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Tsamis KI, Kontogiannis P, Gourgiotis I, Ntabos S, Sarmas I, Manis G. Automatic Electrodiagnosis of Carpal Tunnel Syndrome Using Machine Learning. Bioengineering (Basel) 2021; 8:bioengineering8110181. [PMID: 34821747 PMCID: PMC8615235 DOI: 10.3390/bioengineering8110181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023] Open
Abstract
Recent literature has revealed a long discussion about the importance and necessity of nerve conduction studies in carpal tunnel syndrome management. The purpose of this study was to investigate the possibility of automatic detection, based on electrodiagnostic features, for the median nerve mononeuropathy and decision making about carpal tunnel syndrome. The study included 38 volunteers, examined prospectively. The purpose was to investigate the possibility of automatically detecting the median nerve mononeuropathy based on common electrodiagnostic criteria, used in everyday clinical practice, as well as new features selected based on physiology and mathematics. Machine learning techniques were used to combine the examined characteristics for a stable and accurate diagnosis. Automatic electrodiagnosis reached an accuracy of 95% compared to the standard neurophysiological diagnosis of the physicians with nerve conduction studies and 89% compared to the clinical diagnosis. The results show that the automatic detection of carpal tunnel syndrome is possible and can be employed in decision making, excluding human error. It is also shown that the novel features investigated can be used for the detection of the syndrome, complementary to the commonly used ones, increasing the accuracy of the method.
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Affiliation(s)
- Konstantinos I. Tsamis
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: (K.I.T.); (G.M.)
| | - Prokopis Kontogiannis
- Department of Computer Science and Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Gourgiotis
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - Stefanos Ntabos
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - Ioannis Sarmas
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - George Manis
- Department of Computer Science and Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece;
- Correspondence: (K.I.T.); (G.M.)
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Multanen J, Uimonen MM, Repo JP, Häkkinen A, Ylinen J. Use of conservative therapy before and after surgery for carpal tunnel syndrome. BMC Musculoskelet Disord 2021; 22:484. [PMID: 34039330 PMCID: PMC8157685 DOI: 10.1186/s12891-021-04378-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.
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Affiliation(s)
- Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland. .,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
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Atroshi I, Tadjerbashi K, McCabe SJ, Ranstam J. Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial. Trials 2019; 20:531. [PMID: 31455398 PMCID: PMC6712840 DOI: 10.1186/s13063-019-3635-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 08/08/2019] [Indexed: 11/26/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed. Methods This is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial’s eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial’s primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks. Discussion This is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS. Trial registration ISRCTN Registry, ISRCTN81836603. Registered on May 5, 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3635-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isam Atroshi
- Department of Clinical Sciences - Orthopedics, Lund University, SE-22100, Lund, Sweden. .,Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, SE-28125, Hässleholm, Sweden.
| | - Kamelia Tadjerbashi
- Department of Clinical Sciences - Orthopedics, Lund University, SE-22100, Lund, Sweden.,Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, SE-28125, Hässleholm, Sweden
| | - Steven J McCabe
- Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Jonas Ranstam
- Department of Clinical Sciences - Orthopedics, Lund University, SE-22100, Lund, Sweden
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Theillet G, Grard G, Galla M, Maisse C, Enguehard M, Cresson M, Dalbon P, Leparc-Goffart IL, Bedin F. Detection of chikungunya virus-specific IgM on laser-cut paper-based device using pseudo-particles as capture antigen. J Med Virol 2019; 91:899-910. [PMID: 30734316 DOI: 10.1002/jmv.25420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 01/11/2023]
Abstract
The incidence of arbovirus infections has increased dramatically in recent decades, affecting hundreds of millions of people each year. The Togaviridae family includes the chikungunya virus (CHIKV), which is typically transmitted by Aedes mosquitoes and causes a wide range of symptoms from flu-like fever to severe arthralgia. Although conventional diagnostic tests can provide early diagnosis of CHIKV infections, access to these tests is often limited in developing countries. Consequently, there is an urgent need to develop efficient, affordable, simple, rapid, and robust diagnostic tools that can be used in point-of-care settings. Early diagnosis is crucial to improve patient management and to reduce the risk of complications. A glass-fiber laser-cut microfluidic device (paper-based analytical device [PAD]) was designed and evaluated in a proof of principle context, for the analysis of 30 µL of patient serum. Biological raw materials used for the functionalization of the PAD were first screened by MAC-ELISA (IgM capture enzyme-linked immunosorbent assay) for CHIKV Immunoglobulin M (IgM) capture and then evaluated on the PAD using various human samples. Compared with viral lysate traditionally used for chikungunya (CHIK) serology, CHIKV pseudo-particles (PPs) have proven to be powerful antigens for specific IgM capture. The PAD was able to detect CHIKV IgM in human sera in less than 10 minutes. Results obtained in patient sera showed a sensitivity of 70.6% and a specificity of around 98%. The PAD showed few cross-reactions with other tropical viral diseases. The PAD could help health workers in the early diagnosis of tropical diseases such as CHIK, which require specific management protocols in at-risk populations.
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Affiliation(s)
- Gerald Theillet
- bioMérieux, Innovations New Immuno-Concepts department, Chemin de l'Orme, Marcy-l'Etoile, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection), Marseille, France
| | - Gilda Grard
- Unité des Virus Emergents (UVE: Aix-Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection), Marseille, France.,IRBA, Unité de virologie, CNR des Arbovirus, HIA Laveran, Marseille, France
| | - Mathilde Galla
- Unité des Virus Emergents (UVE: Aix-Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection), Marseille, France.,IRBA, Unité de virologie, CNR des Arbovirus, HIA Laveran, Marseille, France
| | - Carine Maisse
- Infections Virales et Pathologie Comparée, UMR754, INRA, Univ Claude Bernard Lyon1, Lyon, France
| | - Margot Enguehard
- Ecologie Microbienne CNRS UMR 5557, INRA UMR1418, Villeurbanne, France.,CAS Key Laboratory of Molecular Virology and Immunology, Unit of Interspecies transmission of arboviruses and antivirals, Institut Pasteur of Shanghai, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Marie Cresson
- CAS Key Laboratory of Molecular Virology and Immunology, Unit of Interspecies transmission of arboviruses and antivirals, Institut Pasteur of Shanghai, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.,IVPC UMR754, INRA, Univ Lyon, Université Claude Bernard Lyon 1, EPHE, PSL Research University, Lyon, France
| | - Pascal Dalbon
- bioMérieux, Innovations New Immuno-Concepts department, Chemin de l'Orme, Marcy-l'Etoile, France
| | - Isabelle Leparc Leparc-Goffart
- Unité des Virus Emergents (UVE: Aix-Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection), Marseille, France.,IRBA, Unité de virologie, CNR des Arbovirus, HIA Laveran, Marseille, France
| | - Frederic Bedin
- bioMérieux, Innovations New Immuno-Concepts department, Chemin de l'Orme, Marcy-l'Etoile, France
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Drain PK, Hyle EP, Noubary F, Freedberg KA, Wilson D, Bishai WR, Rodriguez W, Bassett IV. Diagnostic point-of-care tests in resource-limited settings. THE LANCET. INFECTIOUS DISEASES 2013; 14:239-49. [PMID: 24332389 DOI: 10.1016/s1473-3099(13)70250-0] [Citation(s) in RCA: 440] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of diagnostic point-of-care testing is to minimise the time to obtain a test result, thereby allowing clinicians and patients to make a quick clinical decision. Because point-of-care tests are used in resource-limited settings, the benefits need to outweigh the costs. To optimise point-of-care testing in resource-limited settings, diagnostic tests need rigorous assessments focused on relevant clinical outcomes and operational costs, which differ from assessments of conventional diagnostic tests. We reviewed published studies on point-of-care testing in resource-limited settings, and found no clearly defined metric for the clinical usefulness of point-of-care testing. Therefore, we propose a framework for the assessment of point-of-care tests, and suggest and define the term test efficacy to describe the ability of a diagnostic test to support a clinical decision within its operational context. We also propose revised criteria for an ideal diagnostic point-of-care test in resource-limited settings. Through systematic assessments, comparisons between centralised testing and novel point-of-care technologies can be more formalised, and health officials can better establish which point-of-care technologies represent valuable additions to their clinical programmes.
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Affiliation(s)
- Paul K Drain
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Farzad Noubary
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - William R Bishai
- Johns Hopkins University, Baltimore, USA; KwaZulu-Natal Research Institute for Tuberculosis and HIV, Durban, South Africa
| | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Chen W, Bennett D. Gaining social values of wireless technology: An interpretive case study in the healthcare institutional context. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2013. [DOI: 10.1016/j.ijinfomgt.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paper-based analytical devices for point-of-care infectious disease testing. Eur J Clin Microbiol Infect Dis 2013; 33:147-56. [DOI: 10.1007/s10096-013-1945-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/29/2013] [Indexed: 12/25/2022]
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Abstract
Electrodiagnostic studies are powerful tools used to objectively examine the physiologic status of a nerve. These consist of nerve conduction studies, which directly examine motor and sensory function of the nerve, and electromyography, which examines spontaneous and voluntary motor unit action potentials in the muscle. Together these studies enable characterization, localization, and duration of nerve pathology. Appropriate timing and use of electrodiagnostic studies assist medical providers in treating nerve pathology.
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Affiliation(s)
- Erik R Bergquist
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
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Green T, Tolonen E, Clarke M, Pathak P, Newey M, Kershaw C, Kallio M. The relationship of pre- and postoperative median and ulnar nerve conduction measures to a self-administered questionnaire in carpal tunnel syndrome. Neurophysiol Clin 2012; 42:231-9. [DOI: 10.1016/j.neucli.2012.02.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 01/07/2012] [Accepted: 02/11/2012] [Indexed: 10/28/2022] Open
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Ahmed A, Kothari MJ. The true utility and indication for hand-held nerve conduction devices. Muscle Nerve 2012; 45:621-2. [DOI: 10.1002/mus.23255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Tan SV, Sandford F, Stevenson M, Probert S, Sanders S, Mills KR, Koutroumanidis M. Hand-held nerve conduction device in carpal tunnel syndrome: a prospective study. Muscle Nerve 2012; 45:635-41. [PMID: 22499088 DOI: 10.1002/mus.23279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION We assessed the clinical impact of replacing standard neurophysiologic testing with a hand-held device (Mediracer) for diagnosis of carpal tunnel syndrome (CTS). METHODS One hundred patients (200 hands) with suspected CTS were studied by blinded assessors [Hand-therapist (HT)1 and Consultant Neurophysiologist] using the Mediracer, followed by standard neurophysiologic testing. To simulate testing by personnel without neurological training, Mediracer recordings were analyzed separately by an assessor who had not seen the patients (HT2). RESULTS Correlation of the CTS grades was 0.94 for the results obtained by HT1, and 0.87 for HT2. The sensitivity and specificity of the Mediracer was 0.85 and 0.9, respectively, by HT1, and 0.84 and 0.89 for HT2. Nine patients had conditions other than CTS, and 35 patients were judged to require further investigation. CONCLUSIONS The Mediracer should only be used in patients with typical CTS symptoms and signs and no muscle wasting who have had careful neurological assessment.
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Affiliation(s)
- S Veronica Tan
- Department of Neurology and Clinical Neurophysiology, St Thomas' Hospital, Guy's and St Thomas' Foundation NHS Trust, Lambeth Palace Road, London, United Kingdom.
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Bourke HE, Read J, Kampa R, Hearnden A, Davey PA. Clinic-based nerve conduction studies reduce time to surgery and are cost effective: a comparison with formal electrophysiological testing. Ann R Coll Surg Engl 2011; 93:236-40. [PMID: 21477439 DOI: 10.1308/147870811x566385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Carpal tunnel syndrome is the most common compression neuropathy affecting the upper limb. Clinical diagnosis is not always clear and electrophysiological testing can be indicated when considering a patient for decompression surgery. The downside of electrophysiological testing is cost and increased time to surgery. Newer methods of performing nerve conduction studies in clinic have become available. MATERIALS AND METHODS We investigated the use of a clinic-based, handheld, non-invasive electrophysiological device (NC-stat®) in 71 patients with suspected carpal tunnel syndrome presenting to our hand clinic in a district general hospital. We compared this to a similar cohort of 71 age-matched patients also presenting to our unit in whom formal nerve conduction studies were performed at a local neurophysiology unit. Our outcome measures were time from presentation to carpal tunnel decompression, the cost of each pathway and the practicalities of using the device in a busy hand unit. RESULTS AND CONCLUSIONS The NC-stat® proved to be a successful device when compared with referring patients out for more formal nerve conduction studies, shortening the time from presentation to surgery from 198 days to 102 days (p<0.0001). It was also cost effective with a calculated saving to the hospital of more than £70 per patient. The device is easy to use and acceptable to patients and no adverse effects were noted.
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Strickland JW, Gozani SN. Accuracy of in-office nerve conduction studies for median neuropathy: a meta-analysis. J Hand Surg Am 2011; 36:52-60. [PMID: 21131139 DOI: 10.1016/j.jhsa.2010.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Carpal tunnel syndrome is the most common focal neuropathy. It is typically diagnosed clinically and confirmed by abnormal median nerve conduction across the wrist (median neuropathy [MN]). In-office nerve conduction testing devices facilitate performance of nerve conduction studies (NCS) and are used by hand surgeons in the evaluation of patients with upper extremity symptoms. The purpose of this meta-analysis was to determine the diagnostic accuracy of this testing method for MN in symptomatic patients. METHODS We searched the MEDLINE database for prospective cohort studies that evaluated the diagnostic accuracy of in-office NCS for MN in symptomatic patients with traditional electrodiagnostic laboratories as reference standards. We assessed included studies for quality and heterogeneity in diagnostic performance and determined pooled statistical outcome measures when appropriate. RESULTS We identified 5 studies with a total of 448 symptomatic hands. The pooled sensitivity and specificity were 0.88 (95% confidence interval [CI], 0.83-0.91) and 0.93 (95% CI, 0.88-0.96), respectively. Specificities exhibited heterogeneity. The diagnostic odds ratios were homogeneous, with a pooled value of 62.0 (95% CI, 30.1-127). CONCLUSIONS This meta-analysis showed that in-office NCS detects MN with clinically relevant accuracy. Performance was similar to interexaminer agreement for MN within a traditional electrodiagnostic laboratory. There was some variation in diagnostic operating characteristics. Therefore, physicians using this technology should interpret test results within a clinical context and with attention to the pretest probability of MN, rather than in absolute terms.
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Argyriou AA, Karanasios P, Makridou A, Makris N. The significance of second lumbrical-interosseous latency comparison in the diagnosis of carpal tunnel syndrome. Acta Neurol Scand 2009; 120:198-203. [PMID: 19154532 DOI: 10.1111/j.1600-0404.2008.01141.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To assess the significance of the second lumbrical-interosseous latency (2LI-DML) comparison in the diagnosis of carpal tunnel syndrome (CTS). PATIENTS AND METHODS We examined 150 consecutive hands of patients referred with suspected CTS, using the 2LI-DML test and other standard measures of median nerve function. Correlations of the 2LI-DML test with standard tests were computed. RESULTS Hundred and four hands were electrophysiologically confirmed to have CTS. The 2LI-DML test was abnormal in 99/104 (95.2%) hands with CTS with a mean value of 1.54 +/- 1.12 ms. Among the other measures, the orthodromic median-ulnar palmar velocity comparison was the most frequently abnormal test (95/104 hands, 91.3%), followed by the double-peak morphology of orthodromic sensory action potential from digit 4 (94/104, 90.4%). The 2LI-DML test significantly correlated, either positively or negatively, with all other standard tests. CONCLUSION The 2LI-DML comparison is highly sensitive in diagnosing CTS, even in mild cases in which standard tests fail to detect abnormalities.
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Affiliation(s)
- A A Argyriou
- Department of Neurology, Saint Andrew General Hospital of Patras, Patras, Greece.
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Tolonen U, Kallio M, Ryhänen J, Raatikainen T, Honkala V, Lesonen V. Response. Acta Neurol Scand 2008. [DOI: 10.1111/j.1600-0404.2008.01044.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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