Phalen's Test Research Articles

The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome.

Graham, Brent MD, MSc, FRCSC; Peljovich, Allan E. MD, MPH; Afra, Robert MD; Cho, Mickey S. MD; Gray, Rob MD; Stephenson, John MD; Gurman, Andrew MD; MacDermid, Joy PhD; Mlady, Gary MD; Patel, Atul T. MD; Rempel, David MD, MPH; Rozental, Tamara D. MD; Salajegheh, Mohammad Kian MD; Keith, Michael Warren MD; Jevsevar, David S. MD, MBA; Shea, Kevin G. MD; Bozic, Kevin J. MD, MBA; Adams, Julie MD; Evans, Jay Mark MD; Lubahn, John MD; Ray, Wilson Zachary MD; Spinner, Robert MD; Thomson, Grant MD, MSc; Shaffer, William O. MD; Cummins, Deborah S. PhD; Murray, Jayson N. MA; Mohiuddin, Mukarram MPH; Mullen, Kyle MPH; Shores, Peter MPH; Woznica, Anne MLS; Linskey, Erica; Martinez, Yasseline; Sevarino, Kaitlyn MBA

Predictors of Normal Electrodiagnostic Testing in the Evaluation of Suspected Carpal Tunnel Syndrome

Electrodiagnostic studies (electromyography and nerve conduction velocity; EMG/NCV) are used to confirm the diagnosis of carpal tunnel syndrome (CTS) and to evaluate its severity. We investigated the hypothesis that normal electrodiagnostic median nerve testing is predicted by 1) Physician pre-test confidence in the diagnosis of CTS, and 2) Puzzling patient factors. One hundred and forty consecutive patients who underwent electrodiagnostic testing to evaluate for possible CTS were reviewed retrospectively. Both physician confidence in the diagnosis of CTS and puzzling patient factors (heightened illness concern, disproportionate complaints, and vague/nonanatomical/noncharacteristic symptoms) were recorded. Electrodiagnostic testing was used as the reference standard for diagnosis of CTS. Electrodiagnostic testing confirmed CTS in 115 patients and was within normal limits in 25 patients. Low physician confidence in the diagnosis of CTS was highly predictive of a normal electrodiagnostic test (p < 0.001), with high sensitivity (97%), moderate specificity (40%), and high overall accuracy (87%). Puzzling patient factors were moderately predictive of normal electrodiagnostic testing (p < 0.001), with low sensitivity (16%), high specificity (96%), and high overall accuracy (81%). The best multivariable model retained younger age, negative Phalen's test, and low physician confidence as the best predictors of normal electrodiagnostic testing and explained 35% of the variation in test results. A model with low confidence alone explained 19% of the variation in test results. Physician intuition as recorded in the medical record in terms of puzzlement and low confidence are very specific and accurate predictors of normal electrodiagnostic testing in the setting of suspected carpal tunnel syndrome.

Value of ratio of sensory nerves conductive velocity along palm-median finger/wrist-palm in diagnosing the carpal tunnel syndrome

To Verify the value of the ratio of sensory nerves conductive velocity along palm-median finger /wrist-palm minus 1 for diagnosis of the mild-moderate carpal tunnel syndrome(CTS). The different value between 1 and the ratio of sensory nerves conductive velocity along palm-median finger/wrist-palm was defined as index-CTS which was used to assess the severity of CTS.The index-CTS of 100 palms from healthy controls and 58 palms from mild-moderate CTS patients were calculated and compared.Multiple regression was used to identify the relative factors of index-CTS.The ROC curve was used to evaluate the sensitivity and specificity of index-CTS at different values. The value of index-CTS from healthy controls and patients both fitted Gaussian distribution.The mean value were -0.053±0.042 vs 0.055±0.074 in the controls and the patients respectively.The difference was statistically significant between the two groups by T-test(P<0.001). Multiple regression analysis showed that Tinel sign, Phalen sign, laterality, clinical grade, electrical grade were identifiable factors related to index-CTS.When index-CTS was over 0.001 and Ⅳ-DL over 0.395 ms , specificity of diagnosis by both can get 92%, but index-CTS showed more higher sensitivity(98.3% vs 89.7%). Rising index-CTS could be the most significant electrophysiological feature in CTS.It can be used as a sensitive marker to assess the extent of conduction block of median nerve in carpal tunnel.

The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study.

Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. Randomized, placebo-controlled, double-blind study. Thirty patients with chronic carpal tunnel syndrome participated in the study. Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.

Prevalence and Related Characteristics of Carpal Tunnel Syndrome Among Orchardists in the Gyeongsangnam-do Region.

ObjectiveTo determine the prevalence and related characteristics of carpal tunnel syndrome (CTS) in orchardists and to investigate the association between electrodiagnostic severity and physical examinations.MethodsBetween July 2013 and September 2014, 377 subjects (174 men and 203 women) visited the Gyeongsang National University Hospital's Center for Farmer's Safety and Health. All the subjects underwent electrodiagnostic tests and physical examination, including Phalen's test, Tinel's sign, and Durkan's carpal compression test (CCT). The subjects were classified into 2 groups, the normal group and the CTS group, according to electrodiagnostic test results. To determine the related characteristics of CTS, potential variables, including age, sex, drinking, smoking, body mass index, waist circumference, and total work time, were compared between the 2 groups. The association between electrodiagnostic severity and physical examinations was analyzed.ResultsCTS was diagnosed in 194 subjects based only on electrodiagnostic test results, corresponding to a prevalence of 51.5%. Among the variables, mean age (p=0.001) and total work time (p=0.007) were significantly correlated with CTS. With respect to the physical examinations, low specificities were observed for Tinel's sign, Phalen's test, and Durkan's CCT (38.4%, 36.1%, and 40.9%, respectively) in the subjects aged ≥65 years. In addition, Phalen's test (p=0.003) and Tinel's sign (p=0.032) in men and Durkan's CCT (p=0.047) in women showed statistically significant differences with increasing CTS severity. The odds ratio was 2.066 for Durkan's CCT in women according to the multivariate logistic regression analysis.ConclusionCTS prevalence among orchardists was high, and Durkan's CCT result was significantly quantitatively correlated with the electrodiagnostic test results. Therefore, Durkan's CCT is another reliable examination method for CTS.

The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome (CTS) is the most common nerve entrapment. Subjective sensory symptoms are common place in patients with CTS, but sometimes they are not supported by objective findings in the neurological examination. Electrodiagnostic (EDx) studies are a valid and reliable means of confirming the diagnosis. The amplitudes along with the conduction velocities of the sensory nerve action potential and motor nerve action potential reflect the functional state of axons, and are useful parameters and complement the clinical grading in the assessment of severity of CTS. To conduct median nerve sensory and motor conduction studies on patients with carpal tunnel syndrome and correlate the relationship between nerve conduction study parameters and the clinical severity grading. Based on clinical assessment, the study patients were divided into 03 groups with mild CTS, moderate CTS and severe CTS respectively as per Mackinnson's classification. Median and ulnar nerve conduction studies were performed on bilateral upper limbs of 50 patients with symptoms of CTS and 50 age and sex matched healthy control subjects. The relationship between the clinical severity grade and various nerve conduction study parameters were correlated. In this prospective case control study, 50 patients with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined over a 10 month period. A total of 30 patients had unilateral CTS (right upper limb in 19 and left upper limb in 11) and 20 patients had bilateral CTS. Female to male ratio was 3.54 to 1. Age ranged from 25 to 81 years. The mean age at presentation was 49.68±11.7 years. Tingling paresthesias of hand and first three fingers were the most frequent symptoms 48 (98%). Tinel's and Phalen's sign were positive in 36 (72%) and 44 (88%) patients respectively. The mean duration of symptoms at presentation was 52.68±99.81 weeks. 16 patients (32%) had mild CTS, 25 (50%) had moderate CTS and 9 (18%) had severe CTS clinically. Prolongation of motor latency, latency difference between median and ulnar amplitudes, motor and sensory nerve conduction velocities, sensory latency between median and ulnar nerves, sensory nerve conduction velocities showed significant changes in comparison with controls. Among them sensory latency difference between median and ulnar nerves and sensory nerve conduction velocities are the most sensitive and specific for diagnosing CTS. In this study, there was a graded deterioration of electrophysiological parameters along with the clinical severity grades, thus reiterating the fact that NCS provide additional, independent objective evidence in the diagnosis and severity assessment of CTS. The sensory conductions were more sensitive than motor conductions in assessing CTS.

Musculuskeletal system involvement in hemodialysis patients

Objective: Musculoskeletal problems remain among the main limitations of the quality of life of patients undergoing hemodialysis. This study was designed to evaluate the musculoskeletal system involvement in hemodialysis patients. Methods: This study was carried out on the all of the hemodialysis patients of Khatam-al Anbia Hospital, Zahedan, Iran. All patients underwent a precide physical examination. Venous blood samples were obtained for the measurement of calcium, phosphorous, alkaline phosphatase, and parathyroid hormone. An x-ray of the hand was taken from each patient. Results: Thirty seven (37) patients completed the study. The most common symptoms were: carpopedal spasm 54.0%, symptoms of carpal tunnel syndrome 24.2%, arthralgia 21.6%, and bone pain 13.5%. The most common clinical findings were: a positive Phalen test 32.4%, muscle weakness 40.5%, bone deformity 21.6%, and bone tenderness 18.9%. The most common abnormal laboratory tests were: hypocalcemia 51.4%, hyperphosphatemia 43.2%, increased alkaline phosphatase 75.6%, and raised Parathyroid hormone 81.0%. Conclusion: Musculoskeletal involvement is common in our hemodialysis patients.

임신 중 발생하여 출산 후 악화된 수근관 증후군 한방 치험 1례

ABSTRACT A Case Report on Pregnancy-Related Carpal Tunnel Syndrome Worsened after Birth by Korean MedicineJi-Yeong Im 1 , Kuk-In Han 2 , Eun-Hee Lee 1 , Ah-Yeong Lee 1 , Jong-Uk Kim 31 Dept. of Obstetrics & Gynecology, College of Korean Medicine, Woo-Suk University 2 Dept. of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Woo-Suk University 3 Dept. of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Woo-Suk UniversityObjectives: This study is to report the effect of Korean medical treatment on a patient suffered from carpal tu nnel syndrome (CTS) occurred in pregnancy and worsened after birth. Methods: We treated the patient diagnosed as carpal tunnel syndrome by Korean medical treatment such as acupuncture, pharmacopuncture and herbal medicine at ⃝⃝Hospital of Korean Medicine from July 31th 2015 to August 6th 2015. And we evaluated changes of symptoms by Visual Analog Scale (VAS), Tinel sign, Phalen's test, and Digital Infrared Thermographic Imaging (DITI). Results: 1. Through Korean medical treatment, postpartum carpal tunnel syndrome was significantly improved. VAS was decreased from 4 to 2, Phalen’s test was manifested from 10 seconds to 26 seconds and Tinel sign was changed from p ositive to negative.2. We compared the gap of temperature between palm and forearm before and after Korean medical treatment through DITI. The temperature on the right side was changed from 0.74℃ to 1.01℃ and the left one from 0.63℃ to 1.01℃. Conclusions: This case report shows that Korean medical treatment is useful to treat pregnancy-related carpal tunnel syndrome worsened after birth. Key Words: Carpal tunnel syndrome, Postpartum, Korean medical treatment, Tinel sign, Phalen's test

Intraoperative dynamic pressure measurements in carpal tunnel syndrome: Correlations with clinical signs

ObjectiveThis study was designed to evaluate the correlations between dynamic carpal tunnel pressure and clinical signs. MethodsFrom December 2008 to May 2010, open carpal tunnel release (OCTR) was performed on a total of 90 hands (83 patients). All patients completed neurological and provocation tests (two-point discrimination, Tinel test, Phalen test, reverse-Phalen test and assessment of thenar muscle atrophy). Carpal tunnel pressure (CTP) was measured in two parts of carpal tunnel (proximal and distal carpal tunnel) and in three different postures (neutral, wrist flexion and wrist extension). ResultsThere were 74 females and nine males aged 36 to 86 years (mean age 54). CTP values were more elevated in the wrist extension than wrist flexion in the proximal carpal tunnel but not at the distal carpal tunnel. There was no statistically significant correlation among CTP, provocation testing, and clinical signs. However, two-point discrimination (2-PD) showed a statistically significant correlation with CTP, especially in the proximal area in the wrist extension posture (P<0.01). Duration of symptoms (SD) statistically correlated with CTP in the distal carpal tunnel in the neutral posture (P<0.01). Conclusions2-PD and duration of symptoms are correlated with the CTP value in specific areas and with hand postures. This emphasizes the importance of releasing the entire carpal tunnel lesion since CTP values appear to vary within the carpal tunnel space and according to hand posture.

Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers.

ObjectiveTo describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations.Materials and MethodsTwo hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome.ResultsCarpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel’s test (p < 0.0001), Phalen’s test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24).ConclusionThe prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

Carpal Tunnel Syndrome-A Battery of Tests can Improve the Diagnosis

INTRODUCTION: The gold standard for diagnosis of carpal tunnel syndrome (CTS) is not well defined. At times, patients of suspected carpal tunnel syndrome fail to respond to treatment if the diagnosis is based on symptoms alone or on one or two clinical tests probably because the diagnosis is not correct. The purpose of this study was to compare the relative merits of various diagnostic modalities in establishing the diagnosis of CTS and also to define the accurate test or combination of tests to help diagnose and manage CTS.MATERIAL AND METHODS: Patients presenting with symptoms suggestive of CTS were evaluated using (i) Clinical Provocative tests - Durkan's test and Phalen's test, (ii) Tests for sensory perception thresholds using Semmes-Weinstein monofilament nylons (iii) Nerve conduction studies predominately sensory and motor and (iv) Gray scale sonography.RESULTS: When a positive Phalen's test was taken as reference, the positive predictive value of Durkan's test and ultrasonography was 100%, Nylon perception test and neurophysiological studies had a value of 90 and 89% respectively. When Durken's test was used as reference, ultrasonography had a positive predictive value 0f 98% followed by nylon perception testing - 94%. Phalen's test and neurophysiological studies had values of the order of 92 and 88% respectively.CONCLUSION: Our observations suggest that clinical history and physical examination can be used to screen the patients. The perception threshold testing with monofilament nylons and ultrasonographic examination of carpal tunnel (CT) improve the diagnosis. In addition, ultrasonographic examination of CT provides the information on anatomy and condition of the contents of CT and help planning the treatment. A combination of clinical provocative tests, Semmes-Weisntein monofilament testin and high frequency sonography could be considered as definitive diagnostic battery for diagnosing carpal tunnel syndrome.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 26-30

Ultrasonography as a tool in diagnosis of carpal tunnel syndrome

ObjectiveWe aimed to determine the value of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS). MethodsTwo hundred patients (400 hands) were submitted to wrist US to measure median nerve area (MNA), questioning on paresthesia and pain in the median nerve territory, Tinel and Phalen maneuvers. An MNA >9mm2 was considered diagnostic of CTS. ResultsMeasurement of MNA by US was >9mm2 in 27% of the hands. A good association with pain (p<0.0001), paresthesia (p<0.0001), Tinel test (p<0.0001) and Phalen test (p<0.0001) was found. According to the clinical criteria for classification of CTS from American Academy of Neurology the MNA by US had 64.8% of sensibility and 77.0% of specificity in this sample. ConclusionMeasurement of MNA by US performs well and can be used as first option for the investigation of patients with CTS.

Ultrassonografia no diagnóstico da síndrome do túnel do carpo

ObjectiveWe aimed to determine the value of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS). MethodsTwo hundred patients (400 hands) were submitted to wrist US to measure median nerve area (MNA), questioning on paresthesia and pain in the median nerve territory, Tinel and Phalen maneuvers. An MNA>9mm2 was considered diagnostic of CTS. ResultsMeasurement of MNA by US was>9mm2 in 27% of the hands. A good association with pain (p<0.0001), paresthesia (p<0.0001), Tinel test (p<0.0001) and Phalen test (p<0.0001) was found. According to the clinical criteria for classification of CTS from American Academy of Neurology the MNA by US had 64.8% of sensibility and 77.0% of specificity in this sample. ConclusionMeasurement of MNA by US performs well and can be used as first option for the investigation of patients with CTS.

Associations analysis of GSTM1, T1 and P1 Ile105Val polymorphisms with carpal tunnel syndrome.

Oxidative stress was related with carpal tunnel syndrome (CTS). We aimed to clarify the associations between glutathione S-transferase (GST)M1, GSTT1 and GSTP1-Ile105Val polymorphisms and CTS. One hundred-forty patients with CTS and 97 healthy controls were enrolled in this study. Tinel and Phalen signs were noted as positive or negative. Functional and clinical status of patients was evaluated by the Boston Questionnaire. The intensity of hand and/or wrist pain was evaluated on 10cm visual analog scale (VAS). We applied the polymerase chain reaction (PCR) to determine the polymorphisms of the GSTM1 and GSTT1 and the PCR-restriction fragment length polymorphism method for detecting the GSTP1-Ile105Val polymorphism. The M1 null genotype was significantly higher in patients with CTS compared to healthy controls, and the M1 null genotype seemed to increase the risk of CTS approximately two-fold (P = 0.011; odds ratio (OR) = 1.98; 95% confidence interval (CI) 1.17-3.36). The M1 null, T1 present combined genotype was significantly higher in patients with CTS compared to healthy controls (P = 0.043); however, it seemed not to increase the risk of CTS (P = 0.14; OR = 0.62; 95% CI 0.33-1.76). We found significantly higher levels of the VAS, Boston Symptom Severity Scale and Phalen sign in patients with the Ile/Val or the Val/Val genotypes compared to those in patients with the Ile/Ile genotype (P = 0.003, 0.004 and 0.044, respectively). We proposed that genes involved in the protection from oxidative stress may influence the susceptibility, clinical and functional status of CTS. The GSTM1 null genotype may be related with the development of CTS, whereas the Val allele of GSTP1-Ile105Val polymorphism may be associated with worse functional and clinical status in CTS.

The prevalence of median neuropathy at wrist in systemic sclerosis patients at Srinagarind Hospital

Objectives: To determine the prevalence and factor related with median neuropathy at wrist (MNW) in systemic sclerosis patients. Study Design: Cross-sectional study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: Systemic sclerosis patients who attended the Scleroderma Clinic, Srinagarind Hospital. Materials and Methods: Seventyfive systemic sclerosis patients were prospectively evaluated by questionnaire, physical examination, and electrodiagnostic study. The questionnaire consisted of the symptoms, duration, and type of systemic sclerosis. The physical examination revealed skin score of systemic sclerosis, pinprick sensation of median nerve distribution of both hands, and weakness of both abductor pollicis brevis muscles. The provocative test which were Tinel's sign and Phalen's maneuver were also examined. Moreover, electrodiagnostic study of the bilateral median and ulnar nerves was conducted. Results: The prevalence of MNW in systemic sclerosis patients was 44% - percentage of mild, moderate, and severe were 28%, 9.3%, and 6.7%, respectively. The prevalence of asymptomatic MNW was 88%. There were no association between the presence of MNW and related factors of systemic sclerosis. Conclusions: MNW is one of the most common entrapment neuropathies in systemic sclerosis patients. Systemic sclerosis patients should be screened for early signs of MNW.

Researching Effects of Drawing on Prevalence of Carpal Tunnel Syndrome with Architecture Students

Objectives: Carpal tunnel syndrome is an important peripheral neuropathy in architecture students because of the working and writing position for long hours. The purpose of this study was assesing and comparing carpal tunnel syndrome signs in the first grade and fourth grade architecture students. Methods: 30 first grade and 30 fourth grade students were included in the study. Each patient was assessed with a questionnaire, muscle tests, pain assesment and examination signs (Phalen Test, Tinnel Test, Durkan Signs). Results: Some of the muscle test performances were better in first grade students compared to fourth grade students. There were more pain complaints with fourth grade students (p=0.003). There were statistically significant differences between the two groups in Phalen’s (p=0.001), Durkan’s (p=0.001) and Tinel’s signs (p=0.044). The fourth grade students’ signs were positive while first grade students’ were negative. Conclusions: Working long hours with wrong position of the hand causes carpal tunnel syndrome in architecture students. Ergonomic interventions, such as keyboard modifications, positioning the wrist is in a straight position and wrist exercises were recommended to prevent carpal tunnel syndrome in architecture students.

Concomitant presentation of carpal tunnel syndrome and trigger finger

BackgroundCarpal tunnel syndrome (CTS) and trigger finger (TF) are common conditions that may occur in the same patient. The etiology of most cases is unknown. The purpose of this study was to evaluate the rate of concomitant occurrence of these two conditions at presentation and to compare the concomitant occurrence in normal and diabetic patients.MethodsOne-hundred and eight consecutive subjects presenting to our hand clinic with CTS and/or TF were evaluated. The existence of both of these conditions was documented through a standard history and physical examination. The definition of trigger finger was determined by tenderness over the A1 pulley, catching, clicking or locking. CTS was defined in the presence of at least two of the following: numbness and tingling in a median nerve distribution, motor and sensory nerve loss (median nerve), a positive Tinel's or Phalen's test and positive electrophysiologic studies.ResultsThe average age of the participants was 62.2 ± 13.6 years. Sixty-seven patients presented with symptoms and signs of CTS (62%), 41 (38%) subjects with signs and symptoms of TF. Following further evaluation, 66 patients (61%) had evidence of concomitant CTS and TF. Fifty-seven patients (53% of all study patients) had diabetes. The rate of subjects with diabetes was similar among the groups (p = 0.8, Chi-square test).ConclusionCTS and TF commonly occur together at presentation though the symptoms of one condition will be more prominent. Our results support a common local mechanism that may be unrelated to the presence of diabetes. We recommend evaluation for both conditions at the time of presentation.

Risks of musculoskeletal disorders among betel quid preparers in Taiwan

Betel quid chewing is common in Taiwan. The work of betel quid preparers is characterized by long hours of static work, awkward working posture and highly repetitive hand/wrist motion. However, the musculoskeletal health of betel quid preparers receives very little attention. The Chinese version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ) was administered, and electrogoniometers and electromyography were used in this cross-sectional study to characterize the hand/wrist motion of the subjects. Physical examinations on the thumbs and wrists of the subjects were conducted by means of Phalen's test and Finkelstein's test, respectively. Among the 225 participants, more than 95% attributed their musculoskeletal complaints to their work, and shoulder, neck, hand/wrist, and lower back discomfort were most frequently reported. More than 70% of the preparers did not seek medical treatment for their musculoskeletal problems. Based on the physical examination, 24% of the participants had suspected symptom of either carpal tunnel syndrome (CTS) or DeQuervain's tenosynovitis. The instrumental measurements indicated that betel quid preparation is characterized by extreme angle ranges and moderate repetition of wrist motion as well as low forceful exertion. This study concludes that betel quid preparers are a high risk group of developing musculoskeletal disorders (MSDs). Future studies by electrogoniometers and detailed physical examination on betel quid preparers are needed to determine the predisposing factors for CTS. Some intervention measures to prevent MSDs and to lessen psychological stress for this group of workers are strongly suggested.

Cutaneous B-Cell Lymphoma Presenting as a Hand Mass: A Case Report.

Primary cutaneous lymphomas are a rare yet diverse group of lymphoid neoplasms, representing 19% of extranodal non-Hodgkin lymphomas1. In the United States, the majority of primary cutaneous lymphomas are of T-cell origin (71%)1. Cutaneous B-cell lymphomas (CBCLs) comprise the remaining 29%, and rarely occur in the upper extremity (11.9% of all CBCLs)1; CBCL in the hand is extremely rare1. We present a case of CBCL in the hand, originally suspected to be a hemangioma on the basis of the physical examination and magnetic resonance imaging (MRI). The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-nine-year-old woman with a history of Sjogren syndrome and psoriasis sought evaluation of a discolored mass on the ulnar side of the left hand. She had been aware of the mass for three months. She reported mild pain at the site of the mass. She also described generalized pain and numbness in the hand with typing and brushing her teeth. The physical examination revealed a slightly elevated, light blue-red mass measuring 2 cm in diameter, located at the junction of the glabrous and nonglabrous skin of the ulnar border of the hand, beginning 1 cm distal to the wrist crease (Fig. 1). The Phalen test was positive at twenty seconds. Two-point discrimination and median innervated intrinsic strength were normal. Fig. 1 Physical examination revealed a slightly elevated, light blue-red papular mass measuring 2 cm in diameter, located at the junction of the glabrous and nonglabrous skin of the ulnar border of the hand, beginning 1 cm distal to the wrist crease. MRI revealed a T2 hyperintense, …

The Quantitative Relationship Between Physical Examinations and the Nerve Conduction of the Carpal Tunnel Syndrome in Patients With and Without a Diabetic Polyneuropathy

ObjectiveTo understand the quantitative correlation between the clinical severity and physical examinations along with the electrodiagnostic findings by subjects with carpal tunnel syndrome (CTS) and also the influence of diabetic polyneuropathy (DPN) on physical examinations by subjects with CTS.MethodsAmong 200 patients suffering from hand tingling sensations, 68 patients were diagnosed with CTS on at least one hand by nerve conduction tests. Therefore, the Phalen test (PT), hand elevation test (HET), Tinel sign (TS) results were recorded on both hands. The physical examination grades were compared with the electrophysiological CTS grades in 126 hands of 68 patients. Also the comorbidity effect of DPN to CTS was evaluated. For the evaluation of the severity correlations between CTS, PT, HET, and TS, the Spearman analysis was used. An attempt was started to create a formula which could depict the electrophysiological severity of CTS.ResultsOut of the 68 tested subjects, 31 were diagnosed with both DPN and CTS, and 37 with CTS only. Both PT and HET correlated well with the severity of CTS where the correlation of PT was higher than that of HET. The formula were the motor distal latency (MDL)=(72.4-PT)/5.3 and MDL=(76-HET)/7.2. Both PT and HET showed in the presence of DPN a relatively higher relation with CTS without significance.ConclusionPT and HET would be useful screening tools for the diagnosis and treatment of CTS as the grade of PT and HET present the severity of CTS well. During this study, a formula was created expecting the severity of nerve conduction study with PT and HET through the time domain value of physical examinations.