Provocative tests used in the diagnosis of carpal tunnel syndrome
Journal Title: Rehabilitacja Medyczna - Year 2007, Vol 11, Issue 4
Abstract
The carpal tunnel syndrome (CTS) is the most often diagnosed compressive neuropathy of the upper limb. As a result of the changes within the tunnel of the median nerve, the disease is associated with hypersensitivity to some external factors such as: an increase in pressure within the carpal tunnel, direct or indirect pressure on the wrist level, hypoxia. These factors are used in provocative tests. The aim of this article is to make a distinction between functional test’s classifications used in the CTS diagnosis, depending on the method of ailment provocation. Different modifications used in common tests and their average sensitivity and specificity are also presented. Carpal tunnel syndrome should be diagnosed clinically; although electro-diagnostic studies are a standard method of establishing the diagnosis, they do have limitations. Clinical diagnostic skill must be reinforced by a valuable provocative test: the Provocative Test, the Phalen test + mCCT, Tinel’s sign, Phalen’s and reverse Phalen’s test, Durkan Carpal Compression Test (mCCT). There are also tests, which, due to their low sensitivity and specificity, be not applied in the CTS diagnostics. Provocative tests are more easily performed than electro-diagnostic studies and are the most appropriate diagnostic tools in the ambulatory setting. Provocative tests are commonly needed for establishing the diagnosis for treatment, screening and determining aetiology. To improve the efficiency of provocative tests, we should apply univocal standards for their performance and interpretation. A combination of tests might be more powerful than a single test in establishing the diagnosis. Taking medical history and performing physical examination should be the primary methods of diagnosing CTS. The combination of hand diagram, questionnaires, abnormal sensibility and positive provocative tests will provide a diagnostic tool for CTS with high sensitivity and specificity. The addition of nerve conduction studies is unnecessary in most cases.
Authors and Affiliations
Filip Georgiew
Keywords
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