Diagnose Carpal Tunnel Syndrome Waupaca WI
Medical School: Med Coll Of Wi, Milwaukee Wi 53226
Graduation Year: 1960
Medical School: Bowman Gray Sch Of Med Of Wake Forest Univ, Winston-Salem Nc 27157
Graduation Year: 1972
Medical School: Mi State Univ Coll Of Human Med, East Lansing Mi 48824
Graduation Year: 1984
Hospital: St Michaels Hospital, Stevens Point, Wi
Group Practice: Ministry Health Care At Rice Medical Center; Rice Medical Center Ministry Health Care
Neuroscience Group of NE Wisconsin
Cervical spine disorders,Degenerative disc disease,Degenerative spinal conditions,Herniated disc / bulging disc,Lumbar spine disorders,Muscle pain / muscle strain,Neck pain,Sciatica / radiculopathy,Scoliosis and deformity,Spinal stenosis,Spondylolisthesis,Sports injuries,Thoracic spine disorders,Whiplash
Exercise,McKenzie Method,Musculoskeletal manipulation,Physical therapy,Rehabilitation,Sports medicine,Strength and Conditioning
Wisconsin Chiropractic Association,National Strength and Conditioning Association
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...