The “Hierarchical” Scratch Collapse Test for Identifying Multilevel Ulnar Nerve Compression

Davidge, Kristen M.; Gontre, Gil; Tang, David; Boyd, Kirsty U; Yee, Andrew; Damiano, M.; Mackinnon, Susan E.

doi:10.1007/s11552-014-9721-z

Cited by 43 publications

(27 citation statements)

References 43 publications

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“…The presence of a Tinel sign at the cubital tunnel and a Froment sign were recorded. A scratch collapse test was used to localize the site of compression along the ulnar nerve 30,31 . Upper-extremity impairment was evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire 32,33 .…”

Section: Clinical Datamentioning

confidence: 99%

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome

Power

Sharma

El-Haj

et al. 2019

The Journal of Bone and Joint Surgery

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Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome.Background: Cubital tunnel syndrome has a spectrum of presentations ranging from mild paresthesias to debilitating numbness and intrinsic atrophy. Commonly, the classification of severity relies on clinical symptoms and slowing of conduction velocity across the elbow. However, changes in compound muscle action potential (CMAP) amplitude more accurately reflect axonal loss. We hypothesized that CMAP amplitude would better predict functional impairment than conduction velocity alone.Methods: A retrospective cohort of patients who underwent a surgical procedure for cubital tunnel syndrome over a 5year period were included in the study. All patients had electrodiagnostic testing performed at our institution. Clinical and electrodiagnostic variables were recorded. The primary outcome was preoperative functional impairment, defined by grip and key pinch strength ratios. Multivariable regression identified which clinical and electrodiagnostic variables predicted preoperative functional impairment.Results: Eighty-three patients with a mean age of 57 years (75% male) were included in the study. The majority of patients (88%) had abnormal electrodiagnostic studies. Fifty-four percent had reduced CMAP amplitude, and 79% had slowing of conduction velocity across the elbow (recorded from the first dorsal interosseous). On bivariate analysis, older age and longer symptom duration were significantly associated (p < 0.05) with reduced CMAP amplitude and slowing of conduction velocity across the elbow, whereas body mass index (BMI), laterality, a primary surgical procedure compared with revision surgical procedure, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, and visual analog scale (VAS) scores for pain were not. Multivariable regression analysis demonstrated that reduced first dorsal interosseous CMAP amplitude independently predicted the loss of preoperative grip and key pinch strength and that slowed conduction velocity across the elbow did not. Conclusions:Reduced first dorsal interosseous amplitude predicted preoperative weakness in grip and key pinch strength, and isolated slowing of conduction velocity across the elbow did not. CMAP amplitude is a sensitive indicator of axonal loss and an important marker of the severity of cubital tunnel syndrome. It should be considered when counseling patients with regard to their prognosis and determining the necessity and timing of operative intervention.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article

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Section: Clinical Datamentioning

confidence: 99%

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome

Power

Sharma

El-Haj

et al. 2019

The Journal of Bone and Joint Surgery

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“…Provocative tests for points of nerve compression are then attempted (Phalen's test for carpal tunnel, resisted pronation for pronator syndrome, etc.). The scratch-collapse can be very helpful in testing for proximal points of compression and determining which point among many is most significant in the case of multiple entrapment points along the same nerve [62][63][64][65][66][67][68]. Finally, the Tinel test is then performed [69,70].…”

Section: Physical Examinationmentioning

confidence: 99%

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. However, recent literature suggests that surgical management of carefully diagnosed generators of pain can greatly reduce patients' pain and narcotic requirements. This article reviews recent literature on surgical management of pain and four specific sources of chronic pain amenable to surgical treatment: painful neuroma, nerve compression, myofascial/ musculoskeletal pain, and complex regional pain syndrome type II.

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“… 24 A positive test is noted if there is transient loss of muscle resistance resulting in the arm collapsing, thus, coining the term of this provocative test “the scratch collapse test.” This concept can also be applied to other nerve compression syndromes. Mackinnon has demonstrated diagnostic utility for ulnar nerve entrapment in cubital syndrome 10 , 11 and peroneal nerve compression. 12 Since its inception, several refinements have been suggested by the creator, such as the addition of ethyl chloride spray to assist in detecting multiple levels of nerve compression, which are outlined in detail by Kahn et al 13 …”

Section: Introductionmentioning

confidence: 99%

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Huynh¹,

Karir²,

Bennett³

2018

Plastic and Reconstructive Surgery - Global Open

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Background:Despite the fact that carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, the diagnostic accuracy of clinical screening examinations for CTS is controversial. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. The purpose of our study was to determine the diagnostic accuracy of the SCT for CTS.Methods:A literature search was performed using PubMed (1966 to April 2018); Ovid MEDLINE (1966 to April 2018); EMBASE (1988 to April 2018); and Cochrane Central Register of Controlled Trials (The Cochrane Library, to April 2018). We examined the studies for the pooled sensitivity, specificity, and likelihood ratios of the SCT. This review has been registered with PROSPERO (CRD42018077115).Results:The literature search generated 13 unique articles. Seven articles were included for full text screening and 3 articles met our inclusion criteria, all of which were level II evidence with low risk of bias (165 patients). Pooled sensitivities, specificities, positive likelihood ratio, and negative likelihood ratios were 0.32 [95% CI (0.24–0.41)], 0.62 [95% CI (0.45–0.78)], 0.75 [95% CI (0.33–1.67)], and 1.03 [95% CI (0.61–1.74)], respectively. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy.Conclusion:The SCT has poor sensitivity; however, it is moderately specific. Based on the current literature and their variable quality of the evidence, we conclude that the SCT is not an adequate screening test for detecting CTS.

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The “Hierarchical” Scratch Collapse Test for Identifying Multilevel Ulnar Nerve Compression

Cited by 43 publications

References 43 publications

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

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