Diagnose Carpal Tunnel Syndrome Chapel Hill NC

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Eric Ivars Francke, MD
Chapel Hill, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Nc At Chapel Hill Sch Of Med, Chapel Hill Nc 27599
Graduation Year: 2000

Data Provided By:
Laurence Earl Dahners, MD
(919) 966-3340
3153 Bioimformatics Bldg 130 Mason Farm Rd CB 7055,
Chapel Hill, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Az Coll Of Med, Tucson Az 85724
Graduation Year: 1978
Hospital
Hospital: University Of North Carolina H, Chapel Hill, Nc
Group Practice: Unc Med Ctr-Orthopedics

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William Robert Proffit, DDS
(919) 966-4428
University Of Nc Unc Sch Of Dentistry
Chapel Hill, NC
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Andrew R Jones
(919) 968-6008
101 Conner Dr
Chapel Hill, NC
Specialty
Orthopedic Surgery

Data Provided By:
Jeffrey T Spang, MD
(919) 966-9071
School of Medicine CB 7055,
Chapel Hill, NC
Specialties
Orthopedics
Gender
Male
Education
Graduation Year: 2007

Data Provided By:
Mark R McGinnis, MD
(828) 322-5172
30078 Britt
Chapel Hill, NC
Gender
Male
Education
Medical School: Wv Univ Sch Of Med, Morgantown Wv 26506
Graduation Year: 1984

Data Provided By:
Dr.Paul Lachiewicz
(919) 966-4131
101 Conner Drive
Chapel Hill, NC
Gender
M
Education
Medical School: Cornell Univ Med Coll
Year of Graduation: 1977
Speciality
Orthopedic Surgeon
General Information
Accepting New Patients: Yes
RateMD Rating
3.0, out of 5 based on 2, reviews.

Data Provided By:
Kyle Emerson Black Jr, MD
(919) 220-5255
203 Timberhill Pl
Chapel Hill, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Bowman Gray Sch Of Med Of Wake Forest Univ, Winston-Salem Nc 27157
Graduation Year: 1978

Data Provided By:
Donald Benj Kettelkamp, MD
(919) 968-0310
103 Windhover Dr
Chapel Hill, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Ia Coll Of Med, Iowa City Ia 52242
Graduation Year: 1955

Data Provided By:
John Rankin Frick, DDS
(919) 929-7010
102 S Estes Dr
Chapel Hill, NC
Specialties
Orthodontics/Dentofacial Orthopedics

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Best Way to Diagnose Carpal Tunnel Syndrome

Dr. Brent Graham at the Toronto Western Hospital (Canada) has been working on finding the best way to diagnose carpal tunnel syndrome (CTS). Currently, there isn't a clear consensus on the best clinical tests to use in making this diagnosis.

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist. Carpal tunnel syndrome is also known as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of carpal tunnel syndrome.

In the past, Dr. Graham tested and validated a new clinical tool called the CTS-6. This instrument is a diagnostic scale for carpal tunnel syndrome. It includes six tests from the history and physical exam to estimate the likelihood that carpal tunnel syndrome is present. The CTS-6 has been tested and validated as a reliable instrument.

Now, in this study, Dr. Graham compared the results of the CTS-6 with electrodiagnostic testing. Electrodiagnostic testing consisted of sensory nerve conduction velocity (NCV). A segment of the median nerve was tested from the wrist to the middle finger.

There were several steps in this study. First, a hand therapist tested all new patients referred to the center for possible upper extremity peripheral nerve problem. The CTS-6 test was used to determine the pre-test chances the patient had carpal tunnel syndrome. Then these same patients were tested using a standard nerve conduction velocity test.

With the CTS-6 scale, each of the six items is given a point value. The six items include 1) numbness in the hand and fingers supplied by the median nerve, 2) muscle atrophy and/or weakness, 3) a positive Phalen test (standard clinical test used to diagnose carpal tunnel syndrome), 4) loss of two-point discrimination (feeling two separate points touched on the skin), 5) numbness at night that wakes the patient up, and 6) a positive Tinel sign (another standard clinical test used to diagnose carpal tunnel syndrome).

A total score of 12 or more suggests a strong probability (80 per cent chance) that the patient has carpal tunnel syndrome. A total score less than five indicates a very small chance (25 per cent) that the patient has carpal tunnel syndrome.

Comparing the results of the CTS-6 test with the results of the nerve conduction velocity test, the authors report the added information from the electrodiagnostic test was not enough to change the diagnosis or warrant the expense. A low probability of carpal tunnel syndrome (judged by the CTS-6) in a patient whose nerve conduction velocity was negative only lowered the chances of the diagnosis being carpal tunnel syndrome. There wasn't much value added by the electrodiagnostic test -- not enough to support the cost and discomfort to the patient.

With the availability of the CTS-6, there is much less...

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