Carpal Tunnel Syndrome Hands Research Articles

A Role of Thermography in the Diagnostics of Carpal Tunnel Syndrom

Presented paper deals with infrared thermography (IRT) used for the diagnostics of Carpal Tunnel Syndrome (CTS). More studies on medical thermography in the relation with CTS diagnostics were published. Jesensek Papez B. et al. in 2008 and 2009 improved outcome with classification success rates near to or over 80% in dorsal segments of hand. The background of this study is the skin physiological temperature distribution difference on the dorsal hands and pathophysiological temperature distribution on hands with CTS and non-invasiveness and painlessness of IRT. For presented study, the database of 268 thermal images of the dorsal side of 120 healthy (n= 120) and 14 pathological hands (n=14) with clinically diagnosed CTS of 8 patients were examined. Pre-surgical thermograms of the hands with CTS of each subject were taken and stored by using IRT (Thermocamera Fluke Ti55/20, FLUKE, USA). The new methodology of measurement and evaluation process of thermograms (SmartView 2.1, FLUKE, USA) was assessed. We observed the temperature distribution of the whole hand and the partial temperatures of the center point of carpals (D1), the center point of metacarpals (D2) and the finger tips of the third finger from proximal phalanges (D3), the intermediate phalanges (D4) to the distal phalanges (D5) and the Median Nerve Index (MI=(D1-D5)) were calculated [35]. Results obtained from measurements of the five defined points on the dorsal side of hands showed, that the temperature of CTS hands is characterized by a higher temperature in the phalanges unlike the wrist (MI<0, 71,4%), while the temperature is the lowest on distal phalanges (D5) of healthy hands (MI≥0, 85,8%). The results showed that the skin temperatures of median nerve distribution area on dorsal hands were significantly different between CTS and the control group. The sensitivity of IRT in diagnostic process of CTS is 0,714. Results will be confirmed by further screening of statistically significant group of patients.

Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome

Carpal tunnel syndrome (CTS), a common entrapment neuropathy involving the median nerve at the wrist, frequently manifests with neuropathic pain. We sought information on pain mechanisms in CTS.We studied 70 patients with a diagnosis of CTS (117 CTS hands). We used the DN4 questionnaire to select patients with neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to assess the intensity of the various qualities of neuropathic pain. All patients underwent a standard nerve conduction study (NCS) to assess the function of non-nociceptive Aβ-fibres, and the cutaneous silent period (CSP) after stimulation of the IIIrd and Vth digits, to assess the function of nociceptive Aδ-fibres. In 40 patients (75 CTS hands) we also recorded laser-evoked potentials (LEPs) in response to stimuli delivered to the median nerve territory and mediated by nociceptive Aδ-fibres. We sought possible correlations between neurophysiological data and the various qualities of neuropathic pain as assessed by the NPSI.We found that the median nerve sensory conduction velocity correlated with paroxysmal pain and abnormal sensations, whereas LEP amplitude correlated with spontaneous constant pain.Our findings suggest that whereas paroxysmal pain and abnormal sensations reflect demyelination of non-nociceptive Aβ-fibres, spontaneous constant pain arises from damage to nociceptive Aδ-fibres.

Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) < or =46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) > or =4.25 ms (wrist to APB, 8 cm). 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

The serial use of two provocative tests in the clinical diagnosis of carpal tunel syndrome.

1) To examine the diagnostic value of the newly proposed manual carpal compression test (mCCT). 2) To evaluate the test efficacy of a serial use of mCCT and Phalen's test (PT) in the clinical diagnosis of carpal tunnel syndrome (CTS) in comparison with standard nerve conduction studies. Prospective, controlled study of 47 patients with 63 symptomatic CTS hands according to clinical as well as electrophysiological criteria. In the control group, 39 hands of 20 healthy volunteers were examined. Clinical neurological examination including mCCT and PT and standard nerve conduction studies were always performed: sensory nerve conduction velocity third and fifth digit to wrist, median distal motor latency. Calculation of sensitivity, specificity, positive and negative predictive value for the mCCT, PT and mCCT+PT, i.e. at least one of both tests positive after sequential application. Sensitivity 83% for mCCT, 79% for PT and 92% for mCCT+PT. Specificity 92% for all three conditions. Excellent positive predictive value of 95% and good negative predictive value of 88% for mCCT+PT. The serial application of mCCT and PT is very useful in the clinical diagnosis of CTS. This finding facilitates the clinical diagnosis by the primary physician, it helps to improve referral decisions to electrophysiological departments and other ancillary examinations and may reduce costs.

Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands.

To evaluate the following points about carpal tunnel syndrome (CTS): 1) characterization of a wide population; 2) sensitivity of electrodiagnostic tests, and particularly the contribution of disto-proximal ratio test; 3) validity of a neurophysiological classification developed by us. Prospective study in 500 hands with CTS symptoms. Neurophysiological "standard" tests were always performed: sensory nerve conduction velocity (SNCV) first- and third digit-wrist and distal motor latency (DML). In "standard negative" hands disto-proximal ratio technique (R) was performed. Neurophysiological classification: Extreme CTS (absence of median motor, sensory responses), Severe (absence of sensory response, abnormal DML), Moderate (abnormal SNCV, abnormal DML), Mild (abnormal SNCV, normal DML), Minimal (abnormal R or other segmental/comparative test, normal standard tests). Sensibility of standard tests: 77%. R increased the diagnostic yield by 20%. CTS classification appeared reliable with significant differences between groups. R is a useful test, the classification may be useful in clinical/therapeutical decisions.

Laser evoked potentials in Carpal Tunnel Syndrome

The aim of this study was to evaluate the function of Adelta fibers at the hand level in patients with clinical symptoms of Carpal Tunnel Syndrome (CTS) using CO(2) laser evoked potentials (LEPs), in light of the intensity and distribution of sensory symptoms and pain. Thirty-four CTS outpatients (62 hands) were compared to 23 sex- and age-matched control subjects (46 hands). The periungueal skin of the first, second, third and fifth fingers, and the dorsum of the hands were stimulated in random order. The latency and amplitude of the N2, P2 and N1 components were evaluated with respect to the Nerve Conduction Study (NCS) data, clinical scales, pain intensity and glove-like symptoms distribution. The amplitude of the N2-P2 complex was significantly reduced in CTS hands compared to normal hands after stimulation of the second and third fingers, even in patients with mild nerve conduction impairment. No significant fifth finger LEP abnormalities were found in patients with glove-like distribution symptoms. The N2-P2 amplitude at the second and third fingers was positively correlated with the severity of sensory symptoms. The involvement of median nerve Adelta fibers in CTS seems to be an early phenomenon, which concurs with the impairment of large motor and sensory afferents and is linked to the severity of the disease. The finding of reduced sensory symptoms in patients with severe thin afferents damage, may suggest a slight expression of central sensitisation phenomena in the advanced stage of CTS syndrome.

Pain and motor function in carpal tunnel syndrome

Patients with carpal tunnel syndrome (CTS) complain of motor symptoms. The study is aimed to understand which features are associated with the presence of motor symptoms in CTS. We recruited 282 consecutive CTS patients. After selection, 129 patients (203 hands) were included. Patients were asked about the presence and severity of hand weakness (HW) and hand clumsiness (HC). They underwent a self-administered questionnaire on symptoms, clinical evaluation and neurographic study. Quantitative sensory testing (QST) was performed on the patients with unilateral right CTS. HW and HC may be found in 56 % and 48 % of CTS hands, respectively. HW was related to the severity of sensory symptoms (pain, numbness and tingling) but not to clinical-neurographic measures of median nerve involvement. HC was related to the severity of sensory symptoms and to the clinical-neurographic signs of motor but not sensory nerve damage. Motor symptoms were significantly more frequent in right hands. QST showed a relationship between the presence and severity of HW and HC and the warm threshold. Motor symptoms may be found in approximately half of CTS hands. Clinical and neurographic signs of median nerve motor damage appear to be poorly correlated to motor symptoms. The factor that can help reconcile the discrepancy between motor symptoms and motor signs is pain. Pain modulation on motor function may take place at various anatomical levels in CTS. Nociceptive C-fibers may be involved in pain-motor interactions finally leading to motor symptoms.

The pneumatic compression test and modified pneumatic compression test in the diagnosis of carpal tunnel syndrome

There are no precise criteria for the diagnosis of carpal tunnel syndrome (CTS): the history is useful but the value of the various provocative tests is questionable. The purpose of this study was to examine the diagnostic value of a new provocative test, the 'modified pneumatic compression test' in CTS. The study group consisted of 37 patients with 50 symptomatic CTS hands. A control group of 50 healthy volunteers was recruited. The diagnosis was based on a combination of the history, the clinical findings on examination and electrophysiological criteria. Sensitivity for the pneumatic compression and the modified pneumatic compression tests were 68% and 84%, respectively. Specificities for these tests were 97% and 95%, respectively. The modified pneumatic compression test demonstrated high sensitivity and specificity for CTS. This test facilitated the diagnosis and was easy to use. It may reduce referrals for neurophysiology testing, and so reduce costs.

Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome

In previous studies, changes in impulse transmission of ulnar motor axons have been documented in patients with carpal tunnel syndrome (CTS). We examined ulnar sensory conduction in 144 CTS hands. In particular, conduction parameters of the dorsal ulnar cutaneous branch (DUC) running outside Guyon's canal were compared with those of the superficial sensory branches (U4 and U5) passing through the canal. U4 and U5 response amplitudes and U5 conduction velocity were significantly lower than in controls. Conduction parameters of the DUC were similar in both groups. Patients with more severely impaired median conduction had smaller ulnar sensory action potentials. We propose that the ulnar nerve may be subject to compression in Guyon's canal as a consequence of high pressure in the carpal tunnel of CTS patients. This may provide insights into the mechanisms underlying extra-median spread of sensory symptoms in CTS patients.

Research—Carpal Tunnel Syndrome—Hand Conditions

Research—Carpal Tunnel Syndrome—Hand Conditions

Postoperative relieve of abnormal vasoregulation in carpal tunnel syndrome

Objective To study the skin temperature changes as a sign of altered blood flow regulation due to abnormal sympathetic nerve function in carpal tunnel syndrome (CTS) and the efficacy of carpal tunnel release (CTR) operation in the alleviation of those signs and other symptoms of CTS. Subjects and methods Forty-one healthy hands ( n = 41) of 22 volunteers and 22 hands ( n = 22) with clinically diagnosed carpal tunnel syndrome of 16 patients were examined. A series of infrared photos of the hands of each subject were taken and stored by using digital infrared thermography (DIRT) before and 6 months after the CTR. The temperatures of the finger tips from digit 1 (D1) to digit 5 (D5), the center point of thenar (Th) and hypothenar (Ht) eminences were measured, the median nerve index (MI = (D1 − D2) + (D1 − D3) + (D2 − D3)) and the temperature differences between the median and the ulnar nerve distribution area (MED·ULN = (D1 − D5) + (D2 − D5) + (D3 − D5) + (Th − Ht)) were calculated. Absolute values were used when calculating the temperature differences between different points. Results All the CTS patients were released from the CTS symptoms, i.e. numbness and pain after the operation, and the results of nerve conduction studies (NCS) were all back to normal. The MI and MED·ULN in CTS hands were significantly smaller before CTR compared to those of healthy control subjects (MI: p < 0.001, MED·ULN: p < 0.005), and those after CTR ( p < 0.005 for both parameters). The results also showed that all finger tips of the affected hand including those innervated by the ulnar nerve were cooler before but warmer after the operation. Before the operation, the non-CTS hands of the CTS patients, were also colder (although the difference was not significant) than the healthy control subjects but approached the same level after the CTR operation of the CTS hands. Conclusion The results of DIRT measurements suggest that the blood flow regulation in CTS is abnormal possibly because of disturbed sympathetic vasomotor regulation and that the circulation gets normal together with the alleviation of the other symptoms of CTS as recorded 6 months after CTR operation.

The median palmar cutaneous nerve in normal subjects and CTS

Objective The neurophysiological confirmation of carpal tunnel syndrome (CTS) relies on detecting abnormal median nerve transcarpal conduction in the presence of unaffected comparator nerves. We compare the palmar cutaneous median branch (PCBm) with the ulnar sensory nerve conduction to digit 5 (US 5) as comparator nerves for diagnosing CTS. Methods In a prospective case control study of patients with clinically defined carpal tunnel syndrome and normal subjects, we determined and compared the PCBm and US 5 conduction velocity. Results We examined 57 hands with clinically defined CTS and 59 control hands. Comparison showed highly significantly slowed PCBm conduction ( p < 0.0001) but not for US 5 conduction ( p = 0.488). Using a 3 percentile cut-off for abnormality derived from controls, PCBm conduction velocity was abnormal in 46% of CTS hands. Conclusions The high frequency of PCBm nerve conduction abnormality in CTS suggests that this nerve should not be used as a comparator nerve for the neurophysiological diagnosis of CTS. This finding may help explain some of the extension of sensory symptoms outside the median nerve distribution in CTS. Significance In CTS frequent abnormality of PCBm conduction makes this a poor comparator nerve and may explain extension of sensory symptoms beyond the median nerve.

A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome

Objective The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument–assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands. Methods The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM. Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at 3 months' follow-up). Results After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions. Data from the control hand did not change across measurement time points. Conclusions Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.

The significance of intact sympathetic skin responses in carpal tunnel syndrome

The current study aimed to investigate the impact of carpal tunnel syndrome (CTS) on sympathetic skin response (SSR) recorded from the median and ulnar territory. Thirty patients were studied and idiopathic CTS was documented in a total of 46 hands. These were classified, according to electrophysiological criteria, into two groups; a group of 31 hands with severe CTS and a group of 15 hands with mild/moderate CTS, and were compared with a group of 30 hands of age-matched controls. SSR was recorded simultaneously from the median and ulnar side of the palm following electrical stimulation at the wrist, in a mid-point between median and ulnar nerve. Latency, amplitude, habituation and the median-to-ulnar ratio were estimated. In all controls clear recordings of SSR were obtained. In the patient groups, absence of SSR was never observed either in mild/moderate or in the severe CTS hands. The mean SSR latency and amplitude values recorded from both the median and ulnar nerves did not significantly differ between mild/moderate or severe CTS hands and controls. Likewise, the median-to-ulnar ratio and habituation of SSR latencies and amplitudes did not significantly differ between groups. SSR does not seem to be a sensitive method for evidence of autonomic involvement in CTS, even in patients manifesting sudomotor or other autonomic symptoms. In the present setting, SSR appeared to be independent of somatic afferent function and the corresponding sensory action potentials.

Carpal tunnel syndrome in older adults

The clinical and electrophysiologic characteristics of carpal tunnel syndrome (CTS) in elderly adults are not well established. We examined age differences in clinical, functional, and electrophysiologic features in elderly adults referred to a neuromuscular service for evaluation of symptoms suggestive of CTS. Of 415 consecutive subjects referred over an 18-month period, 343 met clinical criteria for CTS. There were 158 young (<or=50 years), 115 middle-aged (51-64 years), and 70 elderly adults (>or=65 years). There were no age differences in the duration of CTS symptoms, hand function, or presence of autonomic symptoms. The elderly adults had a higher prevalence of thenar weakness and thenar atrophy than younger subjects. Electrophysiologic abnormalities were more common and more severe in the older subjects. Our study shows that although there are no age differences in subjective complaints of CTS, older adults had objective clinical and electrophysiologic evidence of a more severe median nerve entrapment. The findings suggest that greater attention needs to be paid to objective evidence of CTS severity rather than subjective complaints when evaluating elderly adults presenting for clinical evaluation of CTS.

Sympathetic pathology evidenced by hand thermal anomalies in carpal tunnel syndrome

Objective: To clarify sympathetic pathology in carpal tunnel syndrome and the usefulness of digital infrared thermography as a diagnostic aid. Material and methods: 38 clinically diagnosed carpal tunnel syndrome hands from 30 patients (confirmed by the standard nerve conduction studies) and 41 hands from 22 healthy volunteers (the hands having current finger inflammation were excluded) were studied. A series of hand infrared photos of each subject were taken and stored by using the technique of digital infrared thermography. We studied the infrared pictures and measured the temperatures of finger tips from digit 1 (D1) to digit 5 (D5), the center point of thenar (Th) and hypothenar eminences (Ht), then we calculated the temperature differences (absolute values) between each two of the 7 points, and median index (MI): (D1 − D2) + (D2 − D3) + (D1 − D3). The means of D2 and Th (MD2 + Th), D5 and Ht (MD5 + Ht) were also calculated. Results: The results showed that the temperatures of median nerve distribution area in the hands were highly significantly different (Th − Ht, p < 0.001, MI, p < 0.001) between carpal tunnel syndrome (CTS) and the control group. The differences between the median and ulnar nerve distribution area were also highly significantly different in CTS hands (MD2 + Th compared to MD5 + Ht, p < 0.01). The sensitivity and specificity of digital infrared thermography were 84 and 91%, respectively. Conclusion: Digital infrared thermography suggests sympathetic neural pathology in carpal tunnel syndrome. It may also be useful as an additional non-invasive tool in the diagnosis of CTS especially in the early stage.

Sympathetic skin response in idiopathic and diabetic carpal tunnel syndrome

Background In carpal tunnel syndrome (CTS), certain changes were expected in sympathetic skin response (SSR) because median nerve carries postganglionic unmyelinated fibres. Purpose To investigate the median and ulnar SSR in idiopathic and diabetic CTS without autonomic dysfunction in hands and to find possible relations with electrophysiological features of these diseases. Patients and methods SSRs were elicited by electrical stimulation on the supraorbital nerve and recorded from the median and ulnar territories in the hand from 20 diabetic patients with only CTS (29 hands), 24 idiopathic CTS patients (42 hands) and 13 normal subjects (26 hands). Hands with ulnar neuropathy at the wrist without symptoms and normal hands of unilateral CTS were excluded. In addition to classical parameters and comparative methods, SSR waveform changes and percentile method was used in finding abnormality. Results Median SSRs had significant delayed latency compared to ulnar latency in both CTS patients but this was not important clinically (1.38/1.37 s for idiopatic CTS; 1.43/1.36 s for diabetic CTS). Median and ulnar SSR amplitude, area, median/ulnar latency difference, amplitude and area ratio were compared and only median/ulnar latency difference and median/ulnar latency ratio were found different between the three groups. Four idiopathic CTS hands were outside of the limits or absent (9.5%). SSR waveforms were significantly different from normal subjects in CTS patients. P type SSR replaced M type in idiopathic CTS and N type in diabetic CTS. Conclusions Findings regarding SSR parameters suggest that unmyelinated C fibers were affected in CTS. These values were not useful because they were too small. Data on SSR were not normally distributed and the percentile method seems to be more convenient for finding any abnormality in clinical practice. Also, SSR waveform analysis could give us valuable data and should add to the SSR examination parameters.

Outcome of surgical release among diabetics with carpal tunnel syndrome

Mondelli M, Padua L, Reale F, Signorini AM, Romano C. Outcome of surgical release among diabetics with carpal tunnel syndrome. Arch Phys Med Rehabil 2004;85:7–13. Objective To compare the results of surgical decompression of carpal tunnel syndrome (CTS) in patients with diabetes with those of patients with idiopathic CTS. Design Prospective case series. Setting Ambulatory care in Italy. Participants Twenty-four consecutive patients with diabetes type 1 or 2 and CTS (mean age, 66.7y) were matched for age and sex with 72 patients (mean age, 66.2y) with idiopathic CTS. Interventions All patients underwent surgical release of CTS by the mini-incision of palm technique. Main outcome measures Clinical and electrophysiologic evaluation and patient self-administered Boston Questionnaire (BQ) for the assessment of severity of CTS symptoms and hand functional status before and 1 and 6 months after surgery. Results After surgical release, almost all patients of both groups reported an absence of pain, disappearance or reduction of paresthesia, and improvement in hand function. One month after surgery, there was a significant improvement in clinical status, BQ scores, and distal conduction velocities of the median nerve. A further improvement was evident at 6-month follow-up. There were no differences between the 2 groups in the number of surgical complications, in clinical and electrophysiologic status, or in BQ scores before and after surgery. The improvement in distal conduction velocities of the median nerve, BQ scores, and clinical and electrophysiologic status were similar in the 2 groups after surgery. Conclusion Diabetes is not a risk factor for poor outcome of surgical decompression of CTS. Patients with diabetes have the same probability of positive surgical outcome as patients with idiopathic CTS.

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 32

Carpal Tunnel Syndrome (CTS) is a well‐known entrapment disease. Recently, many study allowed us to improve our knowledge on CTS. Nevertheless many other topics on this common entrapment are not thoroughly assessed. The Italian CTS Study Group performed a multicenter (11 centers) survey study on more than 500 CTS hands with a large, multi‐perspective and multi‐measurement assessment. We used validated clinical, neurophysiological, and patient‐oriented measurements of CTS. In this study we assessed the following issues: 1) It is well known that menopause is related with CTS but no studies evaluated the clinical relationship between the entrapment and the clinical condition. 2) It is still matter of debate if alcohol may be related with CTS. 3) Someone hypothesized that computer pointing devices (mouse and keyboards) may cause CTS. 4) It is well known that patients with CTS complain of partial disability of the hand with frequent falling objects, but no study evaluated this important aspect in daily activity and related with the severity of the disease. Further issues, acquired through the database were assessed. Multi‐perspective and multi‐measurement assessment, even by using validated patient‐oriented tool, provided interesting information confirming and clarifying some poorly studied aspects often observed in CTS patients.

A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment

Objective: To validate a new clinical scale of carpal tunnel syndrome (CTS). The scale is based on clinical history and physical examination findings and includes two figures. The first is a score determined by clinical history and objective findings. The second evaluates the presence/absence of pain as a dichotomous categorical score.Methods: One hundred and sixty-eight consecutive idiopathic CTS hands were studied in two centers (Rome, Siena). We compare the results of the historical-objective scale (Hi-Ob scale) with the results of other validated measurements of CTS severity: (1) the Italian version of the Boston Carpal Tunnel Questionnaire, (2) the neurophysiological classification adopted by the Italian CTS study group. Furthermore, for the Hi-Ob scale the intra-observer and inter-observer evaluations were assessed.Results: The main Hi-Ob parameter was positively related to the conventional validated measurements. Conversely, the category ‘PAIN’ of the Hi-Ob scale appeared unrelated to the other clinical and electrophysiological parameters. Intra- and inter-observer evaluation showed the reproducibility of the Hi-Ob assessment.Conclusions: Our data show that the Hi-Ob scale is a reliable measurement which may be useful in CTS evaluation either for clinical or for scientific purposes.