The Validity of Sensory Threshold Measures and Functional Measures in Patients with Carpal Tunnel Syndrome

2011 ◽  
Vol 24 (4) ◽  
pp. 380-381
Author(s):  
Derek K. Cheung ◽  
Joy C. MacDermid ◽  
Dave Walton ◽  
Ruby Grewal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Sensory Threshold ◽  
Functional Measures ◽  
Tunnel Syndrome

scholarly journals The Construct Validity and Responsiveness of Sensory Tests in Patients with Carpal Tunnel Syndrome

2014 ◽  
Vol 8 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Derek K.M Cheung ◽  
JoyC MacDermid ◽  
Dave Walton ◽  
Ruby Grewal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Construct Validity ◽  
Carpal Tunnel ◽  
Hand Function ◽  
Change Score ◽  
Important Change ◽  
Measurement Properties ◽  
Sensory Threshold ◽  
Tunnel Syndrome ◽  
Sensory Tests

Background and Purpose : Sensory evaluation is fundamental to evaluation of patients with Carpal Tunnel Syndrome (CTS). The purpose of this study was to determine the construct validity and responsiveness for sensory threshold tests in patients with CTS. Methods : Sixty-three patients diagnosed with CTS were evaluated prior to orthotic intervention and again at follow up at 6 and 12 weeks. Sensory tests included touch threshold PSSD (Pressure Specified Sensory Device) and vibration threshold (Vibrometer). Construct validity was assessed by comparing sensory tests to hand function, and dexterity testing using Spearman rho (rs). Patients were classified as either responders or non-responders to orthotic intervention based on the change score of the Symptom Severity Scale (SSS) of 0.5. Responsiveness of the sensory tools was measured using ROC (receiver operating characteristic) curves, SRM (Standardized Response Mean), and ES (Effect Sizes). Results : The PSSD had low to moderate correlations (rs ≤ 0.32) while Vibrometer scores had moderate correlations (rs = 0.36 - 0.41) with dexterity scores. The Clinically Important Difference (CID) for the PSSD was estimated at 0.15 g/mm2 but was not discriminative. The Vibrometer demonstrated moderate responsiveness, with a SRM = 0.61 and an ES = 0.46 among responders. The PSSD had a SRM = 0.09 and an ES = 0.08 and showed low responsiveness for patients with a clinically important improvement in symptoms. Conclusion : Measurement properties suggest that the Vibrometer was preferable to the PSSD because it was more correlated to hand function, and was more responsive. Clinicians may choose use the Vibrometer opposed to the PSSD for determining important change in sensation after orthotic intervention.

The impact of cell phone texting on superficial blood flow, touch threshold, and symptoms for individuals with carpal tunnel syndrome

Work ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mike Szekeres ◽  
Derek Cheung ◽  
Joy Macdermid
Keyword(s):  
Blood Flow ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Group Versus ◽  
Sensory Threshold ◽  
Short Term ◽  
Time Points ◽  
Tunnel Syndrome ◽  
The Impact

BACKGROUND: It is unclear how individuals with carpal tunnel syndrome (CTS) are affected by texting, or how the texting performance of those with CTS might be impaired or different from individuals without CTS. OBJECTIVE: The primary purpose of this case-control study was to determine the immediate effects of texting on superficial blood flow, sensory threshold, and symptoms of fatigue, numbness, and pain for individuals with CTS compared to asymptomatic age-matched controls. Another objective was to detect differences in texting performance between the two groups. METHODS: Superficial blood flow, pain, fatigue, numbness, and touch threshold were measured before, and at three time points following a standardized 15-minute texting task. Overall texting speed was compared between groups. RESULTS: Changes in red blood cell concentration after the texting task was not significantly different for either the CTS group or controls for any of the measurement time points. Mean touch thresholds at baseline were 4.0 g/mm2 for the CTS group versus 2.6 g/mm2 for healthy controls; a 53%greater touch threshold. Following the texting task, touch threshold did not change for normal controls, but increased to 6.7 g/mm2 for the CTS group, representing a significant increase in touch threshold from baseline. Texting performance was compromised in people with CTS, and symptoms worsened with a short-term controlled texting task. CONCLUSIONS: Our results suggest that texting performance is limited in individuals with CTS and that texting results in a short term increase in touch threshold values for individuals with CTS. Further study is needed to determine the effect of long term texting on carpal tunnel pressures.

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.

Sign in / Sign up

Export Citation Format

Share Document