The association between different patterns of hand symptoms and objective evidence of median nerve compression: A community-based survey

Abstract

Objective. To examine the association between different patterns of hand symptoms and the presence of delayed nerve conduction in the general population.Methods. We performed a 2-stage screening survey involving a questionnaire on current hand symptoms, and nerve conduction testing in samples of subjects with and without symptoms. Of 648 respondents to the symptom questionnaire, 212 reported hand symptoms. In all, 155 were tested for nerve conduction of sensory and motor median nerve latencies, including 40 who had reported no symptoms. Patterns of hand symptoms were compared with nerve conduction results and associations weighted back to the general population.Results. The presence of any hand symptoms had only a 40% sensitivity for delayed nerve conduction on latency testing. The presence of typical symptoms of carpal tunnel syndrome had a much lower sensitivity.Conclusion. In a community setting, the distribution of hand symptoms does not usefully correlate with the presence of delayed nerve conduction in the median nerve.Carpal tunnel syndrome (CTS) is clinically defined as the occurrence of hand and arm symptoms as a

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

“…Our population of newly hired workers was slightly higher for combined classic/probable ratings (right hand 25.5%) than in previous studies of general and active worker population that showed rates of 11 to 18% for combined classic/probable results [3,26]. These classic and probable rates are generally higher in clinic based studies given that patients are seeking treatment for a symptomatic hand related disorder [22,37].…”

“…Judgment and interpolation are required by raters. Many past studies that have used this tool have not described the protocol for how the diagrams were rated, nor the consistency of agreement among raters [16,26,37]. In order to better understand the validity and reliability of case definitions derived from hand diagrams, researchers should report these methods and results.…”

“…Patients seeking medical attention may bias physician ratings of a hand diagram, increasing the sensitivities found in past studies [17,22]. Work and general population studies have shown less ability to predict nerve conduction abnormalities from hand diagram results with a wide range of sensitivity (0.19-0.90) and specificity (0.39-0.95) [5,26,27].…”

“…Similarly, general population based studies have shown a broad range of sensitivity and specificity values [5,[25][26][27]. Despite varying validity, reliability has shown consistently high results with kappa and intraclass correlation coefficients of 0.89 to 0.93 [24,25].…”

Reply

“…Mattioli et al question the validity of the UK Health and Safety Executive criteria case definitions as utilized in the Southampton examination protocol (1,2).…”