Elfar John C, Yaseen Zaneb, Stern Peter J, Kiefhaber Thomas R
Division of Hand Surgery, Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY 14642, USA.
J Hand Surg Am. 2010 Nov;35(11):1807-12. doi: 10.1016/j.jhsa.2010.08.013.
Sensibility testing plays a role in the diagnosis of carpal tunnel syndrome (CTS). No single physical examination test has proven to be of critical value in the diagnosis, especially when compared with electrodiagnostic testing (EDX). The purpose of this study was to define which digits are most affected by CTS, both subjectively and with objective sensibility testing.
A prospective series of 35 patients (40 hands) with EDX-positive, isolated CTS were evaluated preoperatively using 2 objective sensibility tests: static 2-point discrimination (2PD) and abbreviated Semmes-Weinstein monofilament (SWMF) testing. Detailed surveys of subjective symptoms were also collected.
Patients identified the middle finger as the most symptomatic over all others (51%). Objective 2PD results of each digit mirrored the subjective data, with higher values for the middle finger (mean 6.07 mm, (p < .0001). Values for the index finger failed to show a significant difference from the ulnar-innervated small finger. The most symptomatic finger matched 2PD results in over two thirds of patients. The SWMF testing showed similar, statistically significant results (middle > thumb > index > small). Correlations failed between EDX, symptoms, and SWMF results or 2PD in the index finger. Positive but weak correlation (p = .002, r = .42) was found between EDX and 2PD only in the middle fingers.
The middle finger is the most likely to show changes in 2PD in patients with positive EDX findings for CTS. Middle finger 2PD is best able to correlate with EDX when compared with 2PD of other digits. The SWMF testing also shows the middle digit testing as more sensitive, but this finding may be difficult to use clinically.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic I.
感觉测试在腕管综合征（CTS）的诊断中发挥作用。没有单一的体格检查测试被证明在诊断中具有关键价值，特别是与电诊断测试（EDX）相比时。本研究的目的是确定哪些手指在主观和客观感觉测试中受CTS影响最大。
对35例（40只手）EDX阳性的孤立性CTS患者进行前瞻性研究，术前使用2种客观感觉测试：静态两点辨别（2PD）和简化的Semmes-Weinstein单丝（SWMF）测试。还收集了详细的主观症状调查。
患者认为中指是所有其他手指中症状最明显的（51%）。各手指的客观2PD结果反映了主观数据，中指的值更高（平均6.07毫米，（p <.0001）。食指的值与尺神经支配的小指相比没有显著差异。超过三分之二的患者中，症状最明显的手指与2PD结果相符。SWMF测试显示了类似的、具有统计学意义的结果（中指>拇指>食指>小指）。食指的EDX、症状与SWMF结果或2PD之间未发现相关性。仅在中指中发现EDX与2PD之间存在正相关但较弱的相关性（p =.002，r =.42）。
对于EDX检查结果为阳性的CTS患者，中指最有可能出现2PD变化。与其他手指的2PD相比，中指2PD与EDX的相关性最佳。SWMF测试也显示中指测试更敏感，但这一发现可能在临床上难以应用。
研究类型/证据水平：诊断性I级。
