THE CARPAL-TUNNEL SYNDROME - DIAGNOSTIC UTILITY OF THE HISTORY AND PHYSICAL-EXAMINATION FINDINGS
THE CARPAL-TUNNEL SYNDROME - DIAGNOSTIC UTILITY OF THE HISTORY AND PHYSICAL-EXAMINATION FINDINGS
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DOI：
10.7326/0003-4819-112-5-321
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发表时间：
1990-03-01
影响因子：
39.2
通讯作者：
LIANG, MH
中科院分区：
文献类型：
--
作者：
KATZ, JN;LARSON, MG;LIANG, MH
本研究的目的是评估病史和体格检查结果在诊断腕管综合征中的价值，并确定临床发现的星座是否识别出腕管综合征的高风险或低风险患者。研究设计是将诊断测试与神经生理学测试进行比较。不同原因的上肢主诉患者转诊至神经生理学实验室进行诊断研究。在神经传导测试之前，从每个患者获得病史、人口统计学和体格检查数据以及手部疼痛图。图表被分类为表明典型的腕管综合征，或作为可能的，可能的，或不太可能表明腕管综合征。在单变量和多变量分析中检查临床数据和神经传导结果之间的关联。在这项研究的110名患者中，44名（40%）患有腕管综合征。就个体而言，最佳预测因子为手部疼痛图评分（阳性预测值，0.59; 95%CI，0.48至0.68）和Tinel征（阳性预测值，0.55; CI，0.45至0.65）。阳性Tinel征和可能或经典图评级的组合具有0.71的阳性预测值; CI，0.53至0.85。体格检查和病史的其他发现不太有用。在40岁以下的患者中，只有9%的患者可能或不可能患有腕管综合征。除了年龄。Tinel征、手部疼痛图评分、体格检查结果和病史的诊断价值有限。40岁以下的患者可能或不太可能的图表评级是在低风险的腕管综合征。这一发现，这应该在一个独立的人群中得到证实，表明患者的子集可以管理没有神经传导研究。
The study objective was to assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findngs identify patients at high or low risk for the carpal tunnel syndrome. The study design was a comparison of diagnostic tests with neurophysiologic testing. Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies. Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses. Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55; CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome. With the exceptions of age. Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies.