工作成年人正中神经症状、体征和电诊断异常。
Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults.
机构信息
From the Rocky Mountain Center for Occupational and Environmental Health (Dr. Hegmann, Dr. Thiese, and Dr. Wood), the Department of Mechanical Engineering (Dr. Merryweather), and the Division of Physical Medicine and Rehabilitation (Dr. Kendall), the University of Utah, Salt Lake City, UT; the Center for Ergonomics, College of Health Sciences (Dr. Garg) and the Department of Occupational Science and Technology (Dr. Kapellusch), the University of Wisconsin-Milwaukee, Milwaukee, WI; Infinity Healthcare, Kenosha, WI (Dr. Foster); the Wood VA Medical Center, Milwaukee, WI (Dr. Drury); and the Hand Center, Wichita, KS (Dr. Melhorn).
出版信息
J Am Acad Orthop Surg. 2018 Aug 15;26(16):576-584. doi: 10.5435/JAAOS-D-17-00034.
INTRODUCTION
Diagnostic screening tests for carpal tunnel syndrome (CTS) have not been rigorously assessed in large populations.
METHODS
This study is a cross-sectional analysis from a prospective cohort study. Participants' (n = 1,194) symptoms and disease prevalence were measured. Sensitivity, specificity, and positive and negative predictive values (NPVs) were calculated.
RESULTS
When defining CTS as tingling/numbness in at least two median nerve-served digits and an abnormal median nerve conduction study, the prevalence was 8.9%. The sensitivity of paresthesias with nocturnal awakening was 77.4%. The sensitivity of the Phalen sign was 52.8% and that of the Hoffman-Tinel sign was only 37.7%.
DISCUSSION
The highest sensitivity (77.4%) for a case definition of CTS in this population of workers was for nocturnal tingling/numbness in a median nerve distribution, and the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign has a sensitivity of 52.8% and NPV of 95%, suggesting that the NPV is of particular diagnostic value. Hoffman-Tinel signs seem primarily helpful for the NPV (93.7%).
LEVEL OF EVIDENCE
Level II diagnostic study.
简介
腕管综合征（CTS）的诊断筛查测试尚未在大规模人群中进行严格评估。
方法
本研究是一项前瞻性队列研究的横断面分析。测量了参与者（n=1194）的症状和疾病患病率。计算了敏感性、特异性、阳性和阴性预测值（NPV）。
结果
当将至少两个正中神经支配的手指麻木/刺痛和异常正中神经传导研究定义为 CTS 时，患病率为 8.9%。夜间觉醒时出现感觉异常的敏感性为 77.4%。Phalen 征的敏感性为 52.8%，Hoffman-Tinel 征的敏感性仅为 37.7%。
讨论
在该工人人群中，针对 CTS 的病例定义，夜间正中神经分布的刺痛/麻木具有最高的敏感性（77.4%），而持续刺痛/麻木的特异性最高（97.5%）。Phalen 征的敏感性为 52.8%，NPV 为 95%，表明 NPV 具有特别的诊断价值。Hoffman-Tinel 征似乎主要有助于 NPV（93.7%）。
证据水平
II 级诊断研究。
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