The Quantitative Relationship Between Physical Examinations and the Nerve Conduction of the Carpal Tunnel Syndrome in Patients With and Without a Diabetic Polyneuropathy

Abstract

ObjectiveTo understand the quantitative correlation between the clinical severity and physical examinations along with the electrodiagnostic findings by subjects with carpal tunnel syndrome (CTS) and also the influence of diabetic polyneuropathy (DPN) on physical examinations by subjects with CTS.MethodsAmong 200 patients suffering from hand tingling sensations, 68 patients were diagnosed with CTS on at least one hand by nerve conduction tests. Therefore, the Phalen test (PT), hand elevation test (HET), Tinel sign (TS) results were recorded on both hands. The physical examination grades were compared with the electrophysiological CTS grades in 126 hands of 68 patients. Also the comorbidity effect of DPN to CTS was evaluated. For the evaluation of the severity correlations between CTS, PT, HET, and TS, the Spearman analysis was used. An attempt was started to create a formula which could depict the electrophysiological severity of CTS.ResultsOut of the 68 tested subjects, 31 were diagnosed with both DPN and CTS, and 37 with CTS only. Both PT and HET correlated well with the severity of CTS where the correlation of PT was higher than that of HET. The formula were the motor distal latency (MDL)=(72.4-PT)/5.3 and MDL=(76-HET)/7.2. Both PT and HET showed in the presence of DPN a relatively higher relation with CTS without significance.ConclusionPT and HET would be useful screening tools for the diagnosis and treatment of CTS as the grade of PT and HET present the severity of CTS well. During this study, a formula was created expecting the severity of nerve conduction study with PT and HET through the time domain value of physical examinations.

Prevalence and Related Characteristics of Carpal Tunnel Syndrome Among Orchardists in the Gyeongsangnam-do Region

“…Of these tests, Durkan's CCT showed a significant odds ratio, which suggests that physical examination accurately reflects CTS severity. These results are not consistent with those reported by Priganc et al [15] and Jeong and Kim [33]. However, these differences can be explained by variation in (1) study subjects, (2) study design, and (3) diagnostic criteria for CTS severity.…”

“…In addition, Priganc and Henry [15] investigated the correlation of CTS severity with Tinel's sign, Phalen's test, and Durkan's compression test, and they reported that the positive rate with Phalen's test increased significantly with greater severity. Jeong and Kim [33] reported that Phalen's and hand elevation tests were significantly correlated with CTS severity, with Phalen's test showing a higher correlation than the hand elevation test.…”

Assessment of Peripheral Nerves With Shear Wave Elastography in Type 1 Diabetic Adolescents Without Diabetic Peripheral Neuropathy

“…Muscle action potential amplitudes, distal latencies, and conduction velocities were measured. The diagnosis of DPN was established if more than 3 abnormal values for more than 2 different nerves were counted and satisfied the electrophysiologic criteria . Later, patients with DPN were excluded from the final study group.…”

The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

“…Again in Iran in another study Phalen and Tinel signs were positive in 82.2% and 71.1% of patients, respectively [8]. A study investigating the correlation between physical examinations and clinical severity along with the electrodiagnostic findings by subjects with CTS both hand elevation test and Phalen test were correlated well with the severity of CTS where the correlation of Phalen was higher than that of hand elevation test [9]. In 2012, Ma and Kim [10] [10].…”