CPR for Carpal Tunnel Syndrome
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Purpose
[edit | edit source]
Clinical prediction rules (CPRs) combine historical and physical examination findings to help clinicians predict the probability of a particular diagnosis.[1] In 2005, Wainner et al published a level IV CPR to aid clinicians in diagnosing carpal tunnel syndrome.[2]
Clinical Prediction Rule Components [2][edit | edit source]
1. Shaking hands to relieve symptoms
2. Wrist ratio >.67
3. Symptom Severity Scale > 1.9
4. Diminished sensation in median sensory field 1 (thumb)
5. Age > 45 years old
Technique[edit | edit source]
Wrist ratio index, as described by Johnson et al,[3] is measured by using a pair of sliding calipers to measure the anteroposterior (AP) wrist width and the mediolateral (ML) wrist width at the distal wrist crease. Wrist ratio index is then calculated by dividing the AP wrist width by the ML wrist width in centimeters. Ratios greater than .70 were found to be a predisposing factor for carpal tunnel syndrome. [3]
Median nerve sensation was measured on the pad of thumb with end of a straightened paper clip, and compared to sensation at the proximal thenar eminence. Sensory tests were grades as absent, reduced, normal or hyperesthestic
Symptom Severity Scale: The symptom severity scale was published in 1993 by Levine et al [4]. It is an 11 item questionnaire that examines the six critical domains for the evaluation of CTS: pain, paresthesia, numbness, weakness, nocturnal symptoms and overall functional status. Each question is scored from 1 (mildest symptoms) to 5 (most severe symptoms); therefore, a higher score indicates a more severe case of CTS. The SSS has been shown to have good reliability, validity and responsiveness. [4]
Evidence[edit | edit source]
| Sensitivity | Specificity | + LR | - LR | |
| > 3 positive tests | .98 | .54 | 2.1 | .04 |
| > 4 positive tests | .77 | .83 | 4.6 | .28 |
| All 5 tests positive | .18 | .99 | 18.3 | .83 |
| Sensitivity | Specificity | + LR | - LR | |
| Phalen test | .77 | .40 |
1.3 |
.58 |
| Tinel Part A | .41 | .58 |
|
1.0 |
| MMT APB | .19 | .89 |
|
.91 |
| c/o symptoms waking at night | .73 | .31 | 1.1 | .86 |
| c/o fumbling or dropping objects with affected hand | .73 | .57 | 1.7 | .47 |
|
Interpretation (shifts in probablitity) |
+ LR | - LR |
|
large shifts, often conclusive |
> 10 | < 0.1 |
|
moderate shifts |
5-10 | 0.1-0.2 |
|
small shifts, sometimes important |
2-5 | 0.2-0.5 |
| small and rarely important shifts |
1-2 |
0.5-1 |
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Childs JD, Cleland JA. Development and Application of Clinical Prediction Rules to Improve Clinical Decision Making in Physical Therapist Practice. Phys Ther. 2006; 122-131.
- ↑ 2.0 2.1 2.2 2.3 Wainner R, Fritz J, Irrgang J, Delitto A, Allison S, Boninger M. Development of a Clinical Prediction Rule for the Diagnosis of Carpal Tunnel Syndrome. Arch Phys Med 2005; 86: 609-618.
- ↑ 3.0 3.1 Johnson E, Gatens T, Poindexter D, Bowers D. Wrist dimensions: correlation with median sensory latencies. Arch Phys Med Rehabil 1993; 64:556-7.
- ↑ 4.0 4.1 Levine D, Simmons B, Koris M, Daltroy L, Hohl G, Fossel A, Katz J. A Self- Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome. J Bone Joint Surg Am 1993; 75: 1585-92.
- ↑ Jaeschke R, Guyatt G, Sackett D. User's Guide to the Medical Literature III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994; 271:703-707.
