PHYSICAL TESTS FOR CTS: A REVIEW

-
Sharma KR (2001) studying on Median sensory nerve conduction velocity: found digit 1 to wrist is more sensitive than the median sensory nerve conduction velocity distoproximal ratio in the diagnosis of mild CTS. However, Electrodiagnostic studies have significant false-positive and false-negative rates in CTS, and therefore provocative tests remain important in its diagnosis. Tinel's (nerve-percussion test), Phalen's(wrist-flexion test,), Reverse Phalen's and carpal tunnel compression tests (tourniquet test) are more sensitive and very commonly employed for physical diagnosis of CTS. In a study consisting of 50 control subjects with electrodiagnostically proved carpal-tunnel syndrome found following:
The sensitivity and specificity of each test of the above were calculated. The wrist-flexion test was found to be the most sensitive while the nerve-percussion test, although least sensitive, was most specific. The tourniquet test was quite insensitive and not very specific, and should not be used as a routine screening test in the diagnosis of carpal tunnel syndrome.
NEWER TESTS:
DURKAN test of carpal tunnel compression is already mentioned above.
1. DURKAN JA (1991) suggested a new test, called the carpal compression test, consists of application of direct pressure on the carpal tunnel and the underlying median nerve. The results of the Tinel percussion test, the Phalen wrist-flexion test, and the new test were evaluated in thirty-one patients (forty-six hands) in whom the presence of carpal tunnel syndrome had been proved electrodiagnostically, as well as in a control group of fifty subjects.
DURKAN found, the carpal compression test was found to be more sensitive and specific than the Tinel and Phalen tests.
2. According to AHN DS (2001) Hand elevation can reproduce the symptoms of carpal tunnel syndrome. This phenomenon prompted the idea of developing a simple hand elevation test to diagnose carpal tunnel syndrome. AHN DS found the sensitivity and specificity of the elevation test were higher than those of Phalen's test and Tinel's test.

Sensitivity of a combined test:
In a study by TETRO AM et al (1998) to establish the value of median nerve compression with wrist flexion as a provocative test for carpal tunnel syndrome (CTS), they recorded results for the common provocative tests (Tinel's percussion test, Phalen's wrist flexion test and the carpal compression test) and the new test which combines wrist flexion with median nerve compression.
TETRO AM et al found that the optimal cut-off time for the wrist-flexion and median-nerve compression test was 20 s, giving a sensitivity of 82% and a specificity of 99%. They have also shown that wrist flexion combined with the median-nerve compression test at 20 s, is significantly better than the other methods, and may thus be clinically useful.
Possibility of a double crush:
Physios do not ever forget to test at least a transverse glide or CPA to Lower Cervical spine to rule out possibility of a double crush in all cases of suspected CTS.

Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an...
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro...
Read more

Chronic fatigue syndrome

-
Introduction: Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as: (1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue. The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activat...
Read more