Diagnose Carpal Tunnel Syndrome Madison TN

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Calvin Robinson Dyer
(615) 263-6500
3443 Dickerson Pike
Nashville, TN
Specialty
Orthopedic Surgery, Sports Medicine

Data Provided By:
Marion G Doyle, DMD
(615) 865-9400
624 W Due West Ave Ste 120
Madison, TN
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Alan Stuart Henson, MD
(615) 865-1337
510 Hospital Dr Ste 100
Madison, TN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Mi State Univ Coll Of Human Med, East Lansing Mi 48824
Graduation Year: 1977

Data Provided By:
Gary David Rubin, MD
500 Hospital Dr
Madison, TN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Southern Il Univ Sch Of Med, Springfield Il 62794
Graduation Year: 1982

Data Provided By:
Steven G McLaughlin
(615) 860-1580
3443 Dickerson Pike
Nashville, TN
Specialty
Orthopedic Surgery

Data Provided By:
Philip G Krewer, MD
665 Myatt Dr
Madison, TN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Southern Ca Sch Of Med, Los Angeles Ca 90033
Graduation Year: 1995

Data Provided By:
Lawrence Brett Babat
(615) 860-1580
3443 Dickerson Pike
Nashville, TN
Specialty
Orthopaedic Surgery of the Spine

Data Provided By:
Lawrence Brett Babat, MD
(615) 860-1580
3443 Dickerson Pike Ste 190
Nashville, TN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Yale Univ Sch Of Med, New Haven Ct 06510
Graduation Year: 1995

Data Provided By:
Jane Meredith Siegel, MD
(615) 329-6600
3443 Dickerson Pike
Nashville, TN
Specialties
Orthopedics, Hand Surgery
Gender
Female
Education
Medical School: Vanderbilt Univ Sch Of Med, Nashville Tn 37232
Graduation Year: 1988

Data Provided By:
Lloyd Alexis Walwyn, MD
(615) 865-1616
601 W Due West Ave
Madison, TN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Howard Univ Coll Of Med, Washington Dc 20059
Graduation Year: 1967

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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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