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

Takwa B Younes,Enas A Elattar

doi:10.4103/1110-161x.123808

Takwa B Younes, Enas A Elattar

Open Access

https://doi.org/10.4103/1110-161x.123808

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Abstract

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

Highlights

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb
(5) Special tests for carpal tunnel syndrome (CTS) (Tinel’s sign, Phalen’s test, and reverse Phalen’s test [1] with a 2-min interval between each test) were carried out before the hand elevation tests and the electrophysiological studies after at least 5 min to avoid their effect on the new attended test. (6) The hand elevation test was performed by just elevating both hands above the head and maintaining in position until the patient felt parasthesia,numbness, and dull pain in the median nerve distribution in the hand; the test result was considered positive if symptoms occurred within 2 min [12]
As the ischemic attack to the median nerve is related to the pathophysiology of CTS, and as hypothesized, hand elevation above the shoulder may be the cause of ischemia of the median nerve [22], this raises the idea beyond the importance of the study of the

Summary

Introduction

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. 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. 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

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