Digit distribution of proper digital nerve action potential

Antidromic sensory nerve action potential testing is well characterized and commonly used to assess the sensory component of the upper limb median and ulnar nerves. The final terminal segments of these nerves are the proper digital nerves. Ring recording electrodes are commonly used to detect the proper digital nerves' antidromic responses. Attempts to record the separate contributions of individual digital nerves along the lateral aspects of each finger, using small surface electrodes, is shown to be unreliable for determining the integrity of a single terminal digital branch. We found between 50% to 77% of the stimulated terminal branch's response amplitude when recorded at electrodes positioned over the non-stimulated branch located 180° from the activated terminal branch. Detecting a single terminal nerve response was achieved by using the fourth digit and the second digit with one of the second digit's branches neurophysiologically blocked by local anesthetic. The volume-conducted response from the opposite side of the finger resulted in this relatively large recorded response, which remains within the range of reference values precluding the simple use of antidromic techniques to assess injury to a single proper digital nerve. Techniques are proposed to avoid such pitfalls and to assess most accurately the desired response.