Simple Clinical Tests in Severe Carpal Tunnel Syndrome
Languages of publication
Patients with severe carpal tunnel syndrome may be characterised by an atypical clinical picture. They assess complaints as becoming less bothersome than in the past. It seems that this may influence the diagnostic value of some clinical tests used in physical examinations.was the selection of the most reliable clinical tests in a group of patients with severe carpal tunnel syndrome.Material and methods. The material comprised 38 cases of severe form of the disease in a group of 37 prospective patients. The methods consisted in the evaluation of the rate of positive results of selected clinical tests, and in the comparison of their statistical correlation with selected parameters of median nerve conduction.Results. The study results indicated that high incidence of two-point discrimination disorders showed a correlation with the sensory conduction parameters, including the median-ulnar sensory latency difference. The Durkan's and Phalen's tests were positive in almost all patients with advanced carpal tunnel. The Katz hand diagram revealed significantly enhanced sensitivity in the “probable” pattern.Conclusions. We speculate that the two-point discrimination, evaluated with the use of a simple paper clip, enables the selection of a group of patients with severe form of the syndrome for further differentiation. The tool used for facilitating the differential diagnosis is the Katz hand diagram. The Durkan's and Phalen's tests have an equally high value. However, they show no correlation with the conduction parameters, as measured by EMG.
1 - 12 - 2012
28 - 12 - 2012
- 1. de-la-Llave-Rincón AI , Puentedura EJ,Fernández-de-las-Peñas C: New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med 2012; 13(72): 343-48.
- 2. Shores JT, Lee WP: An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg 2010; 126(6): 2196-2204.[PubMed][Crossref]
- 3. Kang S, Kwon HK, Kim KH, Yun HS: Ultrasonography of median nerve and electrophysiologic severity in carpal tunnel syndrome. Ann RehabilMed 2012; 36(1): 72-79.[Crossref]
- 4. Werner RA, Andary M: Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44(4): 597-607.[Crossref][PubMed]
- 5. Concannon MJ, Gainor B, Petroski GF et al.: The predictive value of electrodiagnostic studies in carpal tunnel syndrome. Plast Reconstr Surg 1997; 100(6): 1452-58.[Crossref]
- 6. Bland JD: A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23(8): 1280-83.[Crossref][PubMed]
- 7. Kanatani T, Fujioka H, Kurosaka M et al.: Usefulness of distal motor latency measurement after palmar stimulation in advanced carpal tunnel syndrome. J Clin Neurophysiol 2012; 29(3): 260-62.[Crossref][WoS]
- 8. Dale AM, Descatha A, Coomes J et al.: Physical examination has a low yield in screening for carpal tunnel syndrome. Am J Ind Med 2011; 54(1): 1-9.[WoS][Crossref]
- 9. Wiącek R, Pielka S, Rutkowski R i wsp.: Ocena dynamiki poprawy czucia w ręce po operacyjnym leczeniu zespołu kanału nadgarstka. Neurol i N eurochirPol 2007; 41,6: 517-24
- 10. Elfar JC, Yaseen Z, Stern PJ et al.: Individual finger sensibility in carpal tunnel syndrome. JHand Surg Am 2010; 35(11): 1807-12.[Crossref]
- 11. Atroshi I, Gummesson C, Johnsson R et al.: Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMCMusculoskelet Disord 2003; 4: 9.
- 12. D’Arcy CA, McGee S: The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 2000; 283(23): 3110-17.
- 13. Rempel D, Evanoff B, Amadio PC et al.: Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J PublicHealth 1998; 88(10): 1447-51.
- 14. Mondelli M, Passero S, Giannini F: Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001; 103(3): 178-83.[Crossref][PubMed]
- 15. Priganc VW, Henry SM: The relationship among five common carpal tunnel syndrome tests, and the severity of carpal tunnel syndrome. J Hand Ther 2003; 16(3): 225-36.[PubMed][Crossref]
- 16. El Miedany Y, Ashour S, Youssef S et al.: Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 2008; 75(4): 451-57.[Crossref][WoS]
- 17. Schmid AB, Coppieters MW: Left/Right Judgment of Body Parts is Selectively Impaired in Patients With Unilateral Carpal Tunnel Syndrome. Clin J Pain 2012; 28(7): 615-22.[PubMed][WoS][Crossref]
- 18. Geere J, Chester R, Kale S et al.: Power grip, pinch grip, manual muscle testing or thenar atrophy - which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. BMC Musculoskelet Disord 2007; 8: 114.[Crossref][WoS]
- 19. Mallette P, Zhao M, Zurakowski D et al.: Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome. J Hand Surg Am 2007; 32(6): 855-58.[WoS][Crossref]
- 20. Dale AM, Strickland J, Symanzik J et al.: Reliability of hand diagrams for the epidemiologic case definition of carpal tunnel syndrome. J OccupRehabil 2008; 18(3): 233-48.[WoS]
- 21. Clark D, Amirfeyz R, Leslie I et al.: Often atypical? The distribution of sensory disturbance in carpal tunnel syndrome. Ann R CollSurg Engl 2011; 93(6): 470-73.[Crossref][WoS]
Publication order reference