Provocation tests in doppler ultrasonography for carpal tunnel syndrome

2012 ◽  
Vol 47 (1) ◽  
pp. 116-117 ◽  
Author(s):  
Esther S. NG ◽  
Kay W. NG ◽  
Einar P. Wilder-Smith
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Doppler Ultrasonography ◽  
Provocation Tests ◽  
Tunnel Syndrome

scholarly journals Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities

2015 ◽  
Vol 06 (04) ◽  
pp. 504-510 ◽  
Author(s):  
Gaurav M. Kasundra ◽  
Isha Sood ◽  
Amita N. Bhargava ◽  
Bharat Bhushan ◽  
Kirti Rana ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
High Specificity ◽  
Clinical Tests ◽  
Cross Sectional ◽  
Provocation Tests ◽  
Tunnel Syndrome ◽  
Low Sensitivity ◽  
And Function

ABSTRACT Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but not adequately studied in India. Objectives: To study clinical tests, nerve conduction studies (NCS), ultrasonography (USG), and magnetic resonance imaging (MRI) in diagnosing CTS. Materials and Methods: We diagnosed CTS in 54 patients (93 hands) out of 60 screened patients with symptoms compatible with CTS, including 19 control patients (23 hands). We conducted provocative tests and calculated Boston Carpal tunnel Questionnaire (BCTQ) symptom (S) and function (F) scores. NCS positive patients were classified into mild, mild-to-moderate, moderate, severe, and all-CTS groups. Median nerve anteroposterior, transverse, circumference (CIR), and cross-sectional area (CSA) at inlet (I), middle (M), and outlet (O) each was measured by USG in all patients. MRI was done in 26 patients (39 hands). Results: Phalen, hand elevation and pressure provocation tests had higher sensitivity, Tinel's test had higher specificity and tethered median nerve and tourniquet tests had low sensitivity and moderate specificity. USG had low sensitivity but high specificity, and MRI had moderate sensitivity. USG in patients compared to controls was significantly abnormal in CSA-I, CIR-I, and CSA-O. Significant correlation was found between BCTQ-S and NCS and BCTQ-S and CIR-O. CIR-M, CIR-O, CSA-M, and CSA-I had correlation with NCS. MRI was significant in moderate and in moderate + severe groups combined and associated pathologies were detected in 59% patients. Conclusion: NCS remain gold standard but USG and MRI help increase sensitivity and detect mass lesions amenable to surgery.

A NEW DIAGNOSTIC PROVOCATION TEST FOR CARPAL TUNNEL SYNDROME: OKUTSU TEST

Hand Surgery ◽  
2010 ◽  
Vol 15 (02) ◽  
pp. 65-69 ◽  
Author(s):  
A. Yoshida ◽  
I. Okutsu ◽  
I. Hamanaka
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Success Rate ◽  
Carpal Tunnel ◽  
Wrist Joint ◽  
Provocation Test ◽  
Joint Movement ◽  
Wrist Extension ◽  
Provocation Tests ◽  
Positive Rate ◽  
Tunnel Syndrome

Many authors have reported various clinical provocation tests for diagnosis of carpal tunnel syndrome, however, some tests cannot be administered correctly on patients who suffer from restricted wrist joint movement. We compiled positive rates from a new diagnostic provocation test (Okutsu test) carried out on 3474 hands, and compared them and their success rates with results from other provocation tests performed on these same hands. The Okutsu test positive rate was 72.4%. There were statistical differences between Phalen test (69.8%) and wrist-extension test (60.2%) results. The Okutsu test success rate was 99.9% and there were statistical differences between Phalen test (52.8%) and wrist-extension test (56.8%) results. There were no statistical differences between percussion test at the wrist results in positive rate (71.1%) and in success rate (99.7%). The Okutsu test positive rate is high and it serves as a reliable screening test for clinical diagnosis of carpal tunnel syndrome.

Double Crush Syndrome Related to the Thoracic Outlet Syndrome

Hand Surgery ◽  
1997 ◽  
Vol 02 (02) ◽  
pp. 131-133 ◽  
Author(s):  
Jun Nishida ◽  
Katsuaki Ichinohe ◽  
Tadashi Shimamura ◽  
Masataka Abe
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Thoracic Outlet Syndrome ◽  
Cubital Tunnel Syndrome ◽  
Entrapment Neuropathy ◽  
Cubital Tunnel ◽  
Provocation Tests ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Ulnar Tunnel

Cases diagnosed as having thoracic outlet syndrome were examined by neurological examination, including provocation tests, electromyography and radiological examinations, to detect other sites of entrapment neuropathy of the upper extremity. During the last four years, 555 upper extremities of 494 patients were diagnosed as having thoracic outlet syndrome. Forty-five patients (9.3%) were diagnosed as having other entrapment neuropathy in one extremity. Ten cases were complicated by cervical radiculopathy, 15 by carpal tunnel syndrome, 11 by cubital tunnel syndrome, five by radial tunnel syndrome, two by ulnar tunnel syndrome, two by both carpal tunnel and cubital tunnel syndrome, and one by both cubital and ulnar tunnel syndrome. Surgery was performed for 15 limbs, and the distal lesion was operated on the first in two-thirds of these patients. The relationship between thoracic outlet syndrome and cubital tunnel syndrome or carpal tunnel syndrome has been reported by several authors, but the rates of incidence vary among reports. The rate of incidence seems to depend upon the diagnostic technique. After adoption of the appropriate provocation tests, patients with thoracic outlet syndrome complicated by other entrapment neuropathies were detected at a relatively high rate of incidence. Provocation tests seem to be an essential measure for the diagnosis of double crush syndromes.

Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity

2017 ◽  
Vol 39 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Nihal Kutlar ◽  
Ayse Oytun Bayrak ◽  
İlkay Koray Bayrak ◽  
Sevgi Canbaz ◽  
Hande Türker
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Doppler Ultrasonography ◽  
Tunnel Syndrome

Evaluation of Sympathetic Vasomotor Fibres in Carpal Tunnel Syndrome Using Continuous Wave Doppler Ultrasonography

2006 ◽  
Vol 31 (3) ◽  
pp. 306-310 ◽  
Author(s):  
L. A. GALEA ◽  
A. MERCIECA ◽  
C. SCIBERRAS ◽  
R. GATT ◽  
M. SCHEMBRI
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Pulsatility Index ◽  
Doppler Ultrasonography ◽  
Continuous Wave ◽  
Digital Artery ◽  
Maximal Increase ◽  
Continuous Wave Doppler ◽  
Tunnel Syndrome

Sympathetic vasomotor fibres carried by the median nerve and ulnar nerve innervate their respective sensory territories. The sympathetic vasomotor fibres of the median nerve were evaluated in patients with carpal tunnel syndrome and in healthy volunteers using continuous wave Doppler ultrasonography. The pulsatility index of the radialis indicis artery and the radial palmar digital artery of the little finger were measured at baseline and after stimulation. The maximal increase in the pulsatility index of each artery was measured. This was significantly lower for the radialis indicis artery in the CTS group than in the healthy controls. However, there was no significant difference in the maximal increase in pulsatility index of the radial palmar digital artery of the little finger between both groups. Sympathetic vasomotor fibres of the median nerve are affected in carpal tunnel syndrome. Continuous wave Doppler ultrasonography is easy to use and should be investigated further as a possible diagnostic tool for the confirmation of carpal tunnel syndrome.

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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