CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 290-294
DOI: 10.1055/s-0042-1742337
Artigo Original
Mão

Diagnostic Contradictions in Carpal Tunnel Syndrome[*]

Article in several languages: português | English
1   Serviço de Cirurgia da Mão da Santa Casa de São Paulo, São Paulo, SP, Brasil
,
1   Serviço de Cirurgia da Mão da Santa Casa de São Paulo, São Paulo, SP, Brasil
,
1   Serviço de Cirurgia da Mão da Santa Casa de São Paulo, São Paulo, SP, Brasil
,
1   Serviço de Cirurgia da Mão da Santa Casa de São Paulo, São Paulo, SP, Brasil
› Author Affiliations
Financial Support The authors declare that they have received no financial support for the conduction of the present study. All the costs regarding the collection, analysis, interpretation of the results and writing of the article were covered exclusively by the authors.

Abstract

Objective Given the divergence of opinions on the need for complementary tests such as ultrasonography (US) and electroneuromyography (ENMG) for the diagnosis of carpal tunnel syndrome (CTS), we aimed to elucidate which of them presents greater accuracy for the confirmation of the presence or not of this condition.

Methods A total of 175 patients from a hand surgery outpatient clinic were clinically evaluated, and the results of clinical trials (Tinel, Phalen and Durkan), US (normal or altered), and ENMG (normal, mild, moderate and severe) were noted, crossed, and submitted to a statistical analysis to verify the agreement between them.

Results with the sample had a mean age of 53 years, with a prevalence of female patients (159 cases). Of the patients with positive clinical test, 43.7% had normal US and 41.7% had no alterations on the ENMG. Negative results were found on the Tinel in 46.9%, on the Phalen in 47.4%, and on the Durkan in 39.7%. In the crossing between the results of the ENMG and those of the other diagnostic methods, there was little statistical agreement between them.

Conclusion There was no agreement between the results of the clinical examinations, the US and the ENMG in the diagnosis of CTS, and there is no clinical or complementary examination for CTS that accurately determines the therapeutic approach.

Level of Evidence IV, Case Series.

* Work performed at the Hand Surgery and Microsurgery Service of Santa Casa of São Paulo, São Paulo, SP, Brazil.




Publication History

Received: 21 July 2021

Accepted: 14 October 2021

Article published online:
04 February 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Eren Y, Yavasoglu NG, Comoglu SS. The relationship between QDASH scale and clinical, electrophysiological findings in carpal tunnel syndrome. Adv Clin Exp Med 2018; 27 (01) 71-75
  • 2 Keith MW, Masear V, Chung K. et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg 2009; 17 (06) 389-396
  • 3 Hansen PA, Micklesen P, Robinson LR. Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome. Am J Phys Med Rehabil 2004; 83 (05) 363-367
  • 4 Amirfeyz R, Clark D, Parsons B. et al. Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg 2011; 131 (04) 471-474
  • 5 Bickel KD. Carpal tunnel syndrome. J Hand Surg Am 2010; 35 (01) 147-152
  • 6 Stevens JC. American Association of Electrodiagnostic Medicine. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997; 20 (12) 1477-1486
  • 7 Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986
  • 8 Kirkwood BR, Sterne JAC. Essential medical statistics. 2nd ed.. Massachusetts, USA: Blackwell Science; 2006
  • 9 Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998; 9 (03) 342-345
  • 10 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 (01) 65-71
  • 11 Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound 2009; 37 (03) 125-131
  • 12 Akcar N, Özkan S, Mehmetoglu O, Calisir C, Adapinar B. Value of power Doppler and gray-scale US in the diagnosis of carpal tunnel syndrome: contribution of cross-sectional area just before the tunnel inlet as compared with the cross-sectional area at the tunnel. Korean J Radiol 2010; 11 (06) 632-639
  • 13 Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014; 49 (05) 429-436
  • 14 Mondelli M, Filippou G, Gallo A, Frediani B. Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome. Arthritis Rheum 2008; 59 (03) 357-366
  • 15 Padua L, Coraci D, Erra C. et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016; 15 (12) 1273-1284
  • 16 Bagatur AE, Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg Br 2001; 83 (05) 655-658
  • 17 de Krom MC, Knipschild PG, Kester AD, Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. Lancet 1990; 335 (8686): 393-395