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| The
Value of Diagnostic Testing in Carpal Tunnel Syndrome |
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| Robert M.
Szabo, MD, Robert R. Slater, Jr, MD, Thomas B. Farver, PhD, Donna
Breger Stanton, MA, Wahilda K. Sharman, BS, Sacramento, CA |
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| The purpose of
this study was to determine the validity of tests or a combination
of tests for the diagnosis of carpal tunnel syndrome. Three groups
of 50 subjects each were studied: group 1 had definite carpal tunnel
syndrome as defined by history, clinical presentation a, and
improvement of symptoms following carpal tunnel release; group 2 had
a variety of nontraumatic upper extremity disorders other than
carpal tunnel syndrome; and group 3 subjects were asymptomatic
healthy volunteers. |
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| Subjects
submitted a self-administered hand diagram, and were queried about
night pain, symptom duration and coexistant medical conditions.
Phalen’s test, Tinel’s sign, Durkan’s compression test and
Semmes-Weintein monofilament testing both before and after a Phalen’s
maneuver for 5 minutes were performed on each subject. Grip and
pinch strengths were measured. Univarate analysis of groups 1 and 2
showed that the tests with the highest sensitivity were Durkan’s
compression test (89%), Semmes-Weinstein testing after Phalen’s
maneuver (83%) and hand diagram scores (76%). Night pain was a
sensitive symptom predictor (96%). |
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| The most
specific tests were the hand diagram (76%) and Tinel’s sign (71%).
Analysis of groups 1 and 3 without group 2 increased the specificity
and predictive value of a positive test. A regression model was used
to develop a multivariate equation with 4 variables. If a patient
has an abnormal hand diagram, abnormal sensibility by
Semmes-Weinstein testing in wrist-neutral position, a positive
Durkan test, and night pain, the probability that carpal tunnel
syndrome will be correctly diagnosed is 0.86. If all 4 of these
conditions are normal, the probability that the patient has carpal
tunnel syndrome is 0.0068. We found that the addition of
electrodiagnostic tests did not increase the diagnostic power of the
combination of 4 clinical tests. |
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| Journal of
Hand Surgery 1999; 24A: 704-714 |
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