Borg K, Lindblom U
Department of Neurology, Karolinska Hospital, Stockholm, Sweden.
Acta Neurol Scand. 1988 Dec;78(6):537-41. doi: 10.1111/j.1600-0404.1988.tb03698.x.
The initial sensory symptoms of carpal tunnel syndrome (CTS) are usually intermittent and the clinical neurological examination is often normal. The aim of the present study was to determine the rate of impairment of different somatosensory modalities in CTS by means of the following tests: vibrametry, tactile pulses, von Frey hairs, two-point discrimination (2-PD), graphesthesia and warm and cold perception thresholds. The material consisted of 33 hands with CTS from 22 patients. Each of the first 3 tests was abnormal with elevated thresholds in 17 CTS hands (52%), 2-PD was abnormal in 10 hands (30%), graphesthesia in 8 hands (24%), and warm and cold thresholds in only 5 hands (15%). There was an overlap so that at least one test was abnormal in 27 of the 33 CTS hands (82%). Thus, impairment of sensibility can be demonstrated in a majority of patients with CTS if more than one test is applied. Vibrametry and von Frey hairs are recommended instead of the commonly used 2-PD, since abnormality was more often revealed and since they are equally easy to apply. No individual test was sensitive enough to qualify as a diagnostic criterion when it was applied with the hand in resting position. A significant increase in both sensitivity and specificity can be expected for any test if it is combined with provocation, such as wrist flexion, as has been demonstrated for vibrametry.
腕管综合征（CTS）的初始感觉症状通常是间歇性的，临床神经学检查往往正常。本研究的目的是通过以下测试确定CTS中不同躯体感觉模式的损害率：振动觉测量、触觉脉冲、von Frey毛发、两点辨别（2-PD）、图形觉以及温觉和冷觉阈值。研究材料包括来自22例患者的33只患有CTS的手。前三项测试中的每一项在17只CTS手中阈值升高，结果异常（52%），两点辨别测试在10只手中异常（30%），图形觉在8只手中异常（24%），温觉和冷觉阈值仅在5只手中异常（15%）。存在重叠情况，因此33只CTS手中有27只（82%）至少一项测试结果异常。因此，如果应用不止一项测试，大多数CTS患者都可证明存在感觉损害。建议使用振动觉测量和von Frey毛发测试而非常用的两点辨别测试，因为前者更常显示异常，且同样易于操作。当手处于休息位置进行测试时，没有任何一项单独测试足够敏感到可作为诊断标准。如果将任何测试与激发动作（如腕关节屈曲）相结合，可预期其敏感性和特异性都会显著提高，振动觉测量已证实了这一点。
