Assessing the accuracy of a combination of clinical tests for identifying carpal tunnel syndrome.

Spinal Injuries Research Centre, Prince of Wales Medical Research Institute, Barker Street, Randwick 2031, New South Wales, Australia; Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, Sydney, NSW, Australia.
Journal of Clinical Neuroscience (Impact Factor: 1.25). 04/2009; 16(7):929-33. DOI:10.1016/j.jocn.2008.09.004
Source: PubMed

ABSTRACT The aim of the study was to investigate whether a combination of selected provocative manoeuvres and sensory testing could improve the accuracy of clinical diagnosis of carpal tunnel syndrome (CTS). Prospective studies were undertaken in 43 of 296 consecutive patients who were referred with suspected CTS and had undergone nerve conduction studies (NCS). Responses to Phalen's test, a modified carpal compression test (MCCT), and sensory testing over the thenar eminence were assessed for each patient. For each test (Phalen's; MCCT), sensitivity (0.64; 0.14), specificity (0.75; 0.96), positive likelihood ratio (PLR) (2.54; 3.64) and negative likelihood ratio (NLR) (0.49; 0.89) were calculated. The inclusion of sensory testing did not improve sensitivity (0.55; 0.13), specificity (0.75; 0.96), PLR (2.22; 3.29) or NLR (0.60; 0.91). These data indicate that assessment of thenar sensation does not improve the diagnostic accuracy of CTS. However, a positive Phalen's test is more likely to be associated with NCS changes that are consistent with CTS.

0 0
  • [show abstract] [hide abstract]
    ABSTRACT: Although arthritis is the most notable component, rheumatoid arthritis (RA) is a systemic inflammatory disorder where extra-articular manifestations are common; among them, central and peripheral nervous system involvement is frequent and associated with significant morbidity and, in some cases, reduced life span. It may produce a myriad of symptoms and signs ranging from subtle numbness in a hand, to quadriparesis and sudden death. Central and peripheral neurologic manifestations may arise from structural damage produced by RA in diarthroidal joints, by the systemic inflammatory process of the disease itself or by the drugs used to treat it. Neurologic syndromes may appear suddenly or developed slowly through months, and emerge early or after years of having RA. Neurologic manifestations may be easily overlooked or incorrectly assigned to peripheral arthritis unless the attending physician is aware of these complications. In this article, we review neurologic involvement in RA patients with emphasis on clinical approach for early detection.
    Clinical Rheumatology 09/2011; 31(1):1-12. · 2.04 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Tunnel pressure (TP) has been linked to carpal tunnel syndrome (CTS), but the clinical significance of TP is still under investigation. The present study included 58 hands that were diagnosed with idiopathic CTS by nerve conduction velocity (NCV) and received divisions of the flexor retinaculum through a mini-open procedure. Preoperative and postoperative TP were measured segmentally, and surgical outcomes were assessed by the Boston Symptom Severity Score for CTS before surgery and 3months after surgery. We detected significantly increased TP in patients with CTS at 1.5-2.5cm distal to the distal wrist crest (DWC), and the highest value was observed at 2cm. Interestingly, there were still seven hands with a TP of > 30mmHg at 3cm distal to the DWC. The highest mean TP decreased from 52.7mmHg to 7.8mmHg after the operation. No patient had a pressure of >15mmHg proximal to the DWC. The mean Boston Symptom Severity Score decreased from 3.1 to 1.8 at the 3-month follow-up. Although the highest preoperative TP was slightly correlated with the compound muscle action potential and was moderately correlated with the distal motor latency, the latency of the sensory nerve action potential and the sensory conduction velocity, highest preoperative TP could not predict the 3-month outcome. The correlations between the electrophysiological parameters and the highest TP in our series were stronger than previous reports; however, NCV is still better than TP as a tool for predicting the 3-month surgical outcome.
    Journal of Clinical Neuroscience 12/2012; · 1.25 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging.
    The Open Orthopaedics Journal 01/2012; 6:69-76.