손 저림증 환자에서 Tinel 징후와 Phalen 검사의 진단적 가치: 전기생리학적 분석
Diagnostic Value of Tinel Sign and Phalen Test in Patients with Tingling Sensation on Hands: An Electrophysiologic Analysis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: To evaluate the diagnostic value of Tinel sign and Phalen test through electrophysiologic analysis in patients with numb hands. Methods: Electrophysiologic findings were analyzed retrospectively in 430 patients with numb hands. 144 hands were diagnosed as normal, 341 as CTS, and 141 as cervical radiculopathy. The severity of CTS was classified into mild, moderate, severe. Positive rates of Tinel sign and Phalen test were compared in each group and the rates were analyzed according to the electrophysiologic severity of CTS. Results: Positive rate of Tinel sign and Phalen test were 35% and 20% in normal, 59%, 54% in CTS and 31%, 15% in cervical radiculopathy. Positive rate of Tinel sign was significantly higher in the severe CTS group (p<0.001). Phalen test revealed significant lower positive rate in mild group (p=0.01). Conclusions: The positive rates of Tinel sign and Phalen test were highest in CTS and had a diagnostic value of predicting severity. However, there are possibilities of false positive tests since patients with normal electrophysioloigc test and cervical radiculopathy showed have positive results in Tinel sign and Phalen test.
Abstract
Objectives: To evaluate the diagnostic value of Tinel sign and Phalen test through electrophysiologic analysis in patients with numb hands. Methods: Electrophysiologic findings were analyzed retrospectively in 430 patients with numb hands. 144 hands were diagnosed as normal, 341 as CTS, and 141 as cervical radiculopathy. The severity of CTS was classified into mild, moderate, severe. Positive rates of Tinel sign and Phalen test were compared in each group and the rates were analyzed according to the electrophysiologic severity of CTS. Results: Positive rate of Tinel sign and Phalen test were 35% and 20% in normal, 59%, 54% in CTS and 31%, 15% in cervical radiculopathy. Positive rate of Tinel sign was significantly higher in the severe CTS group (p<0.001). Phalen test revealed significant lower positive rate in mild group (p=0.01). Conclusions: The positive rates of Tinel sign and Phalen test were highest in CTS and had a diagnostic value of predicting severity. However, there are possibilities of false positive tests since patients with normal electrophysioloigc test and cervical radiculopathy showed have positive results in Tinel sign and Phalen test.
참고문헌 (23)
- Dale AM, "Physical examination has a low yield in screening for carpal tunnel syndrome", Am J Ind Med, 54, pp.1~9 (2011)
- de Krom MC, "Carpal tunnel syndrome: prevalence in the general population", J Clin Epidemiol, 45, pp.373~376 (1992)
- Atroshi I, "Prevalence of carpal tunnel syndrome in a general population", JAMA, 282, pp.153~158 (1999)
- Stevens JC, "AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome", Muscle Nerve, 20, pp.1477~1486 (1997), American Association of Electrodiagnostic Medicine
- 정세희, "수근관증후군 관련 임상척도와 전기생리학척도 간 비교", 대한 근전도 전기진단의학회지, 7, pp.79~89 (2005)
- El Miedany Y, "Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts", Joint Bone Spine, 75, pp.451~457 (2008)
- Sawaya RA, "When is the Phalen’s test of diagnostic value: an electrophysiologic analysis", J Clin Neurophysiol, 26, pp.132~133 (2009)
- Frank L. Urbano M, "Tinel’s Sign and Phalen’s Maneuver: Physical Signs of Carpal Tunnel Syndrome", Hospital Physician, pp.39~44 (2000)
- Franzblau A, "What is carpal tunnel syndrome", JAMA, 282, pp.186~187 (1999)
- Abbed KM, "Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation", Neurosurgery, 60, pp.S28~S34 (2007)
- 이항재, "수근관 증후군의 전기진단 분류", 대한근전도 전기진단의학회지, 6(1), pp.1~3 (2004)
- Wilbourn AJ, "AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies", Muscle Nerve, 21, pp.1612~1631 (1998), American Association of Electrodiagnostic Medicine
- Wainner RS, "Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome", Arch Phys Med Rehabil, 86, pp.609~618 (2005)
- D'Arcy CA, "Does this patient have carpal tunnel syndrome", Jama-J Am Med Assoc, 283, pp.3110~3117 (2000)
- Katz JN, "Clinical practice. Carpal tunnel syndrome", N Engl J Med, 346, pp.1807~1812 (2002)
- Robert M. Szabo, "The value of diagnostic testing in carpal tunnel syndrome", J Hand Surg Am, 24, pp.704~714 (1999)
- Kuhlman KA, "Sensitivity and specificity of carpal tunnel syndrome signs", Am J Phys Med Rehabil, 76, pp.451~457 (1997)
- Homan MM, "Agreement between symptom surveys, physical examination procedures and electrodiagnostic findings for the carpal tunnel syndrome", Scand J Work Environ Health, 25, pp.115~124 (1999)
- Padua L, "Carpal tunnel syndrome: relationship between clinical and patient-oriented assessment", Clin Orthop Relat Res, pp.128~134 (2002)
- Mondelli M, "Provocative tests in different stages of carpal tunnel syndrome", Clin Neurol Neurosurg, 103, pp.178~183 (2001)
- 황미령, "수근관 증후군의 임상 양상과 전기진단검사의 관계", 대한재활의학회지, 23, pp.974~979 (1999)
- Priganc VW, "The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome", J Hand Ther, 16, pp.225~236 (2003)
- 이종민, "수근관 증후군 환자에서 전기진단 중증도와 증상, 기능, 임상 중증도의 관계", Annals of Rehabilitation Medicine, 27(6), pp.16~911 (2003), 대한재활의학회