2020, Number 1
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Acta Ortop Mex 2020; 34 (1)
Sensitivity and specificity of three complementary methods in the diagnosis of carpal tunnel syndrome
Cristiani-Winer M, Allende-Nores C, Aguirre GL, Robles CO, Ré R
Language: Spanish
References: 14
Page: 31-37
PDF size: 199.97 Kb.
ABSTRACT
Introduction: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class» pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease.
Methods: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method.
Results: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad.
Conclusion: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.
REFERENCES
Fowler JR, Cipolli W, Hanson T. A comparison of three diagnostic tests for carpal tunnel syndrome using latent class analysis. J Bone Joint Surg Am. 2015; 97(23): 1958-61.
Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008; 90(12): 2587-93.
Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006; 31(6): 919-24.
Calandruccio JH, Thompson NB. Carpal tunnel syndrome: making evidence-based treatment decisions. Orthop Clin North Am. 2018; 49(2): 223-9.
Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am. 2014; 39(7): 1403-7.
Fowler JR, Maltenfort MG, Ilyas AM. Ultrasound as a first-line test in the diagnosis of carpal tunnel syndrome: a cost-effectiveness analysis. Clin Orthop Relat Res. 2013; 471(3): 932-7.
Day CS. An alternative solution for the diagnosis of carpal tunnel syndrome: commentary on an article by John R. Fowler, MD, et al. “A comparison of three diagnostic tests for carpal tunnel syndrome using latent class analysis”. J Bone Joint Surg Am. 2015; 97(23): e78.
American Academy of Orthopaedic Surgeons [portal web]. Clinical guideline on diagnosis of carpal tunnel syndrome. Rosemont (IL): American Academy of Orthopaedic Surgeons (AAOS); 2007. [Accesado el 28 de julio de 2014] Disponible in: http://www.aaos.org/Research/guidelines/CTS_guideline.pdf.
Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am. 2008; 33(1): 65e71.
Lane LB, Starecki M, Olson A, Khon N. Carpal tunnel syndrome diagnosis and treatment: a survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2014; 39: 2181-7.
Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med. 2013; 159: 309-17.
D’Auria JL, Montanez A, Toirac A, Goitz RJ, Fowler JR. Accuracy of surgeon diagnosis in predicting carpal tunnel syndrome Hand (NY). 2019; 1558944719856105 [published online ahead of print, 2019 Jun 18].
Sears ED, Swiatek PR, Hou H, Chung KC. Utilization of preoperative electrodiagnostic studies for carpal tunnel syndrome: an analysis of national practice patterns. J Hand Surg Am. 2016; 41(6): 665-672.e1.
Sears ED, Lu YT, Wood SM, Nasser JN, Hayward R, Chung KC, et al. Diagnostic testing requested before surgical evaluation for carpal tunnel syndrome. J Hand Surg Am. 2017; 42(8): 623-629.e1.