Diagnose Carpal Tunnel Syndrome Somerville MA

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Brian J Awbrey MD
(617) 726-3808
151 Merrimac St
Boston, MA
Specialties
Orthopedics

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Robert Ernst Miegel
(617) 491-6766
300 Mount Auburn St
Cambridge, MA
Specialty
Orthopedic Surgery

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Mercedes D Von Deck
(617) 665-1566
1493 Cambridge St
Cambridge, MA
Specialty
Orthopedic Surgery

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John Kenneth Schuler, MD
1493 Cambridge St
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Cincinnati Coll Of Med, Cincinnati Oh 45267
Graduation Year: 1975

Data Provided By:
Anne Holland Johnson
(917) 538-4656
330 Mount Auburn St
Cambridge, MA
Specialty
Foot & Ankle Surgery

Data Provided By:
Lawrence Ira Karlin, MD
(617) 355-6021
300 Longwood Ave
Boston, MA
Business
Children's Hospital Boston Orthopaedic Surger
Specialties
Orthopedics

Data Provided By:
James Edward Phillips
(617) 491-6766
300 Mount Auburn St
Cambridge, MA
Specialty
Orthopedic Surgery

Data Provided By:
Joseph E Noonan Jr, MD
(425) 883-5151
1493 Cambridge St
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Medical School: St Louis Univ Sch Of Med, St Louis Mo 63104
Graduation Year: 1984

Data Provided By:
James Francis Connor
(617) 864-1924
300 Mount Auburn St
Cambridge, MA
Specialty
Hand Surgery

Data Provided By:
Byron Vartan Hartunian
(617) 864-5700
777 Concord Ave
Cambridge, MA
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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