Correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome
DOI:
https://doi.org/10.2340/jrm.v58.44203Keywords:
carpal tunnel syndrome, electrodiagnosis, median neuropathy, pressure, provocativeAbstract
Objective: To assess the correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome.
Design: Cross-sectional correlational study.
Patients: Patients with clinical symptoms consistent with carpal tunnel syndrome were recruited from the electrodiagnosis clinic of the Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between September 2023 and July 2024.
Methods: Patients underwent electrodiagnostic studies, and the severity of carpal tunnel syndrome was classified as mild, moderate, or severe according to the 2011 criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Each participant subsequently received a controlled-pressure provocative test. The time to symptom provocation was recorded, with a maximum duration of 30 s. Spearman’s rank correlation was used to assess the association between test duration and electrodiagnostic severity.
Results: In 124 hands, 31, 45, and 48 hands were categorized by the degree of electrodiagnostic severity as mild, moderate and severe, respectively. There was no correlation (ρ = –0.16, p-value = 0.074) between controlled-pressure provocative test duration and electrodiagnostic severity.
Conclusions: There was no correlation between controlled-pressure provocative test duration and electrodiagnostic severity in patient with carpal tunnel syndrome.
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References
Bland JD. Carpal tunnel syndrome. BMJ 2007; 335: 343–346.
https://doi.org/10.1136/bmj.39282.623553.AD DOI: https://doi.org/10.1136/bmj.39282.623553.AD
Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008; 77: 6–17. DOI: https://doi.org/10.12968/indn.2008.14.3.75647
MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17: 309–319.
https://doi.org/10.1197/j.jht.2004.02.015 DOI: https://doi.org/10.1197/j.jht.2004.02.015
Ozdag Y, Hu Y, Hayes DS, Manzar S, Akoon A, Klena JC, et al. Sensitivity and specificity of examination maneuvers for carpal tunnel syndrome: a meta-analysis. Cureus 2023; 15: e42383.
https://doi.org/10.7759/cureus.42383 DOI: https://doi.org/10.7759/cureus.42383
Wiesman IM, Novak CB, Mackinnon SE, Winograd JM. Sensitivity and specificity of clinical testing for carpal tunnel syndrome. Can J Plast Surg 2003; 11: 70–72.
https://doi.org/10.1177/229255030301100205 DOI: https://doi.org/10.1177/229255030301100205
Lundborg G, Gelberman RH, Minteer-Convery M, Lee YF, Hargens AR. Median nerve compression in the carpal tunnel: functional response to experimentally induced controlled pressure. J Hand Surg Am 1982; 7: 252–259.
https://doi.org/10.1016/s0363-5023(82)80175-5 DOI: https://doi.org/10.1016/S0363-5023(82)80175-5
Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18: 231–241.
https://doi.org/10.1016/s0749-0712(01)00012-9 DOI: https://doi.org/10.1016/S0749-0712(01)00012-9
Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002; 113: 1373–1381.
https://doi.org/10.1016/s1388-2457(02)00169-4 DOI: https://doi.org/10.1016/S1388-2457(02)00169-4
Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 2001; 56: 1459–1466.
https://doi.org/10.1212/wnl.56.11.1459 DOI: https://doi.org/10.1212/WNL.56.11.1459
Kaplan SJ, Glickel SZ, Eaton RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg Br 1990; 15: 106–108.
https://doi.org/10.1016/0266-7681_90_90061-8 DOI: https://doi.org/10.1016/0266-7681_90_90061-8
Alanazy MH, Albulaihe H, Alhumayyd Z, Albarrak AM, Abuzinadah AR. A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome. Brain Behav 2021; 11: e02056.
https://doi.org/10.1002/brb3.2056 DOI: https://doi.org/10.1002/brb3.2056
Cunha TAL, Oliveira OM, Ribeiro MB. Phalen test positivation time and its correlation with electroneuromyography. Acta Ortop Bras 2020; 28: 114–116.
https://doi.org/10.1590/1413-785220202803225744 DOI: https://doi.org/10.1590/1413-785220202803225744
Izadi S, Kardeh B, Hooshiar SSH, Neydavoodi M, Borhani-Haghighi A. Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome. Scand J Pain 2018; 18: 345–350.
https://doi.org/10.1515/sjpain-2017-0164 DOI: https://doi.org/10.1515/sjpain-2017-0164
Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991; 73: 535–538. DOI: https://doi.org/10.2106/00004623-199173040-00009
Williams TM, Mackinnon SE, Novak CB, McCabe S, Kelly L. Verification of the pressure provocative test in carpal tunnel syndrome. Ann Plast Surg 1992; 29: 8–11.
https://doi.org/10.1097/00000637-199207000-00003 DOI: https://doi.org/10.1097/00000637-199207000-00003
Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44: 597–607.
https://doi.org/10.1002/mus.22208 DOI: https://doi.org/10.1002/mus.22208
Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20: 1477–1486.
https://doi.org/10.1002/(sici)1097-4598(199712)20:12<1477::aid-mus1>3.0.co;2-5 DOI: https://doi.org/10.1002/(SICI)1097-4598(199712)20:12<1477::AID-MUS1>3.0.CO;2-5
Yang A, Cavanaugh P, Beredjiklian PK, Matzon JL, Seigerman D, Jones CM. Correlation of carpal tunnel syndrome 6 score and physical exam maneuvers with electrodiagnostic test severity in carpal tunnel syndrome: a blinded prospective cohort study. J Hand Surg Am 2023; 48: 335–339.
https://doi.org/10.1016/j.jhsa.2022.11.020 DOI: https://doi.org/10.1016/j.jhsa.2022.11.020
Dabbagh A, MacDermid JC, Packham T, Grewal R, Fraser J. Provocative maneuvers demonstrate excellent accuracy in the “virtual” diagnosis of carpal tunnel syndrome among people with upper limb conditions: a short technical report. J Hand Ther 2024; 37: 153–156.
https://doi.org/10.1016/j.jht.2023.06.007 DOI: https://doi.org/10.1016/j.jht.2023.06.007
Zaheer SA, Ahmed Z. Neurodynamic techniques in the treatment of mild-to-moderate carpal tunnel syndrome: a systematic review and meta-analysis. J Clin Med 2023; 12: 4888.
https://doi.org/10.3390/jcm12154888 DOI: https://doi.org/10.3390/jcm12154888
Wang L. Guiding treatment for carpal tunnel syndrome. Phys Med Rehabil Clin N Am 2018; 29: 751–760.
https://doi.org/10.1016/j.pmr.2018.06.009 DOI: https://doi.org/10.1016/j.pmr.2018.06.009
Dabbagh A, MacDermid JC, Yong J, Packham TL, Grewal R, Boutsikari EC. Diagnostic test accuracy of provocative maneuvers for the diagnosis of carpal tunnel syndrome: a systematic review and meta-analysis. Phys Ther 2023; 103: pzad029.
https://doi.org/10.1093/ptj/pzad029 DOI: https://doi.org/10.1093/ptj/pzad029
Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75: 1585–1592.
https://doi.org/10.2106/00004623-199311000-00002 DOI: https://doi.org/10.2106/00004623-199311000-00002
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