Diagnose Carpal Tunnel Syndrome Clinton MD

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Edward G Alexander Jr., MD
(703) 461-7100
4801 Kenmore Ave
Alexandria, VA
Business
Northern Virginia Orthopaedic Group
Specialties
Orthopedics

Data Provided By:
James E Callan MD
(301) 891-6130
7610 Carroll Ave
Takoma Park, MD
Specialties
Orthopedics

Data Provided By:
J Michael Joly, MD
(301) 599-9500
9135 Piscataway Rd Ste 300
Clinton, MD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Georgetown Univ Sch Of Med, Washington Dc 20007
Graduation Year: 1981

Data Provided By:
Alan George Schreiber
(301) 856-1682
8926 Woodyard Road
Clinton, MD
Specialty
Orthopedic Surgery

Data Provided By:
Ryan Michael Jander
(301) 856-1682
8926 Woodyard Road
Clinton, MD
Specialty
Orthopedic Surgery

Data Provided By:
David C Johnson, MD
(202) 291-9266
106 Irving St NW
Washington, DC
Business
National Orthopedics PC
Specialties
Orthopedics

Data Provided By:
Vestinia Madonna Polk
(301) 856-1682
8926 Woodyard Road
Clinton, MD
Specialty
Orthopedic Surgery

Data Provided By:
Dennis Angelo Carlini, MD
(301) 856-1682
8926 Woodyard Rd Ste 701
Clinton, MD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Georgetown Univ Sch Of Med, Washington Dc 20007
Graduation Year: 1973

Data Provided By:
Edward Charles Rabbitt, MD
(301) 856-1682
8926 Woodyard Rd Ste 701
Clinton, MD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Temple Univ Sch Of Med, Philadelphia Pa 19140
Graduation Year: 1979

Data Provided By:
John Philip Byrne
(301) 856-1682
8926 Woodyard Road
Clinton, MD
Specialty
Orthopedic Surgery

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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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