A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study

Abstract

BackgroundCarpal tunnel syndrome (CTS), the most common neuropathy, is caused by a compression of the median nerve in the carpal tunnel and is related to aging. The initial symptom is numbness and pain of the median nerve distributed in the hand area, while thenar muscle atrophy occurs in advanced stages. This atrophy causes failure of thumb motion and results in clumsiness; even after surgery, thenar atrophy does not recover for an extended period. Medical examination and electrophysiological testing are useful to diagnose CTS; however, visits to the doctor tend to be delayed because patients neglect the symptom of numbness in the hand. To avoid thenar atrophy-related clumsiness, early detection of CTS is important.ObjectiveTo establish a CTS screening system without medical examination, we have developed a tablet-based CTS detection system, focusing on movement of the thumb in CTS patients; we examined the accuracy of this screening system.MethodsA total of 22 female CTS patients, involving 29 hands, and 11 female non-CTS participants were recruited. The diagnosis of CTS was made by hand surgeons based on electrophysiological testing. We developed an iPad-based app that recorded the speed and timing of thumb movements while playing a short game. A support vector machine (SVM) learning algorithm was then used by comparing the thumb movements in each direction among CTS and non-CTS groups with leave-one-out cross-validation; with this, we conducted screening for CTS in real time.ResultsThe maximum speed of thumb movements between CTS and non-CTS groups in each direction did not show any statistically significant difference. The CTS group showed significantly slower average thumb movement speed in the 3 and 6 o’clock directions (P=.03 and P=.005, respectively). The CTS group also took a significantly longer time to reach the points in the 2, 3, 4, 5, 6, 8, 9, and 11 o’clock directions (P<.05). Cross-validation revealed that 27 of 29 CTS hands (93%) were classified as having CTS, while 2 of 29 CTS hands (7%) did not have CTS. CTS and non-CTS were classified with 93% sensitivity and 73% specificity.ConclusionsOur newly developed app could classify disturbance of thumb opposition movement and could be useful as a screening test for CTS patients. Outside of the clinic, this app might be able to detect middle-to-severe-stage CTS and prompt these patients to visit a hand surgery specialist; this may also lead to medical cost-savings.

A mobile app implementing the international classification of functioning, disability and health rehabilitation set

“…Professionals and their patients are the two main users of the mobile health apps reported in previouslypublished studies. Some apps were developed to promote patients' self-management, interaction between professionals and patients, disease screening or learning of disease knowledge with patients as the main users [29][30][31][32]. Others were developed to cut costs and improve health outcomes with professionals as the main users [33][34][35].…”

Device Development for Detecting Thumb Opposition Impairment Using Carbon Nanotube-Based Strain Sensors

“…Thus, even a primary doctor or a non-orthopedist with limited knowledge and experience in hand surgery can detect thumb opposition impairment due to diseases such as severe CTS and CM osteoarthritis. Consequently, it may be able to prevent an increase in the number of patients with progression of thenar atrophy who require opponensplasty; furthermore, in the future, this method may be used to detect suspected CTS prior to doctor consultation by using it in combination with specific questionnaires and objective evaluation apps, such as some that have been recently reported [ 49 , 50 ].…”

Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention

“…They also received a tablet pc which was intended to deliver thematically focused information about the use of antibiotics to patients in waiting areas via a pre-installed e-learning application. Tablet-based apps have been used in diverse contexts to provide educational information [23][24][25]. All material referring to the regional intervention addressing the general public were to be introduced to the practice team during the outreach visit as well.…”