Reliability of Hand Diagrams for the Epidemiologic Case Definition of Carpal Tunnel Syndrome

Strickland, Jaime R.; Symanzik, Jürgen; Franzblau, Alfred; Evanoff, Bradley

doi:10.1007/s10926-008-9139-y

Cited by 21 publications

(28 citation statements)

References 40 publications

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“…To confirm their eligibility, we invited patients to fill in the Katz hand diagram questionnaire [22][23][24][25] under the guidance of a clinician. 27 able to respond to questionnaires in Cantonese and able to provide written informed consent.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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Background:The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods:We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results:Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06).Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

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Section: Inclusion Criteriamentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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“…Median nerve symptoms included numbness, tingling, burning, or pain in at least one of the thumb, index, or middle fingers. Subjects indicated the location and description of symptoms on a hand diagram with scores based on modified rules from Katz [Dale et al, 2008; Franzblau et al, 1994; Katz et al, 1990]. Diagrams were rated separately by an occupational therapist and an occupational physician (AMD, BE) for consistency with CTS symptoms; discrepancies were resolved by consensus.…”

Section: Methodsmentioning

confidence: 99%

Self‐reported physical work exposures and incident carpal tunnel syndrome

Gardner

Zeringue

Strickland

et al. 2014

American J Industrial Med

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Background To prospectively evaluate associations between self-reported physical work exposures and incident carpal tunnel syndrome (CTS). Methods Newly employed workers (n=1,107) underwent repeated nerve conduction studies (NCS), and periodic surveys on hand symptoms and physical work exposures including average daily duration of wrist bending, forearm rotation, finger pinching, using vibrating tools, finger/thumb pressing, forceful gripping, and lifting >2 pounds. Multiple logistic regression models examined relationships between peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index. Results 710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTS occurred over 3 year follow-up. All models describing lifting or forceful gripping exposures predicted future CTS. Vibrating tool use was predictive in some models. Conclusions Self-reported exposures showed consistent risks across different exposure models in this prospective study. Workers’ self-reported job demands can provide useful information for targeting work interventions.

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“…We studied a cohort of 1108 newly employed workers in several industries in St. Louis, USA, between July 2004 and October 2006 6 7. Subjects were eligible if they were newly hired workers >18 years old, starting a new full-time job (>30 h/week) or changing from temporary to permanent employment status.…”

Section: Methodsmentioning

confidence: 99%

“…Testing included a symptom questionnaire, structured physical examination and NCS of the median and ulnar sensory nerves bilaterally. Finger symptoms occurring more than three times or lasting more than 1 week in the last year were classified in three levels of specificity for CTS: (1) any symptoms in the fingers; (2) finger symptoms of burning, pain, numbness or tingling (“specific symptoms in fingers”); (3) distribution of symptoms resulting in a rating of “classic” or “probable” for CTS on a Katz hand diagram 6 8. The physical examination included two common provocative tests for CTS (Phalen's and Tinel's tests), and Semmes–Weinstein sensory testing using a 2.83-mm monofilament to determine sensitivity to light touch.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies: Table 1

Descatha

Franzblau

Coomes³

et al. 2009

Occup Environ Med

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Objective We evaluated the utility of physical examination maneuvers in the prediction of carpal tunnel syndrome (CTS) in a population-based research study. Methods We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination, and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as “classic” or “probable” on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination maneuvers, in subjects with and without symptoms. Results The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was less than 50% for all strategies tested. Conclusion Our study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.

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Reliability of Hand Diagrams for the Epidemiologic Case Definition of Carpal Tunnel Syndrome

Abstract: Introduction: The purpose of this study was to evaluate the inter-rater reliability of hand

Cited by 21 publications

References 40 publications

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Self‐reported physical work exposures and incident carpal tunnel syndrome

Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies: Table 1

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