A 76-year-old male patient had presented with history of backache for the last 15 years with features of pain even with mild touch (such as while wearing shirt). He had this complaint more than 15 years back and was operated twice; at tertiary care hospital on one occasion and secondary care hospital on another occasion at one-year interval. He later had persistent pain similar in character to what he had before surgery and used to take OTC analgesics occasionally for pain relief and had considered it 'incurable and his fate.' The treatment details were not available with the patient and could not be traced. On examination, there was an oblique linear surgical scar over inferior angle of right scapula, around 3 cm in length with faint reddish macule present over inferior and lateral aspect (at distal end of scar), which was tender and hypersensitive to touch and cold. Rest of the scar was nontender. The surrounding skin appeared normal with no induration or collection. He had no other site with similar hypersensitive lesion. Examination of Spine, Shoulder and Scapula were within normal limits.
BACKGROUNDCommonly used clinical tests to diagnose Carpal Tunnel Syndrome (CTS) are provocative tests, which involves compression of median nerve at carpal tunnel. Some of these tests are Phalen's test, Durkan's test and Tinel's sign. MATERIALS AND METHODSThis was a descriptive study. Sample size was taken conveniently. 134 consecutive hands (in patients with symptoms suggestive of CTS) were tested with a new clinical test combining Tourniquet test with Tinel's sign (T, TT, TTT) to increase the sensitivity and specificity of both of these tests if done separately. Out of these hands, seventy-one (n) were included for which all data were available. Attempts were made to grade the carpal tunnel syndrome based on severity, similar to grading done for nerve conduction study report. The results obtained were analysed and compared with that of nerve conduction study for carpal tunnel syndrome. RESULTSThe statistical methods used were chi square test (2*6 cross contingency tabulation), Pearson Correlation Coefficient analysis. The new clinical test (Tinel's, Tourniquet, Tinel's with tourniquet-T, TT, TTT) was correlated with the Nerve Conduction Study (NCS) for carpal tunnel syndrome. Pearson correlation coefficient was calculated for both the tests (new test and NCS), which showed positive correlation when 'n' was analysed (0.2339, p < 0.05). When the tests were analysed with two grades considered up or down, there was a 66.2% correlation. Chi square test (2*6 tabulation) returned significant p value. CONCLUSIONThe new clinical test for carpal tunnel syndrome-Tinel's with Tourniquet test (T, TT, TTT) increases the sensitivity of Tinel's test, which is usually considered a clinical test with high specificity. It also helped to assess the severity of the disease, thus helping in decision-making regarding further treatment. Even though the analysis returned a positive correlation, bigger sample size is required to further validate this new test.
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