Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

Abstract

The relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making

“…The MMT was performed using the index finger of the physician opposing the patients’ thumb abduction or index finger abduction (FDI muscle). [ 15 ] Surgery was conducted by one surgeon, assessment was conducted by two different surgeons, results were evaluated according to interclass correlation coefficient (ICC).…”

Cirugía de rescate en el síndrome del túnel del carpo: nuestra experiencia utilizando el colgajo vascularizado de grasa hipotenar

“…realizando una pinza digital con el primer y segundo dedo, y comparándolo con la mano contralateral. 13 Se consideró significativo una disminución de la fuerza mayor al 50%.…”

“…Respecto a ese ámbito, se revisaron todos los EMG que fueron realizados a lo largo de la evolución de los pacientes. 13 Los resultados se clasifican en:…”

“Pronation Compensation Sign” as a New Diagnostic Tool for Carpal Tunnel Syndrome: A Prospective Preliminary Study

“…Abductor pollicis brevis (APB) muscle weakness is common in patients with CTS but seldom assessed in clinical practice. 7 Having noticed that weakness of this muscle can lead to wrist pronation to compensate for limited thumb abduction, here we investigated the “pronation compensation sign” as an additional diagnostic tool to demonstrate this weakness and diagnose CTS. The APB originates from the scaphoid, trapezium, and flexor retinaculum bones and inserts on the lateral aspect of the proximal phalanx and the metacarpophalangeal joint of the thumb.…”