The diagnosis of carpal tunnel syndrome based on clinical symptoms : A prospective study to determine if carpal tunnel syndrome can be diagnosed without additional investigations

Kemper, L.T. (2017) The diagnosis of carpal tunnel syndrome based on clinical symptoms : A prospective study to determine if carpal tunnel syndrome can be diagnosed without additional investigations. thesis, Medicine.

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Abstract

Objective: The aim of this prospective study is to determine if carpal tunnel syndrome can be diagnosed without additional diagnostics like ultrasound or nerve conduction study, because in the literature there are still controversies about the way to diagnose carpal tunnel syndrome. Methods: There were 226 patients (329 hands) included after being referred to the outpatient neurology department for nerve conduction study of the median nerve to diagnose carpal tunnel syndrome. Neurophysiological investigations were performed through nerve conduction study and/or ultrasound. Afterwards patients filled in a questionnaire about risk factors and symptoms based on the guideline Carpal Tunnel Syndrome of the Dutch association of Neurology (NVN) and the Boston Carpal Tunnel Questionnaire (BCTQ). The results of the patients (hands) with and without carpal tunnel syndrome were compared. Results: There were 143 patients with CTS, 75 without CTS and 8 with CTS on one hand, while they had complaints on both hands. The women:men ratio was 3:1 and there were significant differences in age, BMI (and overweight) and diabetes mellitus. However a logistic regression model showed only independent significant differences for age and overweight. The symptoms were analysed per hand and a multiple logistic regression model showed significant differences for the involvement of fingers, tingling during the night and fluttering to reduce symptoms. Clinical scores were added to these variables and a score of 12.5 or higher had a specificity of 92.8% up to 100% for a score of 17.5 and 20.5. There were no relevant significant differences between men and women in symptoms. The BCTQ was not accurate as a diagnostic tool. There were significant differences between men and women with CTS in the pain score, functional score and the total score on the BCTQ. An analysis of the hands without carpal tunnel syndrome showed cubital tunnel syndrome, radicular syndrome or HNP and musculoskeletal pain as most frequent diagnoses, but in almost half of the patients the diagnosis was unknown. Conclusion: A clinical model based on the symptoms of the guideline of the NVN is developed, which shows a relationship of tingling during the night, fluttering to reduce symptoms and symptoms in the median nerve distribution area with carpal tunnel syndrome. The diagnosis carpal tunnel syndrome can be confirmed without additional diagnostics if patients have symptoms in the thumb, index finger, middle finger (and ring finger) with tingling during the night and fluttering helps to reduce symptoms, because the specificity is higher than the specificity of ultrasound or nerve conductions studies. If patients have a clinical score below 12.5 additional diagnostics should be performed. External validation should be performed in order to apply the model for all patients with suspicion of carpal tunnel syndrome.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Houpt, Dr. P. and Department of Plastic Surgery, Isala Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/69

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