Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome

2018 ◽  
Vol 18 (3) ◽  
pp. 345-350 ◽  
Author(s):  
Sadegh Izadi ◽  
Bahareh Kardeh ◽  
Seied Saeed Hosini Hooshiar ◽  
Mojtaba Neydavoodi ◽  
Afshin Borhani-Haghighi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Rating Scale ◽  
Screening Method ◽  
Cross Sectional ◽  
Physical Tests ◽  
Tunnel Syndrome ◽  
Clinical Grading

AbstractBackground and aimsCarpal tunnel syndrome (CTS) is a common debilitating condition. As the reliability of CTS-specific physical tests and its clinical grading remain a matter of debate, we determined the correlations between these assessments with nerve conduction study (NCS).MethodsIn this cross-sectional study, patients with uni or bilateral CTS, which was confirmed in electrodiagnosis, were enrolled. Clinical grading was based on the modified criteria of the Italian CTS Study Group. Numeric Pain Rating Scale (NPRS) and Boston Questionnaire (BQ) were used. Physical tests [Phalen’s, reverse Phalen’s, Tinel’s and manual carpal compression test (mCCT)] were performed by a single blinded neurologist. Ap-value<0.05 was considered statistically significant.ResultsA total of 100 patients (age=47.48±11.44 years; 85% female) with 181 involved hands were studied. The majority of hands (59.7%) were classified as grade 2 of clinical grading. On NCS, hands with mild (64%), moderate (27%) and severe (9%) CTS were identified. Sensory (velocity, latency and amplitude) and motor parameters (latency and amplitude) were significantly correlated with clinical grades (p-value<0.001). The correlation of NPRS (p-value=0.009) and BQ (p-value<0.001) scores with NCS was significant. None of the physical tests were significantly correlated with NCS in terms of result or duration (p-value>0.05).ConclusionsWe found that physical tests are not a reliable screening method for evaluation of CTS severity. However, the BQ and clinical grading can be more valuable due to their significant correlation with NCS.ImplicationsPhysicians might benefit from employing clinical grading and BQ in practice for better assessment of CTS severity.

scholarly journals High prevalence of carpal tunnel syndrome in individuals with rare nerve growth factor-beta mutation

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Mikael Ridderström ◽  
Mats Svantesson ◽  
Oumie Thorell ◽  
Theofilos Magounakis ◽  
Jan Minde ◽  
...  
Keyword(s):  
Nerve Growth Factor ◽  
Growth Factor ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Cross Sectional ◽  
Nerve Growth ◽  
Tunnel Syndrome ◽  
Growth Factor Beta

Abstract In Sweden, a large family with a point mutation in the nerve growth factor-beta gene has previously been identified. The carriers of this mutation have reduced small-fibre density and selective deficits in deep pain and temperature modalities. The clinical findings in this population are described as hereditary sensory and autonomic neuropathy type V. The purpose of the current study was to investigate the prevalence of carpal tunnel syndrome in hereditary sensory and autonomic neuropathy type V based on clinical examinations and electrophysiological measurements. Furthermore, the cross-sectional area of the median nerve at the carpal tunnel inlet was measured with ultrasonography. Out of 52 known individuals heterozygous for the nerve growth factor-beta mutation in Sweden, 23 participated in the current study (12 males, 11 females; mean age 55 years; range 25–86 years). All participants answered a health questionnaire and underwent clinical examination followed by median nerve conduction study in a case–control design, and measurement of the nerve cross-sectional area with ultrasonography. The diagnosis of carpal tunnel syndrome was made based on consensus criteria using patient history and nerve conduction study. The prevalence of carpal tunnel syndrome in the hereditary sensory and autonomic neuropathy group was 35% or 52% depending on whether those individuals who had classic symptoms of carpal tunnel syndrome but negative nerve conduction studies were included or not. Those who had a high likelihood of carpal tunnel syndrome based on classic/probable patient history with positive nerve conduction study had a significantly larger median nerve cross-sectional area than those who had an unlikely patient history with negative nerve conduction study. The prevalence of carpal tunnel syndrome was 10–25 times higher in individuals heterozygous for the nerve growth factor-beta mutation than the general Swedish population. Further studies are needed to better understand the underlying pathophysiological mechanisms.

scholarly journals Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ihsan M. Ajeena ◽  
Raed H. Al-Saad ◽  
Ahmed Al-Mudhafar ◽  
Najah R. Hadi ◽  
Sawsan H. Al-Aridhy
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Cross Sectional Study ◽  
Control Group ◽  
Cross Sectional ◽  
Cross Section Area ◽  
Significant Difference ◽  
Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS) depending on the results of nerve conduction study (NCS).Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS). Furthermore, 40 healthy volunteers (80 wrists) underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI). The cross section area (CSA) of the median nerve (MN) was obtained using HRUS at the carpal tunnel inlet by direct tracing method.Results.There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome.

Carpal tunnel decompression in patients with normal nerve conduction studies

2019 ◽  
Vol 45 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Samuel P. Mackenzie ◽  
Oliver D. Stone ◽  
Paul J. Jenkins ◽  
Nicholas D. Clement ◽  
Iain R. Murray ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Study Groups ◽  
Nerve Conduction Studies ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. Level of evidence: III

scholarly journals Pattern of Peripheral Neuropathy and B12 Assay among Type 2 Diabetic Saudi Patients

2020 ◽  
Vol 5 (11) ◽  
pp. 529-532
Author(s):  
Ahmed Abdulrahaman Ghalib ◽  
Jamil Ramadan ◽  
Bothaina Omar Marae
Keyword(s):  
Peripheral Neuropathy ◽  
Carpal Tunnel Syndrome ◽  
Glycemic Control ◽  
Vitamin B12 ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Axonal Neuropathy ◽  
Hypoglycemic Agents ◽  
Tunnel Syndrome

Objectives: to determine whether the pattern of peripheral neuropathy among Saudi types 2 diabetics has association with B12 status and glycemic control. Method: A cross section hospital based study. The pattern of diabetic neuropathy was determined by nerve conductive velocity (NCV) test, level of vitamin b12 was assayed among the study population and the glycemic control was determined according to Hba1c level. Results: A total of thirty three patients were enrolled in these study twenty one females and twelve males. The age ranged between 79 and 34 with the mean (SD) of 57 of these 17 (51.5%) used oral hypoglycemic agents and 16 (48.5%) were using insulin. HbAc1 more than 7 was found in 28 (84.8%) of the patients reflecting poor control. The nerve conduction study testing revealed that sensory axonal demyelination 6(18.2%), bilateral neuropathy 8 (24.2%), Right Carpal tunnel syndrome 5(15.2%), Left Carpal tunnel syndrome 0 (00%), mild axonal neuropathy 4 (12.1%) and 10 (30.3%) were found to have normal nerve conduction study test. The level of vitamin B12 was found 2(6%) was deficiency <180 pg/ml, 12(36.3%) possible deficiency 212 pg/ml-350 pg/ml and 19(57.5%) was >400 pg/ml. Conclusion: It could be concluded from this study that there is no association between pattern of peripheral neuropathy and B12 level in type II diabetics. Similarly no relation exists between Hb Ac1 level and pattern of peripheral neuropathy.

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