Prediction of the neurophysiological diagnosis of carpal tunnel syndrome from the demographic and clinical data
Prediction of the neurophysiological diagnosis of carpal tunnel syndrome from the demographic and clinical data
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DOI：
10.1016/j.clinph.2005.12.020
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发表时间：
2006-05-01
影响因子：
4.7
通讯作者：
Nora, Daniel Bocchese
中科院分区：
文献类型：
--
作者：
Gomes, Irenio;Becker, Jefferson;Nora, Daniel Bocchese
目的：使用人口统计学和临床数据来确定最能预测腕管综合征（CTS）诊断的临床模式，如神经生理学研究所定义。2535例连续患者的诊断性横断面研究（3907个上肢）2001年8月至2003年1月期间，在3所大学医院和2所私立神经生理学医院接受上肢神经传导研究的12岁以上患者结果：39.1%的患者上肢神经生理学诊断为CTS。前4个手指中至少有2个手指出现感觉异常或疼痛，并伴有以下情况之一：女性、夜间或觉醒时症状恶化、BMI>= 30、鱼际萎缩或其他体征（Tinel's，Phalen's，或Reversed Phalen's sign）;是与诊断相关的最佳模式。我们发现，在大多数人群中，仅凭临床表现似乎不足以正确预测腕管综合征的诊断，腕管综合征的定义是腕管正中神经神经病变。我们认为，在腕管正中神经的压迫性病变可以存在于没有典型症状的CTS（包括无症状的个人）和患者中的神经生理学研究是negative.Significance：进一步的研究将患者分为这些群体将使我们能够确定的长期预后，以及理想的治疗方法，为每一个这些临床情况。(c)2006年国际临床神经生理学联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: To use demographic and clinical data to identify the clinical pattern that best predicts the diagnosis of carpal tunnel syndrome (CTS), as defined by neurophysiologic studies.Methods: A diagnostic cross-sectional study in 2535 consecutive patients (3907 upper limbs) older than 12 years old who were referred for nerve conduction studies in the upper limbs between August 2001 and January 2003 in 3 university hospitals and 2 private neurophysiology services in the state of Rio Grande do Sul, Brazil.Results: A neurophysiologic diagnosis of CTS was established in 39.1% of these upper limbs. The presence of paresthesias or pain at least 2 of the first 4 digits in association with, one of the following: female gender, symptoms worsening at night or on awakening, an BMI >= 30, thenar atrophy, or other sign (Tinel's, Phalen's, or Reversed Phalen's signs); were the best pattern associated with the diagnosis.Conclusions: We have found that the clinical picture alone does not seem sufficient, in majority of the population, to correctly predict the diagnosis of CTS, as defined by median nerve neuropathy at the carpal tunnel. We believe that a compressive lesion of the median nerve at the carpal tunnel can be present both in patients with no typical symptoms of CTS (including asymptomatic individuals) and in patients in which neurophysiologic studies are negative.Significance: Further studies separating patients into these groups will allow us to identify the long-term prognosis as well as the ideal therapeutic approach for each of these clinical situations. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.