AI Article Synopsis
- A meta-analysis was conducted to evaluate the diagnostic validity (sensitivity and specificity) of various physical examination maneuvers for diagnosing carpal tunnel syndrome (CTS), utilizing the PRISMA checklist for methodology.
- The study included 67 articles assessing multiple tests, including Phalen's test (most sensitive), Tinel's sign, and others, analyzing data from a total of 8,924 hands.
- Findings highlighted that while Phalen's test had the highest sensitivity, the static 2-point discrimination test exhibited the best specificity, indicating the need for a combination of tests and patient history for accurate CTS diagnosis due to variability in test effectiveness.
Article Abstract
Our purpose was to assess the diagnostic validity (sensitivity (Sn) and specificity (Sp)) of physical examination maneuvers for carpal tunnel syndrome (CTS). This meta-analysis utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Studies assessing exam maneuvers (including components of the CTS-6) for CTS were identified in MEDLINE (Medical Literature Analysis and Retrieval System Online) and Embase (Excerpta Medica Database) databases. Assessed maneuvers assessed included: Phalen's test, Tinel's sign, Durkan test, scratch-collapse test, Semmes-Weinstein monofilament (SWM), and static 2-point discrimination (2PD) test. Data extracted included: article name, total number of subjects/hands, type of exam, and exam Sn/Sp. Forest plots were presented to display the estimated Sn/Sp and boxplots were used to demonstrate the locality, spread, and skewness of the Sn/Sp through the quartiles. After screening 570 articles, 67 articles involving 8924 hands were included. Forty-eight articles assessed Phalen's test, 45 assessed Tinel's sign, 21 assessed the Durkan test, seven assessed the scratch-collapse test, 11 assessed SWM, and six assessed the static 2PD test. Phalen's test demonstrated the greatest median Sn (0.70, (Q1, Q3): (0.51, 0.85)), followed by the Durkan test (0.67, (Q1, Q3): (0.46, 0.82)). 2PD demonstrated the highest median Sp (0.90, (Q1, Q3): (0.88, 0.90)), followed by SWM (0.85, (Q1, Q3): (0.51, 0.89)). There is considerable variability with respect to the validity of physical exam tests used in the diagnosis of CTS. Upper-extremity surgeons should be aware of inherent limitations for individual exam maneuvers. In the absence of a uniformly accepted diagnostic gold standard, a combination of exams, along with pertinent patient history, should guide the diagnosis of CTS.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10446104 | PMC |
| http://dx.doi.org/10.7759/cureus.42383 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Correlating symptom severity index, clinical diagnostic criteria of CTS-6 and timed Phalen's test in clinical evaluation of carpal tunnel syndrome.
J Family Med Prim Care
November 2024
Department of Physiology, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India.
Background: Carpal Tunnel Syndrome (CTS) poses significant diagnostic challenges, especially in resource-limited settings. Reliable tools such as the 6-item Symptom Severity Index, Timed Phalen's Test (TPT) and CTS-6 are promising but under investigated. Correlation between these tools and symptom severity remains underexplored.
View Article and Find Full Text PDFArticle Synopsis
- Contraceptive implant migration, particularly to the ulnar nerve, is a rare but significant complication that requires careful diagnostic and imaging techniques during insertion and removal procedures.
- A case study of a 32-year-old woman revealed that her Implanon was found embedded within the ulnar nerve, highlighting the need for diligent removal methods to prevent nerve damage.
- It's important for patients experiencing pain or complications from implants to be referred to experienced family planning specialists and peripheral nerve surgeons to ensure the best possible care.
Variation in Interpretation of Provocative Tests for Carpal Tunnel Syndrome.
J Hand Surg Am
August 2024
Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX.
Purpose: We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy.
Methods: We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand).
Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and, less often, weakness in the distribution of the median nerve. Provocative maneuvers, such as the Phalen test and Tinel sign, have varying sensitivity and specificity for the diagnosis of CTS.
View Article and Find Full Text PDFThe forearm elevation-compression test: a novel test for carpal tunnel syndrome.
QJM
November 2024
Department of Biostatistics, University of Alabama at Birmingham School of Public Health, 1667 University Blvd, Birmingham, AL 35294.
Background: As the time available to spend with patients decreases, a rapid test for bedside diagnosis of carpal tunnel syndrome (CTS) could be useful.
Design And Methods: We describe the forearm elevation-compression test (FECT) in this context. The FECT was assessed in 40 patients with clinically suspected CTS and compared to Tinel's and Phalen's signs.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!