Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome
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(2020) 21:679
RESEARCH ARTICLE
Open Access
Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome Francesco Sartorio1, Francesca Dal Negro1, Elisabetta Bravini2, Giorgio Ferriero3* , Stefano Corna1, Marco Invernizzi4 and Stefano Vercelli1
Abstract Background: Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen’s test and Tinel’s sign. Methods: In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman’s (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery. Results: Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p < 0.001) with NCS. The FDT was able to discriminate subjects with severe/extreme NCS findings, and two thresholds (0.29–0.36) were identified. Adding the FDT to the provocative tests improved the overall diagnostic accuracy (specificity: 0.97, CI95% 0.83–0.99; LR+: 14.49, CI95% 2.09–100.53). Conclusions: Sensorimotor impairments related to CTS can affect hand dexterity. The FDT discriminated patients with severe NCS involvement. Positive results on the clinical battery (Phalen, Tinel, and FDT) could help to confirm the CTS diagnosis, showing a very high specificity and LR+. On the contrary, the low sensitivity is not able to rule out CTS in individuals with negative results. Keywords: Clinical tests, Diagnosis, Dexterity, Rehabilitation, Occupational therapy
Background Carpal tunnel syndrome (CTS), caused by median nerve entrapment at the wrist, is one of the most common occupational diseases affecting the hand. Its prevalence in the United States working population is 7.8% [1], with higher and increasing incidence in the industrial sector than in the general population [2, 3]. Classic CTS symptoms and * Correspondence: [email protected] 3 Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate (VA), Via Maugeri 4, I-27100 Pavia, Italy Full list of author information is available at the end of the article
sensorimotor alterations include nocturnal pain associated with tingling, numbness, and - in more severe cases weakness in the median nerve territory that affects the hand motor control, especially during activities involving the first three fingers [4, 5]. A thorough history and physical examination are the key to diagnosis [4]. Thenar atrophy [6] and sensory loss [7] are common findings, but not always presen
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