Diagnose Carpal Tunnel Syndrome Woodbridge VA

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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:
Ghassem A Nejad
(703) 690-2970
2020 Optiz Blvd
Woodbridge, VA
Specialty
Orthopedic Surgery

Data Provided By:
Ghassem Abolghasem Nejad, MD
(703) 494-3180
2020B Opitz Blvd
Woodbridge, VA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Teheran Univ, Fac Of Med, Teheran, Iran
Graduation Year: 1961

Data Provided By:
Richard Lee Layfield III, MD
(952) 746-2529
2280 Opitz Blvd Ste 260
Woodbridge, VA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of South Fl Coll Of Med, Tampa Fl 33612
Graduation Year: 1997

Data Provided By:
Patrick D Hart, DDS
(703) 491-4278
12600 Lake Ridge Dr
Woodbridge, VA
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Frederick Gerson Stern, DDS
(703) 494-9119
2200 Opitz Blvd Ste 370
Woodbridge, VA
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Jahan Joubin, MD
(703) 425-0225
2296 Opitz Blvd
Woodbridge, VA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Shiraz Univ Of Med Sci, Shiraz, Iran
Graduation Year: 1965

Data Provided By:
Kenneth Gerard Ward, MD
(703) 491-2262
2010 Opitz Blvd Ste C
Woodbridge, VA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Umdnj-New Jersey Med Sch, Newark Nj 07103
Graduation Year: 1973

Data Provided By:
John Walter Mann III, MD
(703) 497-1234
14573 Potomac Mills Rd
Woodbridge, VA
Specialties
Orthopedics
Gender
Male
Languages
German
Education
Medical School: Univ Of Va Sch Of Med, Charlottesville Va 22908
Graduation Year: 1987

Data Provided By:
Norman S Levy, DDS
(703) 469-6649
12662 Lake Ridge Dr Ste A
Woodbridge, VA
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
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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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