ( 2/6 : 1,3 ) . Source : Medline Search . Abstract : Compares sensitivity 159 patients of orthodromic palm-wrist mixed palmar median-ulnar peak latency difference with normal < 0.4 ms , antidromic wrist-D4 sensory median-ulnar onset latency difference with normal < 0.5 ms , and the second lumbrical/interossei motor with normal < 0.5 ms . See discussion of benefits of techniques and diagrams of electrode placements and line drawings of electrode and stimulator placement . 202 . Preswick G. The effect of stimulus intensity in motor latency in carpal tunnel syndrome . J Neurol Neurosurg Psychiatry 1963;26:398 - 401 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Loong , 1971 . Abstract : With stimulation at the wrist and coaxial needle electrode recording from the APB , DMLs were recorded at super-maximal stimulation and threshold stimulation in 29 CTS h and s The purpose of this study was to investigate the long-term prognosis of patients with carpal tunnel syndrome ( CTS ) . We prospect ively followed-up patients with CTS for 80 weeks . Thirty cases had been treated with a single injection of methylprednisolone acetate and another 30 with a 10-day course of prednisolone . At the end of the follow-up period , there were no significant differences in symptoms as measured by global symptom score and in the proportion of patients who progressed to decompressive surgery . Few patients who were not operated on ( 11.4 % ) remain asymptomatic Objectives : To determine the efficacy of a two week and a four week course of oral steroids in the conservative treatment of carpal tunnel syndrome . Methods : 109 patients with carpal tunnel syndrome were r and omly divided into two treatment groups : ( 1 ) two weeks of prednisolone 20 mg daily followed by two weeks of prednisolone 10 mg daily ( n = 53 ) ; ( 2 ) two weeks of prednisolone 20 mg daily and two weeks of placebo ( n = 56 ) . A symptom question naire was used to rate the five major symptoms of carpal tunnel syndrome ( numbness , pain , weakness/clumsiness , tingling , and nocturnal awakening 
    Output:
    
Although neurophysiological studies have not shown great differences result ing from the application of corticosteroids , the symptomatic benefit provided by such drugs is clear .
In the short term , local infiltration provides better results than systemic administration of corticosteroids .
Over a 1-year period , however , this difference does not persist .