Diagnose Carpal Tunnel Syndrome Hickory NC

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Richard Marion Garlitz, DDS
(828) 322-1535
382 10Th Avenue Dr Ne
Hickory, NC
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Edwin Louis Peak
(828) 345-6468
36 14th Ave Ne
Hickory, NC
Specialty
Orthopedic Surgery

Data Provided By:
Heber Grey Winfield
(828) 322-5172
214 18th St Se
Hickory, NC
Specialty
Orthopedic Surgery, Sports Medicine

Data Provided By:
John L DePerczel
(828) 324-2800
2165 Medical Park Dr
Hickory, NC
Specialty
Orthopedic Surgery

Data Provided By:
E Louis Peak, MD
(866) 324-2850
2165 Medical Park Dr
Hickory, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Emory Univ Sch Of Med, Atlanta Ga 30322
Graduation Year: 1997

Data Provided By:
David C Hamilton, DDS
(828) 328-1088
322 10th Avenue Dr Ne
Hickory, NC
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Jeremy Clyde Johnson, MD
(704) 355-3184
PO Box 20500
Hickory, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Tulane Univ Sch Of Med, New Orleans La 70112
Graduation Year: 1998

Data Provided By:
John Leslie De Perczel, MD
(828) 294-9164
2165 Medical Park Dr
Hickory, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Loyola Univ Of Chicago Stritch Sch Of Med, Maywood Il 60153
Graduation Year: 1972
Hospital
Hospital: Catawba Mem Hosp, Hickory, Nc; Frye Reg Med Ctr, Hickory, Nc
Group Practice: Carolina Orthopaedic Specialists; Carolina Orthopaedic Specialists Newton

Data Provided By:
Paul Eugene Brown, MD
(828) 322-5172
214 18th St SE
Hickory, NC
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Nc At Chapel Hill Sch Of Med, Chapel Hill Nc 27599
Graduation Year: 1969

Data Provided By:
Alfred E Geissele
(828) 324-2800
2165 Medical Park Dr
Hickory, NC
Specialty
Orthopaedic Surgery of the Spine

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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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