Sensitivity and specificity of clinical testing for carpal tunnel syndrome

Wiesman, Irvin M.; Novak, Christine B.; Mackinnon, Susan E.; Winograd, Jonathan M.

doi:10.1177/229255030301100205

Cited by 33 publications

(26 citation statements)

References 31 publications

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“…All of the clinical tests in this study had positive predictive values greater than 95%, which is high compared with previously reported values of 79% to 91%. 21 These values would be expected to be lower in a population with lower disease prevalence, such as patients who might present to a general practitioner's office for evaluation.…”

Section: Discussionmentioning

confidence: 99%

Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Cheng

Patterson

Beck

et al. 2008

The Journal of Hand Surgery

165

134

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Section: Discussionmentioning

confidence: 99%

Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Cheng

Patterson

Beck

et al. 2008

The Journal of Hand Surgery

165

134

View full text Add to dashboard Cite

“…8,10,17,19,31,41,43,48,50,54,55,57,67,73,76,77 At different stages of nerve compression, different clinical tests are most useful in detecting and quantifying the severity of nerve compression. In the early stages of FIGURE 2.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…53,54 Since that time, many provocative tests have been described in the evaluation of carpal tunnel syndrome. 8,10,15,17,19,25,43,48,50,68,76,77 (Refer to MacDermid's paper in this issue for a complete discussion.) This concept of increasing tension or pressure on the nerve to identify sites of nerve compression can be extrapolated to the other sites of entrapment in the upper extremity (Table).…”

Section: Clinical Evaluationmentioning

confidence: 99%

Upper Extremity Work-Related Musculoskeletal Disorders: A Treatment Perspective

Novak¹

2004

J Orthop Sports Phys Ther

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Numerous terms, including repetitive-stress injuries and cumulative-trauma disorders, have been used to describe what is now commonly termed work-related musculoskeletal disorders. The etiology of work-related musculoskeletal disorders is multifactorial and includes physical, individual, and psychosocial factors that contribute to the presenting symptoms. Prolonged positioning away from the ideal posture will affect neural and other soft tissues in the upper extremity. Abnormal postures and positions may result in chronic nerve compression or may shorten muscles and, if the muscle crosses over a nerve, compression may occur. These postures may also contribute to muscle imbalance. A thorough clinical evaluation is necessary to identify all sites of nerve compression, muscle imbalance, and factors affecting patient symptoms so that appropriate intervention can be instituted. Management must include patient education, postural correction, and a specific physical therapy program to address the multiple levels of nerve compression and cervicoscapular muscle imbalance. In addition to physical therapy intervention, behavioral modification at home and at work may be necessary for successful management. J Orthop Sports Phys Ther 2004;34:628-637.

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“…These symptoms are exacerbated in the extreme wrist flexion position (i.e. Phalen’s maneuver), which is commonly used as a provocative test for diagnostic purposes [1,2]. The median nerve supplies sensory input to the palmar side of the thumb, index finger, middle finger, and the radial half of the ring finger.…”

Section: Introductionmentioning

confidence: 99%

Effects of Carpal Tunnel Syndrome on Force Coordination and Muscle Coherence during Precision Pinch

Xiu

et al. 2017

J. Med. Biol. Eng.

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Carpal tunnel syndrome (CTS), caused by entrapment of the median nerve in the carpal tunnel, impairs hand function including dexterous manipulation. The purpose of this study was to investigate the effects of CTS on force coordination and muscle coherence during low-intensity sustained precision pinch while the wrist assumed different postures. Twenty subjects (10 CTS patients and 10 asymptomatic controls) participated in this study. An instrumented pinch device was used to measure the thumb and index finger forces while simultaneously collecting surface electromyographic activities of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Subjects performed a sustained precision pinch at 10% maximum pinch force for 15 sec with the wrist stabilized at 30° extension, neutral, or 30° flexion using customized splints. The force discrepancy and the force coordination angle between the thumb and index finger forces were calculated, as well as the β-band (15-30 Hz) coherence between APB and FDI. The index finger applied greater force than the thumb (p < 0.05); this force discrepancy was increased with wrist flexion (p < 0.05), but was not affected by CTS (p > 0.05). The directional force coordination was not significantly affected by wrist posture or CTS (p > 0.05). In general, digit force coordination during precision pinch seems to be sensitive to wrist flexion, but is not affected by CTS. The β-band muscular coherence was increased by wrist flexion for CTS patients (p < 0.05), which could be a compensatory mechanism for the flexion-induced exacerbation of CTS symptoms. This study demonstrates that wrist flexion negatively influences muscle and force coordination in CTS patients supporting the avoidance of flexion posture for symptom exacerbation and functional performance.

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Sensitivity and specificity of clinical testing for carpal tunnel syndrome

Abstract: No one test possesses all the qualities necessary to be the ideal clinical test for the detection of carpal tunnel syndrome.

Cited by 33 publications

References 31 publications

Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Upper Extremity Work-Related Musculoskeletal Disorders: A Treatment Perspective

Effects of Carpal Tunnel Syndrome on Force Coordination and Muscle Coherence during Precision Pinch

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