Functional deficits in carpal tunnel syndrome

Sesto, PT Mary E.; Radwin, Robert G.; Salvi, Frank J.

doi:10.1002/ajim.10241

Cited by 13 publications

(5 citation statements)

References 26 publications

(31 reference statements)

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“…Screening programs have also been implemented for early detection of CTS [Murata et al, 1996; Lundstrom et al, 1992]. A variety of physical exam procedures involving inspection, palpation, provocation maneuvers, and tests of strength and resistance have been used for the diagnosis of this disease [Boland and Kiernan, 2009; Szabo et al, 1999; Sesto et al, 2003; D’Arcy and McGee, 2000; Graham et al, 2006; Phalen, 1966]. Most of these measures address one or more characteristics of the syndrome, such as sensory or motor loss.…”

Section: Introductionmentioning

confidence: 99%

Physical examination has a low yield in screening for carpal tunnel syndrome

Dale¹,

Descatha

Coomes³

et al. 2010

American J Industrial Med

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Background Physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly-hired workers, we evaluated the yield of such screening. Methods Our study population included 1108 newly-hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy. Results Of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing. Conclusion Physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.

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Section: Introductionmentioning

confidence: 99%

Physical examination has a low yield in screening for carpal tunnel syndrome

Dale¹,

Descatha

Coomes³

et al. 2010

American J Industrial Med

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show abstract

“…4 Without sensory modulation control, the hand usually manipulates objects with excessive force output, creating problems with patients' manual dexterity. 2,3,[5][6][7][8] To address this condition, some researchers have analyzed the effects of the wrist's median nerve compression on sensation, grasp force regulation, and manual skills. [9][10][11] Their results suggest that the partial impairment of tactile sensibility impacts grasp force regulation.…”

mentioning

confidence: 99%

Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Hsu

Kuo

Chiu

et al. 2009

Journal Orthopaedic Research

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Patients with median nerve compression at the carpal tunnel often have poor sensory afferents. Without adequate sensory modulation control, these patients frequently exhibit clumsy performance and excessive force output in the affected hand. We analyzed precision grip function after the sensory recovery of patients with carpal tunnel syndrome (CTS) who underwent carpal tunnel release (CTR). Thirteen CTS patients were evaluated using a custom-designed pinch device and conventional sensory tools before and after CTR to measure sensibility, maximum pinch strength, and anticipated pinch force adjustments to movement-induced load fluctuations in a pinch-holding-up activity. Based on these tests, five force-related parameters and sensory measurements were used to determine improvements in pinch performance after sensory recovery. The force ratio between the exerted pinch force and maximum load force of the lifting object was used to determine pinch force coordination and to prove that CTR enabled precision motor output. The magnitude of peak pinch force indicated an economic force output during manipulations following CTR. The peak pinch force, force ratio, and percentage of maximum pinch force also demonstrated a moderate correlation with the Semmes-Weinstein test. Analysis of these tests revealed that improved sensory function helped restore patients' performance in precise pinch force control evaluations. These results suggest that sensory information plays an important role in adjusting balanced force output in dexterous manipulation. ß

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“…A similar examination protocol has been used in previous research with industrial participants. (25) …”

Section: Physical Examinationmentioning

confidence: 97%

Upper Limb Dynamic Responses to Impulsive Forces for Selected Assembly Workers

Sesto

Radwin

Block

et al. 2006

Journal of Occupational and Environmental Hygiene

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This study evaluated the upper limb, dynamic, mechanical response parameters for 14 male assembly workers recruited from selected jobs based on power tool use. It was hypothesized that the type of power tool operation would affect stiffness, effective mass, and damping of the upper extremity; and workers with symptoms and positive physical examination findings would have different mechanical responses than asymptomatic workers without physical examination findings. Participants included operators who regularly used torque reaction power hand tools, such as nutrunners and screwdrivers, and nontorque reaction power hand tools, such as riveters. The mechanical parameters of the upper limb were characterized from the loading response of an apparatus having known dynamic properties while worker grasps an oscillating handle in free vibration. In addition, all workers underwent a physical examination, magnetic resonance imaging, and completed a symptom survey. Workers were categorized as controls or cases based on reported forearm symptoms and physical exam findings. A total of seven workers were categorized as cases and had less average mechanical stiffness (46%, p > 0.01), damping (74%, p > 0.01), and effective mass (59%, p > 0.05) than the seven workers categorized as controls. Magnetic resonance imaging (MRI) findings suggestive of muscle edema were observed for two workers classified as cases and who regularly used torque reaction power tools. No MRI enhancement was observed in the seven subjects who did not regularly use torque reaction power tools. The ergonomic consequences of less stiffness, effective mass, and damping in symptomatic workers may include reduced capacity to react against rapidly building torque reaction forces encountered when operating power hand tools.

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Functional deficits in carpal tunnel syndrome

Cited by 13 publications

References 26 publications

Physical examination has a low yield in screening for carpal tunnel syndrome

Physical examination has a low yield in screening for carpal tunnel syndrome

Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Upper Limb Dynamic Responses to Impulsive Forces for Selected Assembly Workers

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