scholarly journals Content validation of the Kamath and Stothard questionnaire for carpal tunnel syndrome diagnosis: a cognitive interviewing study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Armaghan Dabbagh ◽  
Joy C. MacDermid ◽  
Tara L. Packham ◽  
Luciana G. Macedo
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Content Validity ◽  
Structured Interview ◽  
Cognitive Interviewing ◽  
Control Group ◽  
Inadequate Response ◽  
Predictive Values ◽  
Family Doctors ◽  
Tunnel Syndrome

Abstract Background Accurate diagnosis of carpal tunnel syndrome (CTS) is essential for directing appropriate treatment; and for making decisions about work injury claims. The Kamath and Stothard Questionnaire (KSQ) is a self-reported tool used for the diagnosis of CTS. Comprehensibility and comprehensiveness of this questionnaire are critical to diagnostic performance and need to be established. The purpose of the study was to describe how potential respondents, clinicians, and measurement researchers interpret KSQ questions in order to identify and resolve potential sources of misclassification. Methods Hand therapists, measurement researchers, participants with CTS, and a control group were interviewed using cognitive interviewing techniques (talk aloud, semi-structured interview probes) in Hamilton, Canada. All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework. Findings Eighteen participants were interviewed. Areas, where questions were unclear to some participants, were recorded and categorized into five themes: Clarity and Comprehension (52%), Relativeness (38%), Inadequate Response Definition (4%), Perspective Modifiers (4%), and Reference Point (2%). Respondents also identified several symptoms of CTS that are not covered by the KSQ that might be of diagnostic value, e.g., weakness and dropping items. Conclusion The content validity of the current iteration of the KSQ was not established. The problematic questions identified in the study have been reported to have low specificity and negative predictive values in a previous quantitative study. The content validity issues identified may explain the poor performance. Recommendations were made to modify the wording of the KSQ and the potential addition of three new questions. Future studies should determine whether the modified questionnaire can provide better diagnostic accuracy and psychometric properties. The results of this study may assist in ruling in or out CTS diagnosis to a wide variety of target audience, such as hand specialists, physical and occupational therapists, as well as family doctors.

scholarly journals Comparison between Carpal Tunnel Syndrome and Individuals with Symptoms of Obsessive- Compulsive Disorder

2020 ◽  
Author(s):  
Meliha GÜNDAĞ PAPAKER ◽  
Anas ABDALLAH ◽  
Mehmet Hakan SEYİTHANOĞLU ◽  
Engin CAN ◽  
Aygül TANTİK PAK ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Patient Group ◽  
Carpal Tunnel ◽  
Significant Relationship ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Tunnel Syndrome ◽  
Anxiety Levels ◽  
The Difference

Abstract Objective: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy and is seen in 3 % of the general population. The aim to this study was examine the relationship between the symptoms of cleaning compulsion with using Moudsley obsessive compulsive inventory ( MOCI ) and patients with CTS. Methods: Sixty patients with CTS and 60 healty controls were evaluated in Bezmialem Vakif University Faculty of Medicine Neurosurgery Clinic. Neurological examination, Electrophysiological findings, the presence of neuropathic pain evaluated by the Leeds assessment of neuropathic symptoms and signs (LANSS) , the symptoms of obsessive- compulsive disorder using with MOCI and anxiety levels assessed by the Beck Anxiety Inventory (BAI) were evaluated. Results: No statistically significant relationship was observed between anxiety levels and CTS (p › 0.005). No statistically significant relationship was found MOCI rumination, control and doubting subscale scores (p › 0.005). Patient group had higher MOCI cleaning subscale scores than the control group and the difference was statistically significant (p=0.008). Patient group had higher MOCI slowness subscale scores than the control group and the difference was statistically significant (p=0.004). Conclusion: Increased wrist movement in people that have the symptoms of compulsive cleaning is associated with the risk of CTS. Our study show that a reduction of high level of wrist flexion-extansion movements may decrease the new CTS cases.

scholarly journals The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

2015 ◽  
Vol 123 (5) ◽  
pp. 1230-1237 ◽  
Author(s):  
Daniele Vanni ◽  
Francesco Saverio Sirabella ◽  
Renato Galzio ◽  
Vincenzo Salini ◽  
Vincenzo Magliani
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Secondary Outcome ◽  
Invasive Technique ◽  
Control Group ◽  
P Value ◽  
Invasive Approach ◽  
Group A ◽  
Tunnel Syndrome

OBJECT The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). METHODS This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. RESULTS The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤ 0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6 ± 0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. CONCLUSIONS The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Hand ◽  
2020 ◽  
pp. 155894472096387
Author(s):  
Kevin H. Kim ◽  
Bryan Duell ◽  
Swapna Munnangi ◽  
Mitchell Long ◽  
Elizabeth Morrison
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Carpal Tunnel Syndrome ◽  
Distal Radius Fracture ◽  
Carpal Tunnel ◽  
Nonoperative Management ◽  
Significant Risk ◽  
The Elderly ◽  
Control Group ◽  
Tunnel Syndrome

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

Use of Nerve Conduction Studies and the Pressure-Specified Sensory Device in the Diagnosis of Carpal Tunnel Syndrome

2009 ◽  
Vol 34 (1) ◽  
pp. 60-65 ◽  
Author(s):  
D. J. SLUTSKY
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Diagnostic Yield ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Control Group ◽  
Asymptomatic Volunteers ◽  
Before And After ◽  
Tunnel Syndrome

Sixty-nine patients with signs of carpal tunnel syndrome (CTS) underwent nerve conduction studies (NCS) and testing with the Pressure-Specified Sensory Device (PSSD). A total of 102 tests were performed (28 bilateral). Twenty patients underwent a carpal tunnel release and were retested after 4 to 6 months. The Symptom Severity Score (SSS) was calculated before and after surgery. A control group of 20 hands in 10 asymptomatic volunteers underwent identical testing. The NCS sensitivity was 87% with a specificity of 90% whereas the PSSD sensitivity was 81% with a specificity of 65%. The combined sensitivity of the two tests was 93%. In the operative group the SSS improved from a mean of 3.34 pre-operatively to 1.95 postoperatively. The NCS improved in 19/21 hands whereas the PSSD improved in 16/19 hands. The non-invasive SSS and PSSD can increase the diagnostic yield in CTS, especially when the NCS are normal.

ELECTRODIAGNOSTIC CRITERIA FOR DIAGNOSING CARPAL TUNNEL SYNDROME NEED TO BE REVISED IN HYPOTHYROID PATIENTS

2017 ◽  
Vol 20 (03) ◽  
pp. 1750014
Author(s):  
Mahdieh Asadi ◽  
Sharareh Roshanzamir
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Control Group ◽  
Tunnel Syndrome ◽  
Clinical Signs And Symptoms ◽  
Relationship Of ◽  
Hypothyroid Patients

Background: Previous studies do not agree with each other on the association between electrodiagnostic findings and clinical symptoms of Carpal tunnel syndrome (CTS). In most of these studies, many variables such as age, sex, obesity and hypothyroidism have not been taken into account. Material & methods: About 62 patients with hypothyroidism and 62 patients without hypothyroidism with sign and symptoms of CTS were included in this study. Electrodiagnostic tests were done for all patients. And relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters was examined statistically in each group. Results: This study showed that distal motor latency in control group (without hypothyroidism) is significantly more prolonged than hypothyroid patients. Also there was significant correlation between clinical symptoms and electrodiagnostic findings in control group, but there was not such correlation in hypothyroid patients. In 62% of hypothyroid patients with clinical signs and symptoms of CTS, electrodiagnostic findings were normal and only in 38% of cases, electrodiagnostic findings were suggestive of CTS. Conclusion: Relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters is very weak in hypothyroid patients. Many hypothyroid patients with clinical signs and symptoms of CTS have normal electrodiagnostic findings; so we need more studies for revising the para-clinic criteria of labeling patients having CTS in hypothyroid patients.

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome

2020 ◽  
Vol 22 (5) ◽  
pp. 313-322
Author(s):  
Filip Georgiew ◽  
Andrzej Maciejczak ◽  
Jakub Florek ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Conduction Disturbances ◽  
Tunnel Syndrome ◽  
Sensory Fibers ◽  
American Academy Of Neurology

Background. Nerve compression underlying carpal tunnel syndrome (CTS) results in an increase in the threshold of superficial sensation in the area supplied by the median nerve, which is a mixed nerve dominated by sensory fibres. The distribution of sensory symptoms is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment at wrist level is still unclear. Patho­logical processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients. Material and methods. The study involved 88 patients (104 hands), with 70 women (83 hands) and 18 men (21 hands) aged between 25 and 77 years. 50 age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. The diagnosis of carpal tunnel syndrome was made according to the criteria of the American Academy of Neurology 1993 guidelines. Based on the results of an ENG trace evaluating the degree of conduction disturbances in the median nerve, the patients were classified to one of three severity subgroups. The threshold of sensory excitability to pulsed current was determined in a test with single 100 ms rectangular pulses. Conclusions. 1. The threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly lon­ger in patients with CTS than in controls. 2. Surgical treatment decreases the threshold of sensation in the fingers innervated by the median nerve. 3. Surgical treatment does not decrease the threshold of sensation in the fingers innervated by the ul­nar nerve. 4. The preoperative and postoperative threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly longer in patients with severe carpal tunnel than in mild and moderate cases.

scholarly journals A Clinical Scoring System for Distinguishing Patients With Coincident Cubital Tunnel Syndrome Among Patients With Carpal Tunnel Syndrome

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 43-49
Author(s):  
Justin Koh ◽  
Kodi K. Azari ◽  
Prosper Benhaim
Keyword(s):  
High Risk ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Scoring System ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Predictive Values ◽  
Cutoff Value ◽  
Tunnel Syndrome ◽  
Tunnel Syndromes

Background: Coincident carpal and cubital tunnel syndromes present a diagnostic challenge, exacerbated by the limitations of nerve conduction study (NCS) for confirming cubital tunnel syndrome. This study develops a diagnostic scoring system, the Koh-Benhaim (KB) score, to identify patients with coincident compression neuropathies. Methods: A retrospective review of 515 patients was performed from patients surgically treated for carpal and/or cubital tunnel release. These patients were divided as patients with isolated carpal tunnel syndrome (n = 337) or coincident carpal and cubital tunnel syndromes (n = 178), then characterized according to demographics, medical history, physical examination, and NCS results. Univariate and multivariate logistic regression identified predictors of coincident neuropathy. A clinical score was constructed by integerizing regression coefficients of predictive factors. Receiver operating characteristic (ROC) curves were generated for each iteration of the score. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. Results: Decreased intrinsic muscle strength, decreased ulnar sensation, positive elbow flexion test, positive cubital tunnel Tinel’s sign, and abnormal NCS result were selected. The cutoff value for high risk of coincident compression was 3 points: positive predictive value, 82.9% and specificity, 93.4%. Model performance was very good—ROC area under the curve of 0.917. Conclusions: A KB score of 3 or greater represents high risk of coincident cubital tunnel compression. The variables involved are routinely used to assess the cubital tunnel, and all component factors of the KB score were of equivalent clinical weight in assessing patients with potential coincident compression neuropathy.

scholarly journals Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

2014 ◽  
Vol 41 (6) ◽  
pp. 426-433 ◽  
Author(s):  
Adham do Amaral e Castro ◽  
Thelma Larocca Skare ◽  
Paulo Afonso Nunes Nassif ◽  
Alexandre Kaue Sakuma ◽  
Bruno Luiz Ariede ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Clinical Tests ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Before And After ◽  
Tunnel Syndrome

Objective:To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods:We studiedthree groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results:We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work.Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

Exercise as a Prophylactic Device against Carpal Tunnel Syndrome

1989 ◽  
Vol 33 (11) ◽  
pp. 723-727 ◽  
Author(s):  
Thomas L. Williams ◽  
Leo A. Smith ◽  
Richard T. Herrick
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Exercise Program ◽  
Control Group ◽  
Test Results ◽  
Garment Workers ◽  
Liquid Crystal Thermography ◽  
Tunnel Syndrome ◽  
Female Employees ◽  
Garment Manufacturing

The null hupothesis that participation in an on-the-job strength and flexibility exercise program typical of those directed toward prevention of musculoskeletal stress has no prophylactic effect against carpal tunnel syndrome when used as an intervention measure in a population of female garment workers was examined. Grip strength, Phelan's test results, and hand/wrist thermograms obtained by liquid crystal thermography were taken on an experimental group of female employees in a southern garment manufacturing facility before, after five weeks, and after ten weeks of an exercise program and compared with data obtained from a control group. Although the test results suggested the exercise program may have had some benefit, the null hypothesis could not be rejected. An engineering economic analysis, assuming the exercise program was effective and implemented throughout the corporation, indicated the payback period would be approximately eleven years thus casting doubt on its economic efficacy also.

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