Síndrome del túnel del carpo. Correlación clínica y neurofisiológica: revisión de 100 casos

Abstract

The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. This study attempts to find the correlation between the subjective symptomatology and the neurophysiological affectation, establishing a diagnostic guide for the family doctor in order to recognize early CTS for referral to the specialist doctor. After a sample of 100 cases with clinical suspicion of CTS, a clinical evaluation was made with the symptoms (paresthesias, pain, loss of strength), signs (Tinel, Phalen), and the neurophysiological evaluation with electroneurography (ENG) of the median and cubital nerve (sensory velocity (SV), motor distal latency (MDL)), and electromyography (EMG) of tenar eminence muscles. With this data an epidemiological study was made with correlation between the clinical and neurophysiological parameters. The patients with pain, loss of strength and Tinel's sign had significant alteration of the parameters of ENG and EMG. Tinel's sign had a sensitivity (SE) = 30.1% and a specificity (SP) = 73% for MDL, a SE = 32.5% and a SP = 88.2% for SV. Phalen's sign had a SE = 22.2% and a SP = 94.6% for MDL, a SE = 18.1% and a SP = 94.1% for SV. The guide to recognize clinically the patients which must be studied neurophysiologically that have a high probability to suffer CTS is: diagnosis for motor alteration, pain (SE = 79%), loss of strength (SP = 86%) and Phalen's sign (SP = 94.6%). Sensory alteration: paresthesias (SE = 97%), Tinel's sign (SP = 88.2%) and Phalen's sign (SP = 94.1%).