Carpal tunnel syndrome: evaluation of its provocative clinical tests

Abstract

Background: The diagnosis of carpal tunnel syndrome (CTS) is established mainly on a clinical basis, and diagnosis is done after careful history taking and examination including known provocative tests with varying efficacy and reliability. Methods: A prospective clinical study of 123 patients with 171 hands presenting with classical symptoms of carpal tunnel syndrome were included in this study, from October 2013 to October 2015, and they underwent open surgical release of flexor retinaculum at the Neurosurgery Department of Benha University Hospital. Results: ART is positive in 88.3%. This is compared to 75, 81.3, 79.7, and 83.6% of positive results in Tinel's test, compression test, Phalen's test, and combined Phalen's and compression test. ART is the most sensitive and specific test and has the highest positive predictive value of 98.3%, negative predictive value of 81.9%, and accuracy of 91.4%. Conclusion: ART is a simple, reliable, and easily performed test for evaluating carpal tunnel syndrome; it is superior to other tests and could be used also to assess improvement after surgery.

Gambaran Risiko Kejadian Carpal Tunnel Syndrome pada Karyawan Administrasi Universitas Kristen Krida Wacana

“…Begitu pula dengan penelitian Setiawan (2019) yang menyatakan adanya hubungan posisi pergelangan tangan dengan risiko kejadian CTS. 11,[16][17][18] Proses pemakaian tetikus dalam keseharian karyawan administrasi mengakibatkan tangan menggenggam tetikus terus-menerus dan menggerakkannya ke kanan dan kiri atau tidak lurus (netral). Dalam keadaan di luar netral/ janggal akan terjadi penekanan atau penegangan pada saraf di pergelangan tangan sehingga terjadi CTS.…”

Estimation of Median Nerve Axonal Degeneration without Needle Electromyography

“…The only way to differentiate the two is to stimulate the median nerve in the palm and compare its amplitude with the wrist stimulation. If the amplitude ratio of the palm to the wrist is greater than 1.6 for sensory and more than 1.2 for the motor, it will be a sign of conduction block [6,7]. However, the needle EMG is often helpful in further characterizing the neuropathic insult in CTS, especially when the CMAP amplitude is reduced because this condition can be a consequence of either distal demyelination or axonal degeneration.…”