Antidromic vs orthodromic sensory median nerve conduction studies

•We review orthodromic and antidromic testing of sensory conduction in median nerve.•The effects of physical and physiological changes differ between the two techniques.•Research studies may specifically demand one or the other technique.

ObjectiveMedian sensory nerve conduction studies are arguably the most often performed electrodiagnostic tests worldwide. Routine tests in clinical practice are done using either antidromic or orthodromic techniques type of stimulation, with no universal agreement on the use of one or the other technique.MethodsWe review the advantages and drawbacks of antidromic and orthodromic as well as their particularities for clinical application and research.ResultsThe two techniques differ on how physical and physiological changes affect the action potential. Near-nerve recording is better suited for the orthodromic than for the antidromic technique, while studies of nerve excitability are better suited for the antidromic than for the orthodromic technique.ConclusionBoth techniques are equally suitable for routine tests but research studies may specifically demand one or the other.