Jump to ContentJump to Main Navigation
Show Summary Details
More options …
New at De Gruyter

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 18, Issue 3

Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome

Sadegh Izadi
  • Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Department of Neurology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Bahareh Kardeh / Seied Saeed Hosini Hooshiar
  • Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Department of Neurology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mojtaba Neydavoodi / Afshin Borhani-Haghighi
  • Corresponding author
  • Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Department of Neurology, Medical School, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran, Phone/Fax: +98-711-627-2287
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-05-22 | DOI: https://doi.org/10.1515/sjpain-2017-0164

Abstract

Background and aims

Carpal tunnel syndrome (CTS) is a common debilitating condition. As the reliability of CTS-specific physical tests and its clinical grading remain a matter of debate, we determined the correlations between these assessments with nerve conduction study (NCS).

Methods

In this cross-sectional study, patients with uni or bilateral CTS, which was confirmed in electrodiagnosis, were enrolled. Clinical grading was based on the modified criteria of the Italian CTS Study Group. Numeric Pain Rating Scale (NPRS) and Boston Questionnaire (BQ) were used. Physical tests [Phalen’s, reverse Phalen’s, Tinel’s and manual carpal compression test (mCCT)] were performed by a single blinded neurologist. A p-value<0.05 was considered statistically significant.

Results

A total of 100 patients (age=47.48±11.44 years; 85% female) with 181 involved hands were studied. The majority of hands (59.7%) were classified as grade 2 of clinical grading. On NCS, hands with mild (64%), moderate (27%) and severe (9%) CTS were identified. Sensory (velocity, latency and amplitude) and motor parameters (latency and amplitude) were significantly correlated with clinical grades (p-value<0.001). The correlation of NPRS (p-value=0.009) and BQ (p-value<0.001) scores with NCS was significant. None of the physical tests were significantly correlated with NCS in terms of result or duration (p-value>0.05).

Conclusions

We found that physical tests are not a reliable screening method for evaluation of CTS severity. However, the BQ and clinical grading can be more valuable due to their significant correlation with NCS.

Implications

Physicians might benefit from employing clinical grading and BQ in practice for better assessment of CTS severity.

Keywords: carpal tunnel syndrome; clinical decision-making; diagnosis; electrodiagnosis; physical examination

References

  • [1]

    Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008;77:6.PubMedGoogle Scholar

  • [2]

    Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. J Am Med Assoc 1999;282:153–8.CrossrefGoogle Scholar

  • [3]

    Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, Burt S, Garg A, Kapellusch J, Merlino L, Thiese MS, Eisen EA, Evanoff B. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013;39:495.Web of SciencePubMedCrossrefGoogle Scholar

  • [4]

    Geoghegan J, Clark D, Bainbridge L, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg Br 2004;29:315–20.CrossrefPubMedGoogle Scholar

  • [5]

    Maghsoudipour M, Moghimi S, Dehghaan F, Rahimpanah A. Association of occupational and non-occupational risk factors with the prevalence of work related carpal tunnel syndrome. J Occup Rehabil 2008;18:152.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [6]

    Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010;31:243–52.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [7]

    Kleopa KA. Carpal tunnel syndrome. Ann Intern Med 2015;163:ITC1.CrossrefWeb of SciencePubMedGoogle Scholar

  • [8]

    MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 2004;17:309–19.PubMedCrossrefGoogle Scholar

  • [9]

    Ghasemi-rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E, Mohammadi MH, Sayed D, Davarian A, Maleki-Miyandoab T, Hasan A. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol 2014;6:284.PubMedCrossrefGoogle Scholar

  • [10]

    Descatha A, Dale A-M, Franzblau A, Coomes J, Evanoff B. Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies. Occup Environ Med 2010;67:133–5.CrossrefWeb of SciencePubMedGoogle Scholar

  • [11]

    Dale AM, Descatha A, Coomes J, Franzblau A, Evanoff B. Physical examination has a low yield in screening for carpal tunnel syndrome. Am J Ind Med 2011;54:1–9.Web of ScienceCrossrefGoogle Scholar

  • [12]

    Amirfeyz R, Clark D, Parsons B, Melotti R, Bhatia R, Leslie I, Bannister G. Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg 2011;131:471–4.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [13]

    Sucher BM, Schreiber AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am 2014;25:229–47.Web of SciencePubMedCrossrefGoogle Scholar

  • [14]

    Cudlip SA, Howe FA, Clifton A, Schwartz MS, Bell BA. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. J Neurosurg 2002;96:1046–51.PubMedCrossrefGoogle Scholar

  • [15]

    Ibrahim I, Khan W, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012;6:69–76.PubMedCrossrefGoogle Scholar

  • [16]

    Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res 2011;469:1089–94.CrossrefGoogle Scholar

  • [17]

    Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23:1280–3.CrossrefPubMedGoogle Scholar

  • [18]

    Padua L, LoMonaco M, Gregori B, Valente E, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96:211–7.PubMedGoogle Scholar

  • [19]

    Padua L, Padua R, LoMonaco M, Romanini E, Tonali P, Group ICS. Italian multicentre study of carpal tunnel syndrome: study design. Ital J Neurol Sci 1998;19:285–9.PubMedCrossrefGoogle Scholar

  • [20]

    Padua L, Padua R, Monaco ML, Aprile I, Tonali P, Group ICS. Multiperspective assessment of carpal tunnel syndrome a multicenter study. Neurology 1999;53:1654–9.CrossrefPubMedGoogle Scholar

  • [21]

    Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. 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.PubMedCrossrefGoogle Scholar

  • [22]

    de Carvalho Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord 2006;7:78.CrossrefPubMedGoogle Scholar

  • [23]

    Greenslade J, Mehta R, Belward P, Warwick D. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire? J Hand Surg 2004;29:159–64.CrossrefGoogle Scholar

  • [24]

    Rezazadeh A, Bakhtiary AH, Samaei A, Moghimi J. Validity and reliability of the Persian Boston questionnaire in Iranian patients with carpal tunnel syndrome. Koomesh 2014:138–45.Google Scholar

  • [25]

    Foroozanfar Z, Ebrahimi H, Khanjani N. Validity and reliability of the Persian Boston Questionnaire in diabetic patients with carpal tunnel syndrome. J Neyshabur Univ Med Sci 2015;2:50–6.Google Scholar

  • [26]

    Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JC. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002;113:1429–34.CrossrefPubMedGoogle Scholar

  • [27]

    McDiarmid M, Oliver M, Ruser J, Gucer P. Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks? Environ Res 2000;83:23–32.PubMedCrossrefGoogle Scholar

  • [28]

    Bland JD. The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought? Muscle Nerve 2005;32:527–32.PubMedCrossrefGoogle Scholar

  • [29]

    Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G, Violante FS. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue-and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med 2009;66:299–304.CrossrefWeb of SciencePubMedGoogle Scholar

  • [30]

    Gulliford MC, Latinovic R, Charlton J, Hughes RA. Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes. Diabetes Care 2006;29:1929–30.CrossrefPubMedGoogle Scholar

  • [31]

    Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002;48:269–73.CrossrefPubMedGoogle Scholar

  • [32]

    Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes. Diabetic Med 2005;22:625–30.CrossrefGoogle Scholar

  • [33]

    Shiri R. Hypothyroidism and carpal tunnel syndrome: a meta-analysis. Muscle Nerve 2014;50:879–83.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [34]

    Srikanteswara PK, Cheluvaiah JD, Agadi JB, Nagaraj K. The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. J Clin Diagn Res 2016;10:OC13–8.PubMedWeb of ScienceGoogle Scholar

  • [35]

    Ansari NN, Adelmanesh F, Naghdi S, Mousavi S. The relationship between symptoms, clinical tests and nerve conduction study findings in carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol 2009;49:53.Google Scholar

  • [36]

    Ogura T, Akiyo N, Kubo T, Kira Y, Aramaki S, Nakanishi F. The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. J Orthop Surg Res 2003;11:190–3.CrossrefGoogle Scholar

About the article

Received: 2017-11-13

Revised: 2018-03-09

Accepted: 2018-03-14

Published Online: 2018-05-22

Published in Print: 2018-07-26


Authors’ statements

Research funding: Funded by a grant from the Shiraz University of Medical sciences (grant no. 10972).

Conflict of interest: Authors declare no conflict of interest.

Informed consent: Informed written declaration of consent was obtained from each patient and data confidentiality was guaranteed.

Ethical approval: Our study was designed according to the Helsinki Declaration and approved by the Ethics Committee of Shiraz University of Medical Sciences.


Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 345–350, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2017-0164.

Export Citation

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.Get Permission

Comments (0)

Please log in or register to comment.
Log in