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Academia Mexicana de Neurología, A.C.

2011, Number 3

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Rev Mex Neuroci 2011; 12 (3)

Clinical prediction rule for diagnosis of the carpal tunnel syndrome

Chiquete E, Miranda-Muñoz A, Castañeda-Moreno V, Vargas-Sánchez Á, García-Llamas L, Ochoa-Guzmán A, Rábago-Cervantes R, Zúñiga-Ramírez C, González-Jaime J, Ruiz-Sandoval JL

Language: Spanish
References: 25
Page: 121-127
PDF size: 259.04 Kb.


ABSTRACT

Introduction: The carpal tunnel syndrome (CTS) is the most frequent compression neuropathy of the upper limbs. This condition may pose difficulties in diagnosis, given the subjectivity of most of their clinical manifestations. Aim: To design a clinical prediction rule that can improve the performance of physical examination in identifying cases with CTS. Methods: A case-control study was performed on patients who were referred to electrodiagnostic testing (here the gold standard) for suspicion of CTS. Bivariate analyses were performed on clinical manifestations and antecedents to select those with the best diagnostic performance and to integrate a clinical prediction rule. Results: A total of 72 patients were analyzed: 40 cases with confirmed CTS (90% women, mean age 50.2 years) and 32 controls with negative electrophysiological tests (84% women, mean age 40.6 years). Hand paresthesias (97 vs. 77%, p = 0.01), positive Phalen’s test (67 vs. 27%, p = 0.001), positive Tinel sign (72 vs. 33%, p = 0.002) and age ≥ 50 (65 vs. 34%, p = 0.01) were more common among CTS cases than in controls. Thus, the presence of ≥ 2 of these characteristics had a sensitivity of 97% (95% CI: 86-100%), specificity of 50% (95% CI: 33-67%), positive predictive value of 70% (95% CI: 56-81%), negative predictive value of 94% (95% CI: 71-100%), and accuracy of 74% (95% CI: 61-86%). Conclusion: Age › 50 years, hand paresthesias, positive Phalen’s test, and positive Tinel sign are variables strongly associated with CTS. The presence of ≥ 2 clinical characteristics has adequate performance in identifying suspicious cases, and their absence correctly exclude false positives.


REFERENCES

  1. Klauser AS, Faschingbauer R, Bauer T, Wick MC, Gabl M, Arora R, et al. Entrapment neuropathies II: carpal tunnel syndrome. Semin Musculoskelet Radiol 2010; 14: 487-500.

  2. Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg 2010; 126: 2196-204.

  3. Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology 2009; 72: 33-41.

  4. Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State. Am J Ind Med 2007; 50: 155-72.

  5. Bekkelund SI, Pierre-Jerome C, Torbergsen T, Ingebrigtsen T. Impact of occupational variables in carpal tunnel syndrome. Acta Neurol Scand 2001; 103: 193-7.

  6. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58: 1589-92.

  7. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002; 25: 918-22.

  8. Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil 2005; 86: 609-18.

  9. Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol 2006; 186: 1240-5. Erratum in: AJR Am J Roentgenol 2006; 187: 266.

  10. Nordstrom DL, Vierkant RA, DeStefano F, Layde PM. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med 1997; 54: 734-40.

  11. Amo C, Fernández-Gil S, Pérez-Fernández S, Amo-Merino P, Amo- Usanos I, Franco C, et al. Síndrome del túnel del carpo. Correlación clínica y neurofisiológica: revisión de 100 casos. Rev Neurol 1998; 27: 490-3.

  12. Gorsche RG, Wiley JP, Renger RF, Brant RF, Gemer TY, Sasyniuk TM. Prevalence and incidence of carpal tunnel syndrome in a meat packing plant. Occup Environ Med 1999; 56: 417-22.

  13. Madrazo J, Marín I, Bringas A, Fernández A. Eficacia del examen neurofisiológico en el diagnóstico del síndrome del túnel del carpo. Rev Neurol 2000; 30: 1005-8.

  14. de Pablos C, Velasco-Zarzosa M, Landeras-Alvaro R, Rubio-Lorenzo M, Martínez-Zubieta P. Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica. Rev Neurol 2007; 45: 210-5.

  15. Armstrong T, Dale AM, Franzblau A, Evanoff BA. Risk factors for carpal tunnel syndrome and median neuropathy in a working population. J Occup Environ Med 2008; 50: 1355-64.

  16. Arrotegui I. Liberación del túnel carpiano: evitar complicaciones. Rev Neurol 2009; 49: 559-60.

  17. Saeed MA, Irshad M. Seasonal variation and demographical characteristics of carpal tunnel syndrome in a Pakistani population. J Coll Physicians Surg Pak 2010; 20: 798-801.

  18. Roh YH, Chung MS, Baek GH, Lee YH, Rhee SH, Gong HS. Incidence of clinically diagnosed and surgically treated carpal tunnel syndrome in Korea. J Hand Surg Am 2010; 35: 1410-7.

  19. Descatha A, Dale AM, Franzblau A, Coomes J, Evanoff B. Comparison of research case definitions for carpal tunnel syndrome. Scand J Work Environ Health 2011. [Epub ahead of print].

  20. Dale AM, Descatha A, Coomes J, Franzblau A, Evanoff B. Physical examination has a low yield in screening for carpal tunnel syndrome. Am J Ind Med 2011; 54: 1-9.

  21. Shepherd MM. Clinical outcomes of electrodiagnostic testing conducted in primary care. J Am Board Fam Med 2010; 23: 584-90.

  22. Grundberg AB. Carpal tunnel decompression in spite of normal electromyography. J Hand Surg Am 1983; 8: 348-9.

  23. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology (Oxford) 2004; 43: 887-95.

  24. Akcar N, Ozkan S, Mehmetoglu O, Calisir C, Adapinar B. Value of power Doppler and gray-scale US in the diagnosis of carpal tunnel syndrome: contribution of cross-sectional area just before the tunnel inlet as compared with the cross-sectional area at the tunnel. Korean J Radiol 2010; 11: 632-9.

  25. Kaymak B, Ozçakar L, Cetin A, Candan Cetin M, Akinci A, Hasçelik Z. A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil 2008; 89: 743-8.




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