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Publication of the Medical Rehabilitation is under the auspices of the Committee on Rehabilitation, Physical Education and Social Integration of the Polish Academy of Science
Article
Medical Rehabilitation - quarterly journal
Volume 11 year 2007, Issue number 4
Provocative tests used in the diagnosis of carpal tunnel syndrome
Authors: Filip Georgiew
Medical Rehabilitation 2007; 11(4): 15-25
Provocative tests used in the diagnosis of carpal tunnel syndrome
Testy prowokacyjne stosowane w diagnostyce zespołu cieśni nadgarstka
Filip Georgiew
Faculty of Health Care, University School in Tarnów, Poland
Division of Rehabilitation, Department of Neurosurgery, St Luke Hospital in Tarnów, Poland
Artykuł otrzymano 30.07.2007
Key words
carpal tunnel syndrome, diagnosis, provocative test, sensitivity, specificity
Abstract
The carpal tunnel syndrome (CTS) is the most often diagnosed compressive neuropathy of the upper limb. As a result of the changes within the tunnel of the median nerve, the disease is associated with hypersensitivity to some external factors such as: an increase in pressure within the carpal tunnel, direct or indirect pressure on the wrist level, hypoxia. These factors are used in provocative tests. The aim of this article is to make a distinction between functional test's classifications used in the CTS diagnosis, depending on the method of ailment provocation. In this article, different modifications used in common tests and their average sensitivity and specificity are also presented. Carpal tunnel syndrome should be diagnosed clinically; although electro-diagnostic studies are a standard method of establishing the diagnosis, they do have limitations. Clinical diagnostic skill must be reinforced by a valuable provocative test: the Provocative Test, the Phalen test + mCCT, Tinel's sign, Phalen's and reverse Phalen's test, Durkan Carpal Compression Test (mCCT). In the article, I also present tests, which, due to their low sensitivity and specificity, are not applied in the CTS diagnostics. Provocative tests are more easily performed than electro-diagnostic studies and are the most appropriate diagnostic tools in the ambulatory setting. Provocative tests are commonly needed for establishing the diagnosis for treatment, screening and determining aetiology. To improve the efficiency of provocative tests, we should apply univocal standards for their performance and interpretation. A combination of tests might be more powerful than a single test in establishing the diagnosis. Taking medical history and performing physical examination should be the primary methods of diagnosing CTS. The addition of nerve conduction studies is unnecessary in most cases. The combination of hand diagram, questionnaires, abnormal sensibility and positive provocative tests will provide a diagnostic tool for CTS with high sensitivity and specificity.
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