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Diagnostic tests used in diagnosis of carpal tunnel syndrome

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Georgiew F., Otfinowska E., Adamczyk T.

Medical Rehabilitation

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2008

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vol. 12(3)

24-35

EN

In 1854 Paget described for the first time that carpal tunnel syndrome (CTS) results from compression of the median nerve within the carpal tunnel. CTS predominantly involves tingling and numbness in the typical median nerve distribution. Pain, described as deep, aching, or throbbing, occurs diffusely in the hand and radiates up the forearm. Atrophy of the muscles of the thenar is usually seen later in the course of the nerve compression. CTS is most frequent among persons between the ages of 30 to 60 and is two to three times more common in women than in men (peak prevalence in women older than 55 years). Carpal tunnel syndrome may affect 1% to 10% of the population. Incorrect diagnosis of CTS has been identified as one of the most common causes of CTS treatment failure. CTS should be diagnosed clinically. Electro-diagnostic studies are a standard method of establishing the diagnosis. Electrodiagnostic studies are performed to confirm the clinical diagnosis, to assess the severity of median nerve compression and to rule out more proximal compression sites. Abnormalities in nerve conduction study results can be the only objective evidence of carpal tunnel syndrome. Lack of objective data, such as ENG can lead to incorrect diagnosis and inappropriate treatment. Clinical diagnosis should be reinforced by valuable diagnostic tests: the Semmes–Weinstein monofilaments test – performed in neutral and Phalen’s positions, vibration threshold measured by means of tuning forks or a vibrometer, by observation of thenar atrophy and using provocative tests. The use of common, sensitive and specific diagnostic tests should improve decision making about patients referral for specific therapies, facilitate the performance of epidemiologic studies, increase the accuracy of diagnosis. The combination of a results obtained using various methods might be more powerful than a single test in establishing the diagnosis of CTS. The combination of hand diagram, questionnaires, abnormal sensibility, thenar weakness or thenar atrophy and positive provocative tests constitutes a sensitive and specific diagnostic tool to establish the diagnosis of CTS. Standardized clinical criteria for CTS would be an important step in reducing inconsistencies and misdiagnoses.

2

Znaczenie wsparcia oraz formy aktywności kinezyterapeutycznej członków rodzin osób dotkniętych chorobą Parkinsona

100%

Wróbel A., Wróbel P., Otfinowska E.

Health Promotion & Physical Activity

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2019

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vol. 6

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issue 1

1-7

EN

Parkinson’s disease is a chronic and progressive degenerative disease of the central nervous system. The disorder is classified as extra pyramidal system diseases. In order to improve the patient’s condition and increase the level of quality of life, pharmacological treatment and rehabilitation are used to eliminate progressive disability. The help of the surrounding environment affects not only the course of the disease, but above all the emotional well-being of the patient. Family support and its participation in the whole therapeutic process greatly optimize its results. The aim of this work is to present the most important issues regarding kinesiotherapy in Parkinson’s disease and to demonstrate the impact of the involvement of the whole family system on the course and results of therapy. Kinesiotherapy as an element of treatment plays a very important role in the process of improving and adapting the patient to perform daily nursing activities. Kinesiotherapeutic treatments have not only a significant impact on the symptoms occurring in the course of the disease, but also on the overall health. The individual selection of therapy and the involvement of the entire team of therapists is extremely important in eliminating both movement and extrinsic symptoms. The correct implementation of the physiotherapist’s recommendations, the patient’s involvement, as well as the active participation of the patient’s environment, is a condition for the effectiveness of the entire process of maintaining health and fitness. Kinesiotherapy prevents permanent disability and helps maintain the longest possible independence and good quality of life. The involvement of the entire family support system has an impact on the results of the therapy.

PL

Choroba Parkinsona jest przewlekłą i postępującą chorobą zwyrodnieniową ośrodkowego układu nerwowego. Schorzenie zalicza się do chorób układu pozapiramidowego. W celu poprawy stanu pacjenta oraz podniesienia poziomu jakości życia stosuje się leczenie farmakologiczne oraz rehabilitację, niwelującą postępującą niesprawność. Pomoc najbliższego otoczenia wpływa nie tylko na przebieg choroby, ale przede wszystkim na dobrostan emocjonalny chorego. Wsparcie rodziny i jej udział w całym procesie terapeutycznym w znacznym stopniu optymalizuje jego wyniki. Celem niniejszej pracy jest przedstawienie najważniejszych kwestii dotyczących kinezyterapii w chorobie Parkinsona oraz wykazanie wpływu zaangażowania całego systemu rodzinnego na przebieg i wyniki terapii. Kinezyterapia odgrywa bardzo ważną rolę w procesie usprawniania i przystosowania pacjenta do wykonywania czynności dnia codziennego. Zabiegi kinezyterapeutyczne mają nie tylko istotny wpływ na występujące objawy w przebiegu choroby, ale też na ogólny stan zdrowia. Niezwykle istotny jest tu indywidualny dobór terapii i zaangażowanie całego zespołu specjalistów, w niwelowaniu zarówno objawów ruchowych jak i pozaruchowych. Poprawne wykonywanie zaleceń fizjoterapeuty, zaangażowanie pacjenta, a także aktywny udział otoczenia chorego, jest warunkiem efektywności całego procesu poprawy, utrzymywania zdrowia i sprawności chorego. Postępowanie kinezyterapeutyczne zapobiega trwałej niepełnosprawności oraz wspomaga utrzymanie jak najdłuższej samodzielności i dobrej jakości życia. Wpływ na wyniki terapii ma zaangażowanie całego systemu wsparcia rodzinnego.

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Evaluation of the degree of subjective pain intensification accompanying carpal tunnel syndrome in relation to the intensification of changes confirmed by electroneurographic (ENG) testing

100%

Georgiew F., Maciejczak A., Otfinowska E.

Medical Rehabilitation

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2010

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vol. 14(2)

17-22

PL

Wprowadzenia: Zespól kanału nadgarstka (ZKN) jest coraz częściej rozpoznawaną patologia występującą najczęściej u pacjentów pomiędzy 30-60 rokiem życia. Schorzenie to 2 do 3 razy częściej dotyczy kobiet. Cel: Sprawdzenie czy istnieje zaleSność pomiędzy stopniem nasilenia ZKN ocenianym na podstawie wyniku badania ENG a ich stanem klinicznym ocenianym jako nasilenie dolegliwości subiektywnych i sprawność funkcjonalna. Materiał i metoda: Zbadano 161 chorych (12S kobiet i 33 mężczyzn) leczonych z powodu ZKN w poradni przyszpitalnej i na oddziale neurochirurgicznym. U 49 chorych występujące objaw}' miały charakter obustronny, tak więc łączna ilość wszystkich zbadanych przypadków wyniosła 210. Wiek chorych w chwili badania wynosił od 25 do 81 lat, średnio 55,2 lat. Ciężkość ZKN oceniono przy pomocy badania ENG a nasilenie objawów klinicznych określono jako ilość punktów uzyskaną przy pomocy kwestionariusza Levina (skala nasilenia objawów SSS + skala stanu funkcjonalnego FSS) oraz przy pomocy skali VAS. Wyniki: Pacjenci z ciężkim ZKN uzyskują średnio wyższe wyniki w pełnym kwestionariuszu Levina w porównaniu z grupa chorych z łagodnym ZKN. Przy pomocy skali SSS wskazano istotne statystycznie różnice nasilenia objawów subiektywnych pomiędzy umiarkowanym i ciężkim stopniem ZKN. Badanie nasilenia objawów bólu i/lub zdrętwienia przy pomocy skali VAS wykazało istotne różnice pomiędzy grupami o lekkim i ciężkim oraz grupami o umiarkowanym i ciężkim stopniu ZKN. Wnioski: Wynik uzyskany przy pomocy kwestionariusza według Levina (BQ) oraz wynik samooceny bólu i/lub zdrętwienia przy pomocy skali VAS może odzwierciedlać stopień uszkodzenia nerwu pośrodkowego jedynie w odniesieniu do chorych z ZKN z ciężkimi zaburzeniami w badaniu ENG.

EN

Introduction: Carpal tunnel syndrome (CTS) is an increasingly widespread pathology occurring in patients from the age of 30 to 60. This illness is 2 to 3 times more common in women.Aim of the study: verification of whether there exists a dependence between the degree of CTS intensification evaluated on the basis of ENG testing and the patients’ clinical state evaluated as an intensification of subjective discomfort and functional ability.Materials and methods: 161 patients were tested (128 women and 33 men) who were being treated for CTS at a hospital clinic and a neurosurgical ward. In 49 patients the symptoms were bilateral in nature hence the combined number of all the tested cases was 210. The age of the patients at the moment of testing was from 25 to 81, the average being 55,2. The severity of CTS was evaluated by means of ENG testing while the intensification of the clinical symptoms was defined as the number of points obtained via the Levin questionnaire (the scale of symptoms SSS (Severity Status Scale) + the functional state scale FSS) as well by means of the VAS scale. Results: Patients with severe CTS obtained on average higher results in the full Levin questionnaire when compared to the group of patients with mild CTS. Through the aid of SSS significant statistical differences were shown in the intensification of subjective symptoms between a moderate and severe degree of CTS. The testing of symptom intensification of pain and/or numbness through the help of the VAS scale showed significant differences between the groups with mild and severe degrees of CTS as well as between the groups with moderate and severe.Conclusions: The result obtained through the help of the Levin questionnaire (BQ) as well as the result of self evaluation of pain and/or numbness through the VAS scale can reflect the degree of damage to the median nerve only in relation to CTS patients with severe disturbances in the ENG test.

4

An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome

100%

Georgiew F., Otfinowska E., Adamczyk T.

Medical Rehabilitation

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2009

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vol. 13(2)

17-22

EN

Background: Using popular provocative tests to diagnose the carpal tunnel syndrome (CTS) facilitates referring patients for specialist treatment and is indispensable to the performance of epidemiologic studies. Patients with severe carpal tunnel syndrome (CTS) are frequently referred for surgery, whereas people with mild CTS are commonly referred for conservative therapy. Finding out which provocative tests are most effective in diagnosing mild cases can aid clinicians in making decisions about further treatment.Objectives: The purpose of this study was to evaluate the sensitivity of provocative tests used for diagnosis of CTS such as Phalen’s, Durkan’s and Tinel’s sign and to find out if the time of paresthesia occurrence during the tests depended on the severity of the syndrome assessed using Levine’s Questionnaire.Material and methods: The study involved 130 women and 33 men with carpal tunnel syndrome confirmed by ENG. 52 patients had bilateral symptoms so a total number of cases examined was 215. Subjects were tested using four CTS provocative tests in random order: Phalen’s, Durkan’s, Provocative and Tinel’s sign. The examiner waited 2 – 3 minutes between each provocative test to ensure that any nerve irritation caused by previous test had abated. Severity level of CTS was assessed using Levine’s Questionnaire .Results: Sensitivity values were: for Phalen’s Test – 85.6%, Durkan’s Test – 86.5%, Provocative Test 84.6%, and Tinel’s sign – 46%. Sensitivity values for Phalen’s, Durkan’s and Provocative tests are higher than 93,1% for moderate, severe and extreme CTS. There is a relationship between testing positive on CTS provocative tests and severity of clinical symptoms. As the severity of CTS increases, the average time of paresthesia occurrence in median nerve distribution decreases. Conclusions: (1) Tinel’s sign should not be recommended as a CTS diagnostic tool because of its low sensitivity. (2) If Levine’s Questionnaire reveals small progression of CTS the sensitivity of the tests is insufficient to confirm CTS. (3) In the case of patients with moderate, severe or extreme CTS according to Levine’s Questionnaire, the diagnosis can be confirmed using valid provocative tests such as Phalen’s, Durkan’s and Provocative.

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Diagnostic tests used in diagnosis of carpal tunnel syndrome

Znaczenie wsparcia oraz formy aktywności kinezyterapeutycznej członków rodzin osób dotkniętych chorobą Parkinsona

Evaluation of the degree of subjective pain intensification accompanying carpal tunnel syndrome in relation to the intensification of changes confirmed by electroneurographic (ENG) testing

An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome