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Electrophysiological assessment of hand elevation test in the diagnosis of carpal tunnel syndrome

Abstract

Background

Provided that the hand elevation test can reproduce the symptoms of carpal tunnel syndrome (CTS), this phenomenon prompted the idea of developing a simple test to diagnose CTS.

Aim

The aim of this study was assess the electrophysiological values of the hand elevation test in the diagnosis of CTS syndrome.

Patients and methods

Thirty patients with initial symptoms and clinical signs of CTS in 49 hands were included. Special provocative tests for CTS were carried out before the hand elevation tests and the electrophysiological studies at least 5 min to avoid their effect on the intended test. The hand elevation test was performed and the test result was considered positive if symptoms occurred within 2 min. Nerve conduction study, including motor and sensory nerve conduction studies with F-wave study for both median nerves, was performed twice immediately before and after the hand elevation provocative test.

Results

This study was carried out on 60 hands; however, the initial complaint was in 49 hands, where the results showed a highly significant difference in parasthesia and hand pain, values of nerve conduction study (distal motor and sensory latencies) both before and after the hand elevation test, and a nonsignificant difference in the F-wave latencies. The posthand elevation distal motor and sensory latencies showed a sensitivity of 100 versus 78.6%, a specificity of 75 versus 81.2%, a positive predictive value of 77.8 versus 78.6%, and a negative predictive value of 100 versus 81.2%, respectively.

Conclusion

Hand elevation is a simple provocative test that could be the physical examination of choice and can be used as a first-order provocative test instead of other tests for the diagnosis of CTS. Its significant provocative value was documented electrophysiologically.

References

  1. Kanaan N, Sawaya R. Carpal tunnel syndrome: modern diagnostic and management techniques. Br J Gen Pract 2001; 51:311–314.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Manente G, Torrieri F, Pinets F, Uncini A. A relief maneuver in carpal tunnel syndrome. Muscle Nerve 1999; 22:1587–1589.

    Article  CAS  Google Scholar 

  3. Werner RA, Andary M. Carpal tunnel syndrome incidence in general population. Clin Neurophysiol 2002; 113:1373–1381.

    Article  Google Scholar 

  4. Cush JJ, Lipsky PE. Approach to articular and musculoskeletal disorders. In: Fauci AS, editor. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Professional; 2004. p. 2035.

  5. Hoitsmaa E, Reulena JPH, de Baetsb M, Frentc M, Soaabnsa F, Faberb CG. Small fiber neuropathy: a common and important clinical disorder. Joint Bone Spine 2005; 72:412–415.

    Article  Google Scholar 

  6. Wilder-Smith E, Seet R, Lim E. Diagnosing carpal tunnel syndrome-clinical criteria and ancillary tests. Nat Clin Pract Neurol 2006; 2:366–374.

    Article  Google Scholar 

  7. Ma H, Kim I. The diagnostic assessment of hand elevation test in carpal tunnel syndrome. J Korean Neurosurg Soc 2012; 52:472–475.

    Article  Google Scholar 

  8. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, Wilson JR. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58:1589–1592.

    CAS  Google Scholar 

  9. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975; 1:277–299.

    Article  CAS  Google Scholar 

  10. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self administered questionnaire for assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1994; 75:1585–1592.

    Article  Google Scholar 

  11. David W, Barry P, Markle M, Lawran P. A self administered questionnaire for assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75:1585–1592.

    Article  Google Scholar 

  12. Ahn DS. Hand elevation: a new test for carpal tunnel syndrome. Ann Plast Surg. 46; 2001. pp. 120–124.

    Google Scholar 

  13. Chang Y, Wang C, Chang F. Classification of carpal tunnel syndrome by nerve conduction and electromyographic criteria. J Hand Surg Eur 2008; 33:32–37.

    Article  Google Scholar 

  14. Delisa JA, Lee HJ, Baran EM. Median nerve motor conduction velocity and latancy, median nerve distal sensory latancy. In: Delisa JA, editor. Manual of nerve conduction velocity and clinical neurophysiology. 3rd ed. New York: Raven Press; 1994. pp. 68–71.

    Google Scholar 

  15. Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D’Amico P, Padua L. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clin Neurophysiol 2002; 113:71–77.

    Article  CAS  Google Scholar 

  16. Hong YP, Ryu KS, Cho BM, Oh SM, Park SH. Evaluation of thermography in the diagnosis of carpal tunnel syndrome: comparative study between patient and control groups. J Korean Neurosurg Soc 2006; 39:423–426.

    Google Scholar 

  17. Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med 1993; 329:2013–2018.

    Article  CAS  Google Scholar 

  18. Report J, Spinner M. Outcomes for peripheral nerve entrapment syndromes. Clin Neurosurg 2006; 53:258–261.

    Google Scholar 

  19. Bland JD. Treatment of carpal tunnel syndrome. Muscle Nerve 2007; 36:167–171.

    Article  Google Scholar 

  20. Atroshi L, Gummesson C, Johnsson R, Omstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4:9.

    Article  Google Scholar 

  21. González del Pino J, Delgado-Martínez AD, González González I, Lovic A. Value of the carpal compression test in the diagnosis of carpal tunnel syndrome. J Hand Surg Br 1997; 22:38–41.

    Article  Google Scholar 

  22. Lewko J, Polityńska B, Kochanowicz J, Zarzycki W, Mariak Z, Górska M, Krajewska-Kułak E. Median nerve conduction impairment in patients with diabetes and its impact on patients’ perception of health condition: a quantitative study. Diabetol Metab Syndr 2013; 25:5–18.

    Google Scholar 

  23. Amirefeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br. 30; 2005. pp. 361–364.

    Google Scholar 

  24. Park YS, Lee JC, Lee SM. Carpal tunnel syndrome: diagnostic application of MRI and sonography. J Korean Neurosurg Soc 1999; 28:1738–1745.

    Google Scholar 

  25. Karatay S, Aygul R, Melikoglu MA, Yildirim K, Ugur M, Erdal A, et al. The comparison of phonophoresis, iontophoresis and local steroid injection in carpal tunnel syndrome treatment. J Joint Bone Spine 2009; 76:719–721.

    Article  Google Scholar 

  26. El Sheshtawy H, Ghoniena EM, Gamrah SA. Local progesterone injection versus local corticosteroid injection in treatment of idiopathic carpal tunnel syndrome. J Egypt Rheumatol Rehabil 2012; 39:23–35.

    Google Scholar 

  27. Lee WJ, Liao YC, Wei SJ, Tsai CW, Chang MH. How to make electrodiagnosis of carpal tunnel syndrome with normal distal conduction. J Clin Neurophysiol 2011; 28:45–50.

    Article  Google Scholar 

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Correspondence to Takwa B. Younes.

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Younes, T.B., Elattar, E.A. Electrophysiological assessment of hand elevation test in the diagnosis of carpal tunnel syndrome. Egypt Rheumatol Rehabil 40, 203–210 (2013). https://doi.org/10.4103/1110-161X.123808

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