Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Cheng, Christine J.; Patterson, Brendan M.; Beck, John L.; Mackinnon, Susan E.

doi:10.1016/j.jhsa.2008.05.022

Cited by 157 publications

(163 citation statements)

References 24 publications

(38 reference statements)

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“…Reprinted with permission [6] All of the 44 patients with a positive preoperative scratch collapse test were found, intraoperatively, to have thickening of Osborne's band creating a tight area of nerve compression. With careful inspection of the entire exposed region of the ulnar nerve, this appeared to be the most clearly compressive region along its course in all of these patients.…”

Section: Resultsmentioning

confidence: 99%

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Brown

Mokhtee

Evangelista

et al. 2009

Hand (New York, N,Y.)

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The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in cubital tunnel syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Cubital tunnel syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain in the ulnar nerve distribution or by the presence of weakness or wasting of the ulnar-innervated intrinsic hand muscles. All diagnoses were confirmed with electrodiagnostic studies. As part of the physical examination, the SCT was performed along three subdivided segments in the region of the cubital tunnel. Results of the SCT were recorded and correlated with intraoperative findings. Of the 64 patients evaluated, 44 had a positive SCT that was either more profound or solely present a few centimeters distal to the medial epicondyle in the region of Osborne's band. All of these patients subsequently underwent anterior submuscular transposition and were found to have a tight compression point at Osborne's band corresponding to their preoperative SCT. This study suggests that the scratch collapse test may be a reliable physical examination technique for localizing the point of maximal nerve compression in patients with cubital tunnel syndrome. That point, in this series, corresponded with Osborne's band.

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Section: Resultsmentioning

confidence: 99%

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Brown

Mokhtee

Evangelista

et al. 2009

Hand (New York, N,Y.)

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“…Clinically, a symptomatic triad will be evident: (1) the patient will have distinct weakness when manually testing the strength of the muscles innervated by the median nerve distal to the lacertus fibrosus, especially the FPL, FDP II, and FCR (see Video 2); (2) external pressure of the median nerve at the level of the lacertus fibrosus will elicit distinct pain and, at times, a positive Tinel's sign; and (3) a positive scratch collapse test [6] over the median nerve at the level of the lacertus fibrosus (see Video 1).…”

Section: Symptoms and Clinical Findingsmentioning

confidence: 99%

Clinical Diagnosis and Wide-Awake Surgical Treatment of Proximal Median Nerve Entrapment at the Elbow: A Prospective Study

Hagert¹

2013

Hand (New York, N,Y.)

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Background Proximal median nerve entrapment (PMNE, or pronator syndrome) at the elbow has traditionally been considered an elusive and rare diagnosis, as it is seldom detectable using electrophysiological techniques. In this paper, the clinical manifestations, physical diagnosis, surgical technique, and results of surgical treatment of PMNE are presented, with accompanying instructional video. Patients/Methods During 2011, 44 patients with PMNE were surgically released and followed prospectively, 22 women/22 men, mean age 48.8 (range 25-66). The patients were equally distributed between right/left hands (23/21) and the dominant hand was treated in 56 % of cases. The diagnosis was based on: (1) weakness in median innervated muscles distal to the lacertus fibrosus; (2) pain upon pressure over the median nerve at the level of the lacertus fibrosus; and (3) positive scratch collapse test. A minimally invasive surgical treatment using only local anesthesia with lidocaine-epinephrine and no tourniquet was used, and direct perioperative return of strength in median innervated muscles was seen in all subjects. Results The average preoperative quick DASH was 35.4 (range 6.8-77.2); work DASH, 44.3 (6.25-100); and activity DASH, 61.6 (12.5-100). There were 71.1 % patients who completed the 6-month follow-up, and the average postoperative quick DASH was 12.7 (range 0-43.1), which is a statistically significant reduction (p<0.0001; Student's paired t test). Similarly, the work and activity DASH was significantly reduced (p<0.001) to 12.5 (0-75) and 6.25 (0-50), respectively. Conclusions PMNE at the level of the lacertus fibrosus should be called lacertus tunnel syndrome to distinguish it from other levels of median nerve entrapment. It is a clinical diagnosis based on three distinct clinical findings: weakness, pain over point of compression, and positive scratch collapse test. Surgical release in local anesthesia allows for a safe, ambulatory, and cost-efficient procedure with low morbidity.

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“…Although prior studies have suggested that undiagnosed pronator syndrome may be a cause for persistent CTS, we caution that secondary compression points causing double crush syndrome should be evaluated in all patients presenting for revision CTR. We have found the scratch collapse test (11) to be particularly valuable in this regard.…”

Section: Discussionmentioning

confidence: 99%

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

Davidge¹,

Zieske²,

Ebersole³

et al. 2013

The Journal of Hand Surgery

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Scratch Collapse Test for Evaluation of Carpal and Cubital Tunnel Syndrome

Cited by 157 publications

References 24 publications

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Clinical Diagnosis and Wide-Awake Surgical Treatment of Proximal Median Nerve Entrapment at the Elbow: A Prospective Study

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

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