Value of Modified Duran’s Test in Clinical Diagnosis of Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is a medical condition, the most common, most important, and best defined, and the most carefully studied of all nerve entrapment syndromes. Objective: Our study aims to evaluate clinical tests in the diagnosis of CTS with special reference to modified Duran’s test regarding specificity and sensitivity. Patients and Methods: A prospective study carried out on 300 hands in 240 patients with symptomatic CTS was taken, from August 2015 to February 2017, at Erbil Teaching hospital (Orthopedic department). History, clinical examination, and Electrophysiological by Electromyography and Nerve conduction study and 250 persons without symptoms on 300 hands were taken as a controlling group. We applied the five clinical provocative tests on each group, Phalen’s test, Tinal’s test, original Duran’s test, arm Tourniquet test, and Reversed Phalen’s test. In this research, we compared former tests by our test modification (Duran’s test), considering specificity, accuracy, and sensitivity. Results: Findings show that the modified Duran’s test was the most specific (94%), accurate (94%), and sensitive (94%) in comparison with the other provocative tests. The modified Duran test had the highest positivity rate, according to the cases in less than 1-month history of symptoms it reached: 81.8% which was higher than the result of the previous tests in comparison to the previous clinical tests. Its mean time was 11.5 s. Conclusions: Modified Duran’s test was simple, noninvasive, most sensitive, and most specific in comparison to other clinical tests. Furthermore, the reaction time of Modified Duran’s test was the shortest,

Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery

Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.

Hypertrophied reverse palmaris longus muscle: a rare cause of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is usually secondary to compression or irritation of the median nerve in the fibro-osseous canal formed by the flexor retinaculum (transverse carpal ligament) and the carpal bones. The prevalence of CTS in the general population is about 7 to 19%. Several causes both local and systemic have been described, but CTS due to aberrant musculature are rare. Here we report a case of a middle-aged female with paresthesia of the hand and a positive Phalen’s test with nerve conduction study of the median nerve showing sensorimotor neuropathy. The patient underwent surgery for open CTS release where we found a hypertrophied reverse palmaris longus muscle attached to the palmar aponeurosis which was excised along with its proximal tendon. On post-operative follow up all the symptoms of CTS were completely resolved. Muscle abnormalities concern three muscles: the palmaris longus, the flexor digitorum superficialis of index, and the lumbricals. These muscles can be hypertrophied, bifid, duplicated, digastric, inverted or have an abnormal insertion, thus creating a mechanical restriction of the carpal tunnel. Surgical resection of abnormal muscle provides excellent functional recovery.

Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users

Objectives: This study aimed to explore the prevalence of carpal tunnel syndrome symptoms among female touchscreen users at Majmaah University, Saudi Arabia and to make a comparison for the wrist range of motion between probable CTS and non-CTS female touchscreen users. Methods: Two hundred and twenty-two female touchscreen users were enrolled in the present study. Among this cohort, fifty-two were academic members, 40 were employees and 130 were undergraduates. A Digital Inclinometer device was used to assess ROM of the wrist movements. A computer-based questionnaire, Phalen’s test, and Tinel’s sign were used to investigate the presence of CTS symptoms. The study was conducted between November 2018 and February 2019 at Majmaah University. Results: The prevalence of probable CTS was 34.2% among touchscreen users; the percent of probable CTS was significantly higher in undergraduates compared to other touchscreen users. There was a significant reduction in wrist flexion between the tested groups. Conclusion: Female touchscreen users at Majmaah University tended to have a high-risk for CTS. Wrist ROM measurements, particularly wrist flexion, could be a beneficial indicator for anticipating deviations in wrist posture after long-term touchscreen use. It is necessary to consider the job nature, age, BMI, and duration of using touchscreen as risk factors for CTS symptoms. doi: https://doi.org/10.12669/pjms.35.5.683 How to cite this:Mohammad WS. Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.683 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Median Neuropathy—Carpal Tunnel Syndrome

This chapter presents general treatment strategies for carpal tunnel syndrome using a clinical case example. It discusses assessment and planning, diagnostic pearls, decision-making, surgical procedures (open and endoscopic carpal tunnel release), management pearls, aftercare, complications and their management, and evidence and outcomes. Physical exams, such as Phalen’s test or a Tinel sign over the median nerve, are introduced, whereas steps in the surgical procedure are shown with intraoperative photographs. The chapter provides information on modern practices for comprehensive management of carpal tunnel syndrome from start to finish.

Gambaran faktor risiko kejadian Carpal Tunnel Syndrome (CTS) pada karyawan bagian redaksi di kantor berita X Jakarta Tahun 2018

Tujuan penelitian ini adalah untuk mengetahui gambaran faktor risiko kejadian CTS pada karyawan bagian redaksi di Kantor Berita Nasional Antara Jakarta Tahun 2018. Faktor risiko CTS terdiri dari faktor personal (jenis kelamin, usia, dan jaringan lemak di tangan) dan faktor pekerjaan (masa kerja, lama kerja, dan posisi kerja). Penelitian ini bersifat deskriptif dengan metode penelitian kuantitatif dan menggunakan desain studi cross sectional. Instrumen yang digunakan adalah lembar kuesioner, lembar observasi dari Assessment of Repetitive Tasks (ART) tool, body composition monitor, microtoise, stopwatch, dan phalen’s test. Waktu pengambilan data dilakukan pada bulan Januari tahun 2018. Sebanyak 42,4% responden yang diteliti terdiagnosis positif CTS. Responden yang terdiagnosis positif CTS terdiri dari 52,9% responden perempuan, 45,5% responden yang berusia > 37,5 tahun, 51,9% responden yang memiliki persentase jaringan lemak terbesar di bagian tangan, 47,1% responden yang memiliki masa kerja > 12 tahun, 41,9% responden yang memiliki lama kerja > 8 jam/hari, dan 43,6% responden dikategorikan dalam level sedang untuk eksposur posisi kerjanya. Penilaian level eksposur posisi kerja tersebut dilihat dari 12 faktor dimana dalam penelitian ini ada tiga faktor yang sangat berpengaruh dalam kejadian CTS yaitu: 1) frekuensi gerakan lengan kanan, dimana semuanya memiliki kategori reasonable dan 42,4% terdiagnosis positif CTS; 2) gerakan berulang pada tangan kiri dan kanan, dimana sebagian besar responden yang positif CTS memiliki kategori good karena sebagian besar memiliki masa kerja > 12 jam dan lama kerja > 8 jam; dan 3) postur pergelangan tangan, dimana semuanya memiliki kategori reasonable dan poor dan 63,6% terdiagnosis positif CTS. Faktor risiko yang memiliki trend tertinggi dalam kejadian CTS adalah faktor persentase jaringan lemak terbesar dibagian tangan, level eksposur posisi kerja, dan jenis kelamin perempuan.

Carpal Tunnel Syndrome-A Battery of Tests can Improve the Diagnosis

INTRODUCTION: The gold standard for diagnosis of carpal tunnel syndrome (CTS) is not well defined. At times, patients of suspected carpal tunnel syndrome fail to respond to treatment if the diagnosis is based on symptoms alone or on one or two clinical tests probably because the diagnosis is not correct. The purpose of this study was to compare the relative merits of various diagnostic modalities in establishing the diagnosis of CTS and also to define the accurate test or combination of tests to help diagnose and manage CTS.MATERIAL AND METHODS: Patients presenting with symptoms suggestive of CTS were evaluated using (i) Clinical Provocative tests - Durkan's test and Phalen's test, (ii) Tests for sensory perception thresholds using Semmes-Weinstein monofilament nylons (iii) Nerve conduction studies predominately sensory and motor and (iv) Gray scale sonography.RESULTS: When a positive Phalen's test was taken as reference, the positive predictive value of Durkan's test and ultrasonography was 100%, Nylon perception test and neurophysiological studies had a value of 90 and 89% respectively. When Durken's test was used as reference, ultrasonography had a positive predictive value 0f 98% followed by nylon perception testing - 94%. Phalen's test and neurophysiological studies had values of the order of 92 and 88% respectively.CONCLUSION: Our observations suggest that clinical history and physical examination can be used to screen the patients. The perception threshold testing with monofilament nylons and ultrasonographic examination of carpal tunnel (CT) improve the diagnosis. In addition, ultrasonographic examination of CT provides the information on anatomy and condition of the contents of CT and help planning the treatment. A combination of clinical provocative tests, Semmes-Weisntein monofilament testin and high frequency sonography could be considered as definitive diagnostic battery for diagnosing carpal tunnel syndrome.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 26-30

Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome

This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen’s test (67%), Durkan’s test (77%), Tinel’s test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan’s test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan’s test and CTS-6 lax. Further studies should seek to limit the influence of a patient’s clinical presentation on scratch test performance and assess the scratch test’s inter-rater reliability.