The role of electrophysiological examination in the diagnosis of carpal tunnel syndrome: Analysis of 2516 patients (original) (raw)
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Examination of patients for carpal tunnel syndrome
Hand Clinics, 2002
Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome diagnosed and affects 0.1% to 0.5% of the general population [1,2]. While a careful history may never establish the cause of the patient's CTS, the history in combination with the physical examination in most cases at least leads to the correct diagnosis. In fact, in many hand surgery practices, a careful history and examination consistent with CTS is all that is needed to confirm the diagnosis. Even though CTS remains a clinical diagnosis, electrodiagnostic testing has replaced a careful physical exam in many practices. Some authors, observing that neurophysiological exams afford the only objective test of median nerve function, have concluded that CTS should be diagnosed solely on the basis of electrodiagnostic examinations [3,4]. A group of 12 medical researchers experienced in conducting epidemiologic studies on CTS could not reach consensus regarding diagnosis of subjects with classic symptoms of CTS with negative electrodiagnostic findings [5]. Also agreed on by consensus, a positive electrodiagnostic test with absent symptoms clearly cannot lead to the diagnosis of carpal tunnel syndrome [5]. Clinical history and physical examination including provocative tests are more easily performed than electrodiagnostic studies, and they are the most appropriate diagnostic tools in the ambulatory setting [6]. A self-administered hand diagram has also proven quite useful in evaluating patients for CTS [7].
Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome
Vojnosanitetski pregled, 2014
Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS). The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ? 14 years and 52 ? 16 years, respectively). All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95). Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS...
A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome
The British journal of general practice : the journal of the Royal College of General Practitioners, 2002
Carpal tunnel syndrome (CTS) comprises a complex of symptoms in the hand, including pain and paresthesia and weakness of hand muscles thought to result from compression of the median nerve. Many clinicians either refer patients for electrodiagnostic studies to aid diagnosis or conduct electrodiagnostic studies, which may be useful as an aid to decisions on treatment. The aim of this systematic review is to evaluate the evidence base for the use of electrodiagnostic tests in the diagnosis and management of carpal tunnel syndrome. A systematic search was undertaken for studies that included patients with clinical diagnosis of CT5 who were undergoing electrodiagnostic tests and surgery together with reported outcomes of surgery. A published systematic review found that electrodiagnosis was not a useful diagnostic test in patients with clinical signs of CTS. Seven primary studies of prognosis reporting electrodiagnosis and surgery outcomes were found, however, one of them was subsequent...
Journal of Dhaka Medical College, 2021
Introduction: Carpal tunnel syndrome (CTS) is a clinical syndrome that results from compression of median nerve within the carpal tunnel at the wrist. The aim of this study was to review the clinical and demographic characteristics and electrophysiological patterns of CTS patients who presented to a tertiary care hospital in Bangladesh. Methodology; A descriptive cross-sectional study was conducted on 150 CTS patients at the neurology department, Dhaka Medical College Hospital between January, 2019 to March , 2020 . All the subjects had clinical evaluation and standardized nerve conduction studies of upper limbs (300 limbs) using the same protocol. Results: 228 hands were found to have clinical and electrophysiological features consistent with CTS. There was female predominance (90%) and the highest occurrence of CTS was in the 45-55 years age group. Bilateral CTS was found in the majority of cases ie 78 (52%) and the rest had unilateral CTS. Among those with unilateral CTS, right h...
Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome
Clinical neurology and neurosurgery, 2004
To describe the clinical features of patients with a neurophysiologic diagnosis of carpal tunnel syndrome (CTS) in the state of Rio Grande do Sul, Brazil. We prospectively studied 1039 patients with a neurophysiologic diagnosis of CTS in southern Brazil. All patients completed a clinicoepidemiological questionnaire which included a drawing of the arm and hand, in which they were asked to paint the areas in which paresthesia and pain occurred. In part of the sample, we also investigated the presence of clinical signs such as Tinel's, Phalen, and tenar atrophy. The diagnosis of CTS was performed using a predetermined neurophysiological protocol. A total of 1528 hands were diagnosed with CTS. The severity of CTS was mild in 42% of cases, moderate in 18% and severe in 40%. Patients had a mean age of 48.3 +/- 12.4 years old, and a ratio of 5.6 females to 1 male was observed. Symptoms restricted to the hand and wrist was observed in 51.8% of cases with paresthesia and in 18.5% of case...
Clinical diagnosis of carpal tunnel syndrome: Old tests–new concepts
Joint Bone Spine, 2008
The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. Earlier data concluding that the higher prevalence of persons with symptoms suggestive of CTS but without evidence of median mononeuropathy highlights the need for a better understanding of the underlying pathophysiology and natural history of CTS to provide a less empirical foundation for diagnosis and clinical management.To examine the relationship between the clinical manifestations of CTS with the outcome of the diagnostic tools (nerve conduction tests and ultrasonography), and its implication for clinical practice.Two-hundred and thirty-two patients (69 male and 163 female, ages ranging between 20 and 91 years) with CTS manifestations and 182 controls were included in this study. Diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. All patients and controls completed a patient oriented questionnaire, were subjected to clinical testing for provocative tests for carpal tunnel syndrome (Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests), blood check for secondary causes of carpal tunnel syndrome, nerve conduction testing as well ultrasonographic assessment of the carpal tunnel and median nerve.One-hundred and seventy-seven out of 232 (76.3%) had abnormal nerve conduction studies. Forearm symptoms and tenosynovitis confirmed by US examination were found in 51.3% of cases. No significant difference was found on comparing anthropometric measures in the affected hands to the control group hands. A higher prevalence of positive Phalen's and CT compression were found in patients suffering from tenosynovitis regardless of their nerve conduction study results. Sensitivity of Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests was higher for the diagnosis of tenosynovitis than for the diagnosis of CTS (Tinel, 46% vs. 30%; Phalen's, 92% vs. 47%; Reverse Phalen's, 75% vs. 42%; carpal tunnel compression test, 95% vs. 46%). Similarly, higher specificity of these tests was found with tenosynovitis than CTS.The results of this study revealed that Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests are more sensitive, as well as being specific tests for the diagnosis of tenosynovitis of the flexor muscles of the hand, rather than being specific tests for carpal tunnel syndrome and can be used as an indicator for medical management of the condition.
Electrodiagnostic evaluation of carpal tunnel syndrome
Muscle & Nerve, 2011
Carpal tunnel syndrome (CTS) is the most common nerve entrapment. Electrodiagnostic (EDX) studies are a valid and reliable means of confirming the diagnosis. This monograph addresses the various EDX techniques used to evaluate the median nerve at the wrist. It also demonstrates the limitations of EDX studies with a focus on the sensitivity and specificity of EDX testing for CTS. The need to use reference values for populations such as diabetics and active workers, where normative values differ from conventional cutoffs used to confirm suspected CTS, is presented. The value of needle electromyography (EMG) is examined. 44: 597-607, 2011 Carpal tunnel syndrome (CTS) is a clinical syn-Abbreviations: AANEM, American Association of Neuromuscular and Electrodiagnostic Medicine; AAOS, American Academy of Orthopedic Surgeons; APB, abductor pollicis brevis; CMAP, compound muscle action potential; CSI, combined summary index; CTS, carpal tunnel syndrome; EDX, electrodiagnostic; EMG, electromyography; inching, median sensory short segment stimulation across the wrist; MGA, Martin-Gruber anastomosis; MMW, median mononeuropathy at the wrist; NAP, nerve action potential; NCS, nerve conduction studies; palmdiff, median-ulnar mixed nerve palm latency difference from palm to wrist; ringdiff, median-ulnar sensory latency difference to the ring finger; SNAP, sensory nerve action potential; thumbdiff, median-radial latency difference to the thumb
Journal of the American Academy of Orthopaedic Surgeons, 2019
Introduction: The purpose of this study was to assess whether median nerve ultrasonography (US) measurements correlate with the severity scale of electrodiagnostic studies (EDS) of carpal tunnel syndrome (CTS). Methods: A retrospective review was conducted of patients aged $18 years who underwent both median nerve US and EDS. US measurements of the median nerve cross-sectional area at the distal wrist crease and forearm were used to calculate the median nerve wrist-to-forearm ratio. EDS severity was classified according to guidelines from the American Association of Electrodiagnostic Medicine. Results: A total of 112 wrists (n = 112) in 78 consecutive patients with a mean age of 59 (range, 26 to 88) years were included. Increased cross-sectional area at the distal wrist crease and wrist-toforearm ratio were significantly correlated with increased EDS severity (P , 0.0001). Discussion: Median nerve US measurements not only distinguished between normal and abnormal EDS but also correlated with the category of EDS severity. Level of Evidence: Diagnostic III C arpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity with an estimated prevalence of 7.8% in working populations in the United States. 1,2 It is estimated that over 500,000 carpal tunnel releases are performed each year in the United States. 3 No consensus on confirmatory testing for the diagnosis of CTS exists. 4-6 Electrodiagnostic studies (EDSs) are commonly used and have a high degree of sensitivity and specificity to confirm the diagnosis of CTS. 7 However, electrodiagnostic procedures are often associated with discomfort at the time of the procedure. 8 Recent interest has developed in ultrasonography (US) as a less invasive method to confirm CTS. 9 Several studies have refined ultrasonographic criteria for the diagnosis of CTS and have confirmed that an increased cross-sectional area of the median nerve at the distal wrist crease (wCSA) correlates with the electrodiagnostic diagnosis of CTS. 9-16 Controversy exists in the published literature regarding how US measurements of the median nerve correlate with the electrodiagnostic graded severity of CTS. 9,11,13-15,17-22