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Research Article | DOI: https://doi.org/DOI:10.31579/2578-8868/398
*Corresponding Author: Salim Hirani, Neurophysiology Department, Ysbyty Gwynedd Hospital, Bangor, North Wales, UK. LL57 2PW.
Citation: Salim Hirani, (2026), Refine Grading of Carpal Tunnel Syndrome (CTS) via Nerve Conduction Study with Case Presentation, J. Neuroscience and Neurological Surgery, 19(2); DOI:10.31579/2578-8868/398
Copyright: © 2026, Salim Hirani. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 20 January 2026 | Accepted: 29 January 2026 | Published: 05 February 2026
Keywords: grading tools for carpal tunnel syndrome, CTS gradings, neurophysiological CTS grading
Background:The severity of carpal tunnel syndrome (CTS) may be categorised in a number of ways, utilising one of a range of presently available grading tools. This paper details a new grading system explained in this paper, with a case presentation to demonstrate its use in practice.The aim of this research is to establish, to show the grading system mentioned in Hirani’s grading in 201914 on evidence base with case presentation including, patient history, Neurophysiological findings, and Consultant conclusion. This is to show the proposed grading scale is clinically appropriate of the current CTS nerve conduction grading tool. It also suggests the improvements in currently used grading system which is 25 years old. The revised grading system confirms with my previously publish research paper in 201914.The suggested revised grading system is based on descriptive categories, ranging from Normal to Early Sensory, Mild Sensory, Mild Sensory Motor, Moderate Sensory, Moderate Sensory Motor, Severe Sensory Motor, Extremely Severe Sensory Motor, and Complete absence. Method: One case presentation with history, Neurophysiological findings and Consultant conclusion of each grading category is included to understand each grade significance. All previously raised questions were answered in this paper which were raised in different National and International Neurophysiology conferences. Result:Each refine Neurophysiological grading shows a clear information with each case presentations and confirms the grading which was previously publish by the Hirani grading in 201914. Conclusion: The revised grading tool clearly offers more diverse grading scale with case presentation to the Clinical Physiologist. This could help the surgeon to ascertain a more precise level of severity which could be used when making decisions regarding conservative or surgical approach to treatment.
The pathology of Carpal Tunnel Syndrome (CTS) is described as “A Neuropathy caused by entrapment of the median nerve at the level of the carpal tunnel” ², ³. Nerve Conduction Studies (NCS) are one of the basic tools used to support clinical diagnosis. NCS are objective tests that assess the physiological status of the median nerve across the carpal tunnel7.
Reason for Grading Carpal Tunnel Syndrome:
The Grading tool is used for the diagnostic assessment of CTS in conjunction with the patient’s clinical history and symptoms in order to diagnose the degree of severity of CTS3.
There are several primary grading tests mentioned in the literature, associated with Phalen’s, Tinel’s and Durkan’s signs which are subjective and are based on patient clinical response. Other tests like Ultrasound, NCS and EMG needle examination are objective tests that have been used for CTS grading which are reliable, evidence-based and objective, not dependent on patient clinical response 2.
However, to ascertain the degree of severity of CTS, a specific neurophysiological grading scale is required12. There are several grading scales for investigations specifically related to CTS; [Campbell5, Padua12, Bland4, Giannini7, Carvalho6, Ajeena2, Jeong9 and Jerosh-Herold10]. Most of the studies show grading in subjectivity which are based on patient experience. Few researchers have used sensitive techniques to diagnose early or very mild CTS or in severe cases used Lumbrical responses to differentiate its severity from complete absence, which therefore cannot be diagnosed as CTS with complete certainty.
In the UK, the Canterbury grading is largely followed due to its depth of detail. In 2014 the Association of Neurophysiological Science (ANS), in collaboration with the British Society for Clinical Neurophysiology (BSCN) published guidelines outlining the accepted grading of CTS in the United Kingdom, which follows the Canterbury4 grading system. The reason given was that it focuses on the clinical physiologist specialism, as well as its element of flexibility. But actually this was not fulfil the whole criteria of the grading system.
The aim of this research is to establish, to show the grading system mentioned in Hirani’s grading in 201914 on evidence base with case presentation including, patient history, Neurophysiological findings and Consultant conclusion to show the propose grading scale is clinically appropriate of the current CTS nerve conduction grading tool. It also suggests the improvements in currently used grading system which is 25 years old. The revised grading system confirms with my previously publish research paper in 201914.
No clinical assessment was conducted during the Neurophysiological test so as to avoid bias from the patient’s condition.
No ethical approval has been taken as this is a retrospective presentation with all patient data anonymised.
The Association of Neurophysiological Scientists (ANS) (2014) guidelines are the minimum standards for the practice of Clinical Neurophysiology in the United Kingdom and AAEM are followed. A few new gradings were introduced after looking at the data to cover the full range of gradings as these new changes are not covered by the Canterbury grading system.
The test was performed by a qualified Clinical Physiologist (Neurophysiology) using Keypoint 9033A07 (Skovlunde, Denmark) machine, on the basis of departmental protocol (Peripheral protocol1, 2015) by checking patient’s hand temperature i.e., more than 30 degrees centigrade. No individual patient was recruited in this research as all cases was selected from the retrospect data collection of 2017. No clinical assessment was conducted prior to the study in the department but patient clinical history was taken directly from the patient and compared with the information mentioned in the referral for counter check. Referral of CTS was considered based on paraesthesia, pain, swelling in median distribution area or digits I-V, worsened by sleep.
The procedure started by carrying out the sensory testing, by placing the stimulating ring electrodes on digit III (which is more sensitive than digit II4) and the recording electrode on the surface of the median nerve at the wrist. The orthodromic technique was used for the sensory and motor NCS test, through the median and ulnar nerves. A supramaximal stimulus was applied to record the full response of the nerve, at the digits II-IV for median sensory and digit V for ulnar sensory recording. A supramaximal current was applied to stimulate median nerve pathways at the wrist and at the elbow for motor recording from abductor pollicis brevis (APB)1 and ulnar nerve pathways from First dorsal interosseous (FDI). Digit II was stimulated only when either the response from digit III was less than 3µV or absent; digit IV was stimulated only when the response from digit III showed conduction velocity between 45-50m/sec. Amplitude was recorded from peak to peak for sensory responses, and base to peak for motor responses. If responses were not recordable from median sensory digit II, III and motor from APB muscles, then motor responses were elicited by placing recording electrodes on 2nd lumbricals by stimulating median and ulnar nerves at the wrist1,6,11,13. If the motor response from FDI shows more than 30% reduction in amplitude below and across elbow as compared to the wrist, the response elicited from median the nerve while recording from FDI was performed to identify the Martin Gruber anomaly. The distance from APB to wrist was kept between 6.5-7.5 cm while recording the motor median nerve.
Median and Ulnar senss
Median sensory recording by stimulating digit III Median motor recording at elbow
Median sensory early changes from digit IV Ulnar FDI motor recording below elbow
Median motor recording at wrist Ulnar FDI motor recording across elbow
Recording from median 2nd Lumbricals for Recording from ulnar 2nd lumbricals for very severe changes. APB wasting very severe changes. APB wasting
All selected patient data was collected by fulfilling the criteria mentioned above and the grades created which are as follows:
The grades are:
Normal (Grade 0): where sensory conduction velocity (SCV) is above 50 m/s and amplitude ≥5 µV with DML ≤4.2 ms, amplitude ≥5mV and motor conduction velocity (MCV) ≥50 m/s.
Early (Grade 1): where SCV is between 45-50 m/s from digit III and double peak latency in digit IV is >0.5ms with DML ≤4.2ms and normal sensory and motor amplitude >5 (sensory in µV and motor in mV).
Mild Sensory (Grade 2): where SCV is between 40-44.9 m/s from digits III with normal sensory amplitude and motor values mentioned in Grade 0.
Mild Sensory-Motor (Grade 3): where SCV is between 40-44.9 m/s from digits III with normal sensory amplitude mentioned in Grade 0, DML ≥4.2ms with normal motor amplitude and CV.
Moderate Sensory (Grade 4): where SCV is less than 40 m/s from digits III with normal sensory amplitude and normal motor values mentioned in Grade 0.
Moderate Sensory-Motor (Grade 5): where SCV is less than 40 m/s from digits III with normal sensory amplitude, DML ≥4.2ms with normal motor amplitude and CV.
Severe Sensory-Motor (Grade 6): where sensory potentials from digits III and digit II are absent or <3>
Extremely Severe Sensory-Motor (Grade 7): where sensory and motor potentials are absent and response recordable only from 2nd lumbricals, where median lumbricals are prolonged compared and low amplitude to ulnar lumbricals.
Complete (Grade 8): where both sensory and motor potentials are absent and responses are not recordable from median 2nd lumbricals but recordable from ulnar 2nd lumbricals. (Please refer to a Comparison of the Canterbury grading with the proposed revised grading is given at the end of this study for more understanding).
One case presentation for each gradings with their history, findings in a form of data and the conclusion was mentioned below. So that the audience can see the differences in the different grading system.
Case 1
29-year-old right-handed working as a Nursery Assistant, presented with intermittent pins and needles in digits I-III in both hands up to the forearms which appears any time for a year. Patient had steroid injections at the base of left thumb 3 weeks ago. Patient has poor hand grip. No Hx of arthritis or diabetes or any symptoms between the elbows to neck.
Sensory and motor data
| Sensory studies | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 2.35 | 34.7 | 1.06 | 125 | 65.8 | |||||
| Digit IV - Wrist | 2.56 | 16.1 | 1.21 | -- | ||||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | 2.56 | 19.2 | 1.02 | 140 | 66.7 | |||||
| Digit IV - Wrist | 2.52 | 13.8 | 1.04 | -- | ||||||
| Ulnar Sensory Left | ||||||||||
| Digit IV - Wrist | 2.48 | 11.2 | 1.33 | -- | ||||||
| Digit V - Wrist | 2.00 | 13.3 | 1.17 | 105 | 68.2 | |||||
| Ulnar Sensory Right | ||||||||||
| Digit IV - Wrist | 2.42 | 7.6 | 1.17 | -- | ||||||
| Digit V - Wrist | 2.04 | 13.5 | 1.27 | 110 | 69.6 | |||||
| Motor Studies | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 2.83 | 10.3 | 6.0 | 7 | ||||||
| Elbow-Wrist | 6.60 | 9.8 | 6.2 | 230 | 61.0 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 2.60 | 11.5 | 5.9 | 7.1 | ||||||
| Elbow-Wrist | 6.15 | 10.0 | 5.8 | 220 | 62.0 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.56 | 11.0 | 5.2 | |||||||
| Bl. Elbow-Wrist | 5.61 | 10.7 | 5.4 | 200 | 65.6 | |||||
| Ab. Elbow-Bl. Elbow | 7.21 | 10.4 | 5.5 | 105 | 65.6 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Wrist - FDI | 2.54 | 14.6 | 5.1 | |||||||
| Bl. Elbow-Wrist | 5.61 | 13.8 | 5.3 | 215 | 70.0 | |||||
| Ab. Elbow-Bl. Elbow | 7.19 | 13.3 | 5.3 | 105 | 66.5 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.33 | 9.4 | 6.4 | |||||||
| Bl. Elbow-Wrist | 5.42 | 8.6 | 5.9 | 200 | 64.7 | |||||
| Ab. Elbow-Bl. Elbow | 7.17 | 9.1 | 6.0 | 105 | 60.0 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.38 | 8.7 | 5.1 | |||||||
| Bl. Elbow-Wrist | 5.50 | 7.5 | 5.3 | 215 | 68.9 | |||||
| Ab. Elbow-Bl. Elbow | 6.83 | 8.3 | 5.4 | 105 | 78.9 | |||||
This study is normal. There is no evidence of Carpal Tunnel Syndrome or ulnar nerve entrapment on either side.
Case 2:
38-year-old right-handed Gardener, presented with numbness in all fingers bilaterally at night or when she is gardening for the past 1year 6 months. The patient gets shocking pain in both palms. There is a history of neck stiffness. Patient has right tennis elbow and weak grip in hands bilaterally.
Sensory motor data:
| Sensory | |||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | ||||
| ms | uV | ms | mm | m/s | |||||
| Median Sensory Left | |||||||||
| Digit III – Wrist | 2.50 | 14.7 | 0.97 | 120 | 55.6 | ||||
| Digit IV – Wrist | 2.58 | 9.0 | 1.02 | -- | |||||
| Median Sensory Right | |||||||||
| Digit III – Wrist | 2.81 | 14.9 | 1.19 | 120 | 52.4 | ||||
| Digit IV – Wrist | 3.00 | 5.0 | 1.04 | -- | |||||
| Ulnar Sensory Left | |||||||||
| Digit IV – Wrist | 2.35 | 6.5 | 1.67 | -- | |||||
| Digit V – Wrist | 2.02 | 7.2 | 1.40 | 100 | 64.9 | ||||
| Ulnar Sensory Right Interpeak latency: 0.6ms | |||||||||
| Digit IV – Wrist | 2.48 | 7.7 | 1.35 | -- | |||||
| Digit V – Wrist | 2.44 | 7.0 | 1.33 | 105 | 60.7 | ||||
| Motor | |||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | ||||
| ms | mV | ms | mm | m/s | |||||
| 1 Median Motor Left | |||||||||
| Wrist – APB | 3.04 | 13.5 | 6.0 | 7 | |||||
| Elbow-Wrist | 6.65 | 13.5 | 6.0 | 210 | 58.2 | ||||
| 1 Median Motor Right | |||||||||
| Wrist – APB | 3.48 | 11.4 | 5.3 | 7.2 | |||||
| Elbow-Wrist | 7.48 | 11.0 | 5.4 | 220 | 55.0 | ||||
| 2 Ulnar FDI Motor Left | |||||||||
| Wrist – FDI | 2.46 | 15.9 | 4.7 | ||||||
| Bl. Elbow-Wrist | 5.62 | 15.3 | 4.5 | 195 | 61.7 | ||||
| Ab. Elbow-Bl. Elbow | 7.82 | 14.0 | 4.3 | 115 | 52.3 | ||||
| 2 Ulnar FDI Motor Right | |||||||||
| Wrist – FDI | 2.89 | 15.5 | 4.5 | ||||||
| Bl. Elbow-Wrist | 5.78 | 14.6 | 4.7 | 190 | 65.7 | ||||
| Ab. Elbow-Bl. Elbow | 7.35 | 15.6 | 4.6 | 110 | 70.1 | ||||
| 3 Ulnar ADM Motor Left | |||||||||
| Wrist – ADM | 2.81 | 13.5 | 5.9 | ||||||
| Bl. Elbow-Wrist | 5.48 | 12.2 | 6.3 | 195 | 73.0 | ||||
| Ab. Elbow-Bl. Elbow | 7.33 | 11.8 | 6.5 | 115 | 62.2 | ||||
| 3 Ulnar ADM Motor Right | |||||||||
| Wrist – ADM | 2.15 | 12.4 | 6.2 | ||||||
| Bl. Elbow-Wrist | 5.00 | 10.8 | 5.9 | 190 | 66.7 | ||||
| Ab. Elbow-Bl. Elbow | 6.67 | 12.1 | 5.6 | 110 | 65.9 | ||||
Above changes in the right hand are a very early sign of carpal tunnel syndrome and could be improved with conservative treatment. If symptoms persist a repeat study in 6 months’ time may be helpful.
There is no evidence of ulnar nerve lesion on either side.
Case 3:
54-year-old left-handed support worker attended again. Her previous study in 2018 shows bilateral early CTS. She still gets intermittent pins and needles and numbness in all fingers bilaterally since 2016. Symptoms become worse at night and she has poor grip bilaterally. She uses crutches in her right hand due to previous right foot surgery. The patient had left ulnar decompression 30 years ago with good symptomatic outcome. No symptoms between elbows to neck.
Sensory motor data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 3.48 | 15.4 | 1.21 | 130 | 44.8 | |||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | 3.38 | 10.1 | 1.63 | 135 | 51.3 | |||||
| Digit IV - Wrist | 3.21 | 3.0 | 1.10 | -- | ||||||
| Ulnar Sensory Left | ||||||||||
| Digit V - Wrist | 2.60 | 9.6 | 1.90 | 100 | 60.6 | |||||
| Ulnar Sensory Right Interpeak latency: 0.5ms | ||||||||||
| Digit IV - Wrist | 2.69 | 7.0 | 1.73 | -- | ||||||
| Digit V - Wrist | 2.38 | 8.8 | 1.60 | 105 | 60.7 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 3.35 | 13.4 | 5.9 | 7.5 | ||||||
| Elbow-Wrist | 7.04 | 14.4 | 6.1 | 235 | 63.7 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 3.19 | 6.6 | 6.0 | 7.4 | ||||||
| Elbow-Wrist | 7.10 | 6.1 | 6.2 | 230 | 58.8 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.51 | 11.4 | 4.9 | |||||||
| Bl. Elbow-Wrist | 5.61 | 10.0 | 6.7 | 215 | 69.4 | |||||
| Ab. Elbow-Bl. Elbow | 7.23 | 9.4 | 6.4 | 105 | 64.8 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Wrist - FDI | 2.45 | 14.3 | 4.7 | |||||||
| Bl. Elbow-Wrist | 5.46 | 13.6 | 5.1 | 205 | 68.1 | |||||
| Ab. Elbow-Bl. Elbow | 7.07 | 13.3 | 5.0 | 105 | 65.2 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.23 | 7.8 | 6.8 | |||||||
| Bl. Elbow-Wrist | 5.40 | 7.9 | 6.7 | 215 | 67.8 | |||||
| Ab. Elbow-Bl. Elbow | 6.88 | 7.3 | 6.8 | 105 | 70.9 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.31 | 7.5 | 6.9 | |||||||
| Bl. Elbow-Wrist | 5.15 | 8.0 | 7.1 | 205 | 72.2 | |||||
| Ab. Elbow-Bl. Elbow | 6.67 | 8.1 | 6.9 | 105 | 69.1 | |||||
There is evidence of left mild sensory carpal tunnel syndrome.
There is no evidence of ulnar nerve lesion on either side.
Case 4
A 36-year-old left-handed health care assistant, presented with intermittent pins and needles and numbness in all fingers bilaterally which becomes worse when holding the phone or driving since February 2022 Test was conducted in 2024.There was no history of diabetes or arthritis. She had pain between elbows to neck and had weak handgrip.
Sensory motor data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 4.06 | 8.7 | 1.81 | 135 | 42.3 | |||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | 3.48 | 7.0 | 1.44 | 130 | 43.9 | |||||
| Ulnar Sensory Left | ||||||||||
| Digit V - Wrist | 2.19 | 5.4 | 1.35 | 110 | 66.7 | |||||
| Ulnar Sensory Right | ||||||||||
| Digit V - Wrist | 2.23 | 9.2 | 1.35 | 110 | 66.7 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 5.02 | 8.1 | 5.0 | 7.3 | ||||||
| Elbow-Wrist | 8.75 | 7.9 | 5.5 | 220 | 59.0 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 4.33 | 9.0 | 4.5 | 7.2 | ||||||
| Elbow-Wrist | 8.29 | 8.7 | 4.7 | 220 | 55.6 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.51 | 14.2 | 4.2 | |||||||
| Bl. Elbow-Wrist | 5.49 | 13.5 | 4.4 | 200 | 67.1 | |||||
| Ab. Elbow-Bl. Elbow | 6.95 | 12.8 | 4.3 | 110 | 75.3 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Wrist - FDI | 2.36 | 15.4 | 4.2 | |||||||
| Bl. Elbow-Wrist | 5.62 | 14.7 | 4.4 | 210 | 64.4 | |||||
| Ab. Elbow-Bl. Elbow | 7.13 | 13.6 | 4.3 | 105 | 69.5 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.13 | 12.8 | 4.4 | |||||||
| Bl. Elbow-Wrist | 5.00 | 13.2 | 4.7 | 200 | 69.7 | |||||
| Ab. Elbow-Bl. Elbow | 6.50 | 11.8 | 4.5 | 110 | 73.3 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.19 | 12.6 | 4.4 | |||||||
| Bl. Elbow-Wrist | 5.20 | 12.3 | 4.9 | 210 | 69.8 | |||||
| Ab. Elbow-Bl. Elbow | 6.73 | 12.5 | 4.6 | 105 | 68.6 | |||||
There is evidence of bilateral mild sensori-motor carpal tunnel syndrome.
There is no evidence of ulnar nerve lesion on either side.
Case 5:
A 52 year old right-handed nurse assistant who was diagnosed as having autoimmune hepatitis, presented with intermittent numbness and pins and needles in all fingers bilaterally, right more than the left for the past 4 years. Occasionally changing to pain in the hands. Symptoms become worse during sleep. She has a history of neck pain. Hand strength is 5/5 on the MRC Scale and there is no stiffness in the hands. The left shoulder has limited movements with pain.
Sensory and motor data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 2.79 | 26.0 | 1.31 | 110 | 52.2 | |||||
| Digit IV - Wrist | 3.15 | 4.8 | 1.56 | -- | ||||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | 3.96 | 6.7 | 2.6 | 115 | 37.3 | |||||
| Ulnar Sensory Left Interpeak latency:0.3ms | ||||||||||
| Digit IV - Wrist | 2.84 | 5.8 | 1.47 | -- | ||||||
| Digit V - Wrist | 2.52 | 6.8 | 1.31 | 90.0 | 50.8 | |||||
| Ulnar Sensory Right | ||||||||||
| Digit V - Wrist | 2.59 | 5.6 | 1.47 | 100 | 50.5 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 2.92 | 9.8 | 5.9 | 7.3 | ||||||
| Elbow-Wrist | 7.21 | 10.4 | 5.9 | 235 | 54.8 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 3.98 | 8.2 | 6.3 | 7.2 | ||||||
| Elbow-Wrist | 8.04 | 8.2 | 7.1 | 235 | 57.9 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.47 | 16.2 | 5.0 | |||||||
| Bl. Elbow-Wrist | 6.01 | 15.9 | 5.0 | 215 | 60.7 | |||||
| Ab. Elbow-Bl. Elbow | 7.75 | 15.1 | 5.1 | 110 | 63.2 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Wrist - FDI | 2.79 | 15.6 | 5.3 | |||||||
| Bl. Elbow-Wrist | 6.25 | 14.4 | 5.5 | 220 | 63.6 | |||||
| Ab. Elbow-Bl. Elbow | 7.91 | 14.2 | 5.6 | 110 | 66.3 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.21 | 11.1 | 5.2 | |||||||
| Bl. Elbow-Wrist | 5.73 | 10.9 | 5.1 | 215 | 61.1 | |||||
| Ab. Elbow-Bl. Elbow | 7.52 | 10.3 | 5.3 | 110 | 61.5 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.33 | 11.4 | 5.0 | |||||||
| Bl. Elbow-Wrist | 5.58 | 10.1 | 5.2 | 220 | 67.7 | |||||
| Ab. Elbow-Bl. Elbow | 7.06 | 10.9 | 5.1 | 110 | 74.3 | |||||
There is evidence of left moderate sensory carpal tunnel syndrome.
There is no evidence of ulnar nerve entrapment on either side.
Case 6:
A 46-year-old right-handed handyman presented with numbness and tingling in all fingers bilaterally most of the time for the last 6 years. In the past 3-4 years, hand symptoms had become worse. The patient also gets pins and needles in his feet. He has weak hand grip. There were no symptoms between the elbows to neck or any history of diabetes or arthritis.
Sensory and motor data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 3.60 | 8.8 | 1.35 | 150 | 51.4 | |||||
| Digit IV - Wrist | 3.35 | 8.7 | 1.50 | -- | ||||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | 5.44 | 3.5 | 1.94 | 145 | 33.8 | |||||
| Ulnar Sensory Left Interpeak latency: 0.9ms | ||||||||||
| Digit IV - Wrist | 2.63 | 5.3 | 1.40 | -- | ||||||
| Digit V - Wrist | 2.63 | 5.6 | 1.17 | 130 | 63.7 | |||||
| Ulnar Sensory Right | ||||||||||
| Digit V - Wrist | 2.48 | 5.5 | 1.31 | 125 | 64.4 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 3.75 | 12.1 | 6.5 | 7 | ||||||
| Elbow-Wrist | 8.60 | 11.1 | 6.7 | 250 | 51.5 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 5.60 | 9.8 | 6.9 | 7 | ||||||
| Elbow-Wrist | 10.3 | 10.7 | 7.2 | 255 | 54.3 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.79 | 7.7 | 7.1 | |||||||
| Bl. Elbow-Wrist | 7.34 | 7.8 | 7.4 | 245 | 53.8 | |||||
| Ab. Elbow-Bl. Elbow | 9.38 | 7.1 | 7.5 | 120 | 58.8 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Med-Ulnar - FDI | 9.10 | 3.0 | 7.5 | |||||||
| Wrist - FDI | 2.69 | 10.3 | 7.3 | |||||||
| Bl. Elbow-Wrist | 7.01 | 5.5 | 7.2 | 240 | 55.6 | |||||
| Ab. Elbow-Bl. Elbow | 9.13 | 6.5 | 7.6 | 110 | 51.9 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.58 | 6.7 | 5.6 | |||||||
| Bl. Elbow-Wrist | 7.04 | 5.8 | 5.5 | 245 | 54.9 | |||||
| Ab. Elbow-Bl. Elbow | 8.94 | 5.9 | 5.9 | 120 | 63.2 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.54 | 6.0 | 5.0 | |||||||
| Bl. Elbow-Wrist | 6.58 | 5.8 | 5.5 | 240 | 59.4 | |||||
| Ab. Elbow-Bl. Elbow | 8.40 | 5.8 | 5.7 | 110 | 60.4 | |||||
Case 7:
A 48-year-old right-handed man who works in a Bar, presented with weakness in the wrist and pain from the forearm to the elbows bilaterally for 5 years. The patient was also having symptoms of intermittent numbness and pins and needles in all fingers bilaterally, which became worse at night. The patient has poor hands grip and wasting of APB muscles in the right hand. No Hx of arthritis or diabetes.
Sensory and motor data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | 4.00 | 6.3 | 1.44 | 150 | 45.0 | |||||
| Digit IV - Wrist | 4.06 | 2.5 | 1.17 | -- | ||||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | Absent | -- | -- | |||||||
| Digit II - Wrist | Absent | -- | -- | |||||||
| Ulnar Sensory Left Interpeak latency: 1.25ms | ||||||||||
| Digit IV - Wrist | 2.81 | 6.9 | 1.23 | -- | ||||||
| Digit V - Wrist | 2.63 | 7.9 | 1.46 | 110 | 53.9 | |||||
| Ulnar Sensory Right | ||||||||||
| Digit V - Wrist | 2.71 | 6.7 | 1.71 | 115 | 56.4 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 3.69 | 11.3 | 6.8 | 7 | ||||||
| Elbow-Wrist | 7.52 | 12.5 | 7.0 | 220 | 57.4 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | 5.29 | 8.1 | 7.4 | 7 | ||||||
| Elbow-Wrist | 9.00 | 8.2 | 8.8 | 230 | 62.0 | |||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 2.81 | 13.5 | 4.8 | |||||||
| Bl. Elbow-Wrist | 5.93 | 12.7 | 5.3 | 210 | 67.3 | |||||
| Ab. Elbow-Bl. Elbow | 7.92 | 12.4 | 5.3 | 110 | 55.3 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Med-Ulnar - FDI | 8.00 | 2.9 | 4.0 | |||||||
| Wrist - FDI | 2.51 | 14.9 | 5.4 | |||||||
| Bl. Elbow-Wrist | 5.98 | 10.5 | 5.6 | 225 | 64.8 | |||||
| Ab. Elbow-Bl. Elbow | 7.72 | 10.7 | 5.6 | 105 | 60.3 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.56 | 10.3 | 5.7 | |||||||
| Bl. Elbow-Wrist | 6.15 | 9.2 | 5.6 | 210 | 58.5 | |||||
| Ab. Elbow-Bl. Elbow | 7.85 | 9.7 | 5.7 | 110 | 64.7 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.50 | 9.3 | 7.5 | |||||||
| Bl. Elbow-Wrist | 5.71 | 7.3 | 7.1 | 225 | 70.1 | |||||
| Ab. Elbow-Bl. Elbow | 7.17 | 9.0 | 7.4 | 105 | 71.9 | |||||
Case 8: 81 year old retired nurse presented with almost constant pins and needles in digits I-IV of the left hand for 2 years with poor gripping. Left APB muscles were wasted. Each shoulder gets pain. The right thumb was infected and covered by tape and the hand was in a glove to stop spreading infection. Left median artery had previously been removed for coronary artery bypass grafting.
Sensory and motor data:
| Sensory | |||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | ||||||
| ms | uV | ms | mm | m/s | |||||||
| Dorsal Ulnar Cutaneous Sensory Left | |||||||||||
| Wrist - IV dorsal space | 1.66 | 7.3 | 1.24 | 75.0 | 71.4 | ||||||
| Median Sensory Left | |||||||||||
| Digit III - Wrist | Absent | -- | -- | ||||||||
| Digit II - Wrist | Absent | -- | -- | ||||||||
| Ulnar Sensory Left | |||||||||||
| Palm - Wrist | Absent | -- | -- | ||||||||
| Digit V - Wrist | Absent | -- | -- | ||||||||
| Motor | |||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | ||||||
| ms | mV | ms | mm | m/s | |||||||
| 1 Median Motor Left | |||||||||||
| Wrist - APB | Absent | -- | -- | ||||||||
| 2 Ulnar FDI Motor Left | |||||||||||
| Wrist - FDI | 3.26 | 10.5 | 6.3 | ||||||||
| Bl. Elbow-Wrist | 7.60 | 8.6 | 6.4 | 245 | 56.5 | ||||||
| Ab. Elbow-Bl. Elbow | 10.2 | 7.7 | 6.5 | 110 | 42.3 | ||||||
| Axilla-Ab. Elbow | 12.2 | 7.5 | 6.7 | 110 | 55.0 | ||||||
| 3 Ulnar ADM Motor Left | |||||||||||
| Wrist - ADM | 2.53 | 6.9 | 6.2 | ||||||||
| Bl. Elbow-Wrist | 6.65 | 6.3 | 6.7 | 245 | 59.5 | ||||||
| Ab. Elbow-Bl. Elbow | 9.20 | 5.8 | 7.0 | 110 | 43.1 | ||||||
| Axilla-Ab. Elbow | 10.9 | 5.6 | 6.9 | 110 | 64.7 | ||||||
| 4 2nd Lumbrical Motor Left | |||||||||||
| Palm - Uln-wrist | 3.40 | 5.1 | 5.1 | 8 | |||||||
| Palm - Med-wrist | 9.93 | 0.39 | 6.3 | 8 | |||||||
Nerve conduction studies on the left median nerve show no response on the left from digits II and III sensory and motor from APB muscles across the carpal tunnel. The only recordable response is from the 2nd lumbricals muscles by stimulating median and ulnar nerves at mid-palm, where the median distal latency is prolonged as compared to the ulnar distal latency at an 8 cm distance from the palm to wrist.
There is evidence of left double crush syndrome of the ulnar nerve i.e. Sensory Guyon’s Canal entrapment and mild Ulnar nerve entrapment across the elbow.
Case 9:
68 years right-handed retired male presented with constant numbness in digits I-III in the right hand for a year. The Complete Right APB wasting was seen, with partial wasting on the left. No paraesthesia was described in the left hand. Occasionally he drops things from both hands. There were no symptoms between the elbows to the neck. No history of diabetes or of arthritis.
Sensory and motor study data:
| Sensory | ||||||||||
| Nerve | Peak Lat | Amp | Dur | Dist | CV | |||||
| ms | uV | ms | mm | m/s | ||||||
| Dorsal Ulnar Cutaneous Sensory Left | ||||||||||
| Wrist - IV dorsal space | 1.77 | 8.7 | 1.35 | 65.0 | 62.5 | |||||
| Dorsal Ulnar Cutaneous Sensory Right | ||||||||||
| Wrist - IV dorsal space | 1.65 | 10.3 | 1.35 | 65.0 | 72.2 | |||||
| Median Sensory Left | ||||||||||
| Digit III - Wrist | Absent | -- | -- | |||||||
| Digit II - Wrist | Absent | -- | -- | |||||||
| Median Sensory Right | ||||||||||
| Digit III - Wrist | Absent | -- | -- | |||||||
| Digit II - Wrist | Absent | -- | -- | |||||||
| Ulnar Sensory Left | ||||||||||
| Palm - Wrist | 2.10 | 2.9 | 1.17 | 80.0 | 49.7 | |||||
| Digit V - Wrist | 3.54 | 0.95 | 1.40 | 105 | 37.2 | |||||
| Ulnar Sensory Right | ||||||||||
| Palm - Wrist | 2.84 | 4.7 | 1.52 | 80.0 | 39.4 | |||||
| Digit V - Wrist | 3.65 | 4.1 | 1.77 | 105 | 37.4 | |||||
| Motor | ||||||||||
| Nerve | Lat | Amp | Dur | Dist | CV | |||||
| ms | mV | ms | mm | m/s | ||||||
| 1 Median Motor Left | ||||||||||
| Wrist - APB | 5.90 | 5.8 | 6.1 | |||||||
| Elbow-Wrist | 11.5 | 5.4 | 6.4 | 255 | 45.5 | |||||
| 1 Median Motor Right | ||||||||||
| Wrist - APB | Absent | -- | -- | |||||||
| 2 Ulnar FDI Motor Left | ||||||||||
| Wrist - FDI | 3.06 | 8.1 | 5.8 | |||||||
| Bl. Elbow-Wrist | 7.32 | 7.1 | 6.2 | 235 | 55.2 | |||||
| Ab. Elbow-Bl. Elbow | 9.83 | 6.3 | 6.2 | 110 | 43.8 | |||||
| Axilla-Ab. Elbow | 12.1 | 6.0 | 6.1 | 120 | 52.9 | |||||
| 2 Ulnar FDI Motor Right | ||||||||||
| Wrist - FDI | 3.85 | 8.2 | 5.6 | |||||||
| Bl. Elbow-Wrist | 8.32 | 7.3 | 5.8 | 240 | 53.7 | |||||
| Ab. Elbow-Bl. Elbow | 10.7 | 7.4 | 6.1 | 105 | 44.1 | |||||
| Axilla-Ab. Elbow | 12.4 | 6.3 | 5.7 | 100 | 58.8 | |||||
| 3 Ulnar ADM Motor Left | ||||||||||
| Wrist - ADM | 2.31 | 6.9 | 6.5 | |||||||
| Bl. Elbow-Wrist | 6.57 | 6.8 | 6.5 | 235 | 55.2 | |||||
| Ab. Elbow-Bl. Elbow | 8.94 | 5.8 | 7.1 | 110 | 46.4 | |||||
| Axilla-Ab. Elbow | 10.9 | 5.8 | 7.3 | 120 | 61.2 | |||||
| 3 Ulnar ADM Motor Right | ||||||||||
| Wrist - ADM | 2.63 | 5.6 | 6.7 | |||||||
| Bl. Elbow-Wrist | 6.68 | 6.8 | 7.1 | 240 | 59.3 | |||||
| Ab. Elbow-Bl. Elbow | 8.95 | 6.5 | 7.1 | 105 | 46.3 | |||||
| Axilla-Ab. Elbow | 10.8 | 6.3 | 7.0 | 100 | 54.1 | |||||
| 4 2nd Lumbrical Motor Right | ||||||||||
| Palm - Uln-wrist | 2.88 | 6.9 | 4.4 | |||||||
| Palm - Med-wrist | Absent | -- | -- | |||||||
Electrophysiologically it is difficult to pin point the entrapment of left median nerve due to response not being recordable from the median-innervated 2nd lumbricals but recordable from ulnar 2nd lumbricals as well. There is no previous study available to compare with current condition.
There is evidence of severe left sensory motor Carpal Tunnel Syndrome.
In addition, there is evidence of mild ulnar nerve entrapment across both elbows.
The grading system devised by Bland4 and used to grade the levels of severity of CTS over the last 23 years within the UK has certain limitations, and the author believes that it needs modification in order to accommodate current practice. The revised grading system mentioned above is evident that, the Canterbury scale is not fulfil the criteria to visualise the grading of CTS properly.
The revised grading tool offer a more precise grading, which is both objective and repeatable. This could not only help the Clinical Physiologist to grade their result according to the proposed grading scale but probably it also supports the surgeon to ascertain the level of severity and thus help to decide on either a conservative or surgical approach to treatment. It is advisable according to each case conclusion that surgeons could consider proposed Grade 1-2 for physiotherapy treatment, Grade 3-4 for conservative or intervention of steroid treatment and Grade 5-7 for surgical intervention where the chances of full recovery. Surgeon could decide for surgical intervention of Grade 8 cases, whether it would be beneficial or not would be in keeping with the patient’s age and other medical history. Grade 9 does not clearly indicate the level of entrapment and further EMG study may be helpful to localise the lesion precisely at the higher level from wrist.
Carpal tunnel syndrome -CTS, Nerve Conduction Studies -NCS, Betsi Cadwaladr University Health Board -BCUHB, General Practices -GPs, Association of Neurophysiological Scientists - ANS, abductor polices braves - APB, sensory conduction velocity - SCV, conduction velocity -CV, British Society for Clinical Neurophysiology - BSCN, Distal Motor Latency - DML, normal sensory amplitude - NSA, Sensory nerve action potentials -SNAP, normal motor amplitude - NMA, Motor nerve action potentials -MNAP, motor conduction velocity – MCV
Written Consent from participants:
A written consent was obtained from all participants and filed in patient notes and a copy kept in the department.
Consent for Publication:
Not Applicable
Availability of data and materials:
The datasets analysed during the current study are not publicly available as they are held within patient records but are available from the corresponding author on request.
Competing Interests:
The Author declares that they have no competing interests.
Funding:
The Author contributed by the collection, analysis and interpretation of data and in writing the manuscript. No funding was arranged in collecting cases, preparing and writing manuscript.
Acknowledgements:
The author would like to acknowledge and thank Dr.Gareth Payne for his encouragement, guidance and help with this study.
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Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
