Provocative testing in the diagnosis of dynamic carpal tunnel syndrome

Braun, Richard M.; Davidson, Kathleen; Doehr, Sandra

doi:10.1016/0363-5023(89)90005-1

Cited by 63 publications

(17 citation statements)

References 4 publications

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“…Some authors have used the term dynamic CTS for these patients. 16 These patients are likely to benefit from conservative management, including alteration of work duties. Therefore, the importance of a well-defined history is particularly important in these cases.…”

Section: The Clinical Examination Historymentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

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Section: The Clinical Examination Historymentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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“…Steroid injections are believed to reduce perineural inflammation or soft tissue swelling, and may stabilise the neural membrane, thus limiting the ephaptic transmission (“cross talk”) in ischaemic nerve fibres which causes symptoms. Positive symptoms—that is, paraesthesiae or pain with activity (“dynamic CTS”8), may be associated with normal NCS 910.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid injection for the treatment of carpal tunnel syndrome

O’Gradaigh

Merry

2000

Annals of the Rheumatic Diseases

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Objective-To compare low and high dose, and short and long acting corticosteroids in the treatment of carpal tunnel syndrome. Methods-A randomised, controlled, single blind trial with electromyographic and subjective outcome measures. Results-25 mg hydrocortisone is as eVective as higher doses or long acting triamcinolone at a six week and six month follow up. Conclusion-As low dose steroid is as eVective, and potentially less toxic, this should be the recommended dose for injection of carpal tunnel syndrome.

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“…I have no doubt that this is responsible for reversible CTS, usually seen in relatively young factory workers which was referred to by Braun et al as 'dynamic' CTS. 20 These cases, incidentally, are not necessarily seen or recognized in hand clinics that are associated with long waiting lists. It also occurs in a subgroup of the more typical middle-aged CTS sufferers in whom chronic flexor tenosynovitis gives rise to fixed flexion contractures of the fingers (as demonstrated on examination by the 'prayer' sign).…”

Section: Carpal Tunnel Syndrome (Cts)mentioning

confidence: 99%

Work related upper limb disorders

Hutson

2014

Indian Journal of Rheumatology

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Work related upper limb disorderNeuropathic arm pain Epicondylitis a b s t r a c t Neuropathic arm pain (NAP), commonly referred to as 'RSI', diffuse upper limb disorder or type II work related upper limb disorder (WRULD) is a regional pain syndrome affecting the upper limb(s), characterized by persistent pain and dysaesthesiae. It is commonly associated with long periods of keyboard use, though may also occur in workers engaged in other types of repetitive stereotyped activities of the hands. Adverse ergonomics is commonly present. Sleep pattern is usually disturbed, and depression, headaches, chronic fatigue, and frustration are frequently experienced. The pathogenesis of NAP is probably linked to overloading of sensorineural mechanisms responsible for pain production and perception. Clinical findings include muscle tension and hyperalgesia in the upper limbs and shoulder girdles, adverse neural dynamics, and frequently (and importantly) proximal dorsal spinal dysfunction. Other factors that are often associated with the development of neurosensitisation include premorbid psychological profile, environmental stresses, misattributions and beliefs, adverse posture and ergonomics, iatrogenesis, and litigation.Conventional investigations such as cervicodorsal spinal radiographs, nerve conduction studies, and MRI are negative. Clinical management is structured on reduction of provocative stresses and treatment of neuromusculoskeletal dysfunction. The differential diagnosis is discussed in this article.

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Provocative testing in the diagnosis of dynamic carpal tunnel syndrome

Cited by 63 publications

References 4 publications

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

Corticosteroid injection for the treatment of carpal tunnel syndrome

Work related upper limb disorders

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