An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome
Journal Title: Rehabilitacja Medyczna - Year 2009, Vol 13, Issue 2
Abstract
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.
Authors and Affiliations
Filip Georgiew, Ewa Otfinowska, Tomasz Adamczyk
Keywords
Related Articles
- EP ID EP82038
- DOI -
- Views 75
- Downloads 0
Principle of operation and use of accelerometry in assessing the musculoskeletal system – a narrative review
Accelerometry is a relatively new but promising method of gait examination. It is based on the usage of sensors which measure linear acceleration at a certain material point. The purpose of this article is to review the...
The impact of relaxation on chronic pain intensity and the functional state
Introduction: The objective of this study was to demonstrate the dependence between relaxation as a part of multidisciplinary pain treatment, pain intensity and a patient’s functional state.Material and methods: The stud...
Physical training during haemodialysis: a review of subject literature
Background: Individuals chronically haemodialysized have a reduced physical ability. For around 30 years attempts have been undertaken at motor rehabilitation of this population.Aim: The aim of the work is an analysis o...
Od Redakcji
Ukształtowanie stóp kobiet po 60 roku życia
Założenia: U osób w podeszłym wieku przyspieszeniu zmian inwolucyjnych w obrębie stóp sprzyja niedostateczna ilość ruchu wynikająca z braku zainteresowania aktywnością ruchową, częstych dolegliwości bólowych, spadku kond...