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Title: Clinical prediction rule for diagnosis of the carpal tunnel syndrome [Regla clínica para el diagnostico del síndrome del túnel del carpo]
Author: Chiquete, E.
Miranda-Munoz, A.
Castaneda-Moreno, V.
Vargas-Sanchez, A.
Garcia-Llamas, L.
Ochoa-Guzman, A.
Rabago-Cervantes, R.
Zuniga-Ramirez, C.
Gonzalez-Jaime, J.
Ruiz-Sandoval, J.L.
Issue Date: 2011
Abstract: Introduction: The carpal tunnel syndrome (CTS) is the most frequent compression neuropathy of the upper limbs. This condition may pose difficulties in diagnosis, given the subjectivity of most of their clinical manifestations. Aim: To design a clinical prediction rule that can improve the performance of physical examination in identifying cases with CTS. Methods: A case-control study was performed on patients who were referred to electrodiagnostic testing (here the gold standard) for suspicion of CTS. Bivariate analyses were performed on clinical manifestations and antecedents to select those with the best diagnostic performance and to integrate a clinical prediction rule. Results: A total of 72 patients were analyzed: 40 cases with confirmed CTS (90% women, mean age 50.2 years) and 32 controls with negative electrophysiological tests (84% women, mean age 40.6 years). Hand paresthesias (97 vs. 77%, p = 0.01), positive Phalen's test (67 vs. 27%, p = 0.001), positive Tinel sign (72 vs. 33%, p = 0.002) and age ≥ 50 (65 vs. 34%, p = 0.01) were more common among CTS cases than in controls. Thus, the presence of ≥ 2 of these characteristics had a sensitivity of 97% (95% CI: 86-100%), specificity of 50% (95% CI: 33-67%), positive predictive value of 70% (95% CI: 56-81%), negative predictive value of 94% (95% CI: 71-100%), and accuracy of 74% (95% CI: 61-86%). Conclusion: Age > 50 years, hand paresthesias, positive Phalen's test, and positive Tinel sign are variables strongly associated with CTS. The presence of ≥ 2 clinical characteristics has adequate performance in identifying suspicious cases, and their absence correctly exclude false positives.
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