Davids Floor A, Ramtin Sina, Razi Amin, Ring David, Teunis Teun, Reichel Lee M
Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX.
Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX.
J Hand Surg Am. 2025 Aug;50(8):909-914. doi: 10.1016/j.jhsa.2024.07.004. Epub 2024 Aug 14.
We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy.
We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand).
Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution.
Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome.
Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).
我们研究了腕管综合征临床检查中对特定症状的解读差异，以评估外科医生将无感觉异常的疼痛视为正中神经病变特征的程度。
我们邀请了变异科学小组的所有上肢外科医生成员完成一项基于病例的实验。外科医生阅读了5 - 10个临床病例，这些病例在患者人口统计学特征以及症状和体征方面存在变异，具体如下：主要症状（夜间麻木和刺痛、持续性麻木和感觉丧失、活动时疼痛）、激发试验（Phalen试验、Durkan试验或Tinel试验）引发的症状（刺痛、疼痛）以及激发试验引发症状的部位（示指和中指、拇指和示指、小指和环指、整个手部）。
与外科医生将激发试验解读为阴性相关的患者因素包括在Phalen试验、Durkan试验或Tinel试验期间出现疼痛而非感觉异常，以及症状位于整个手部而非正中神经分布区域。
专家们不认为无感觉异常的疼痛或非典型症状分布是腕管综合征的特征。
认识到专家认为Phalen试验、Durkan试验和Tinel试验引发疼痛相对不具有正中神经病变的特征，有助于限制正中神经病变过度诊断和过度治疗的可能性，以及精神和社会健康对疾病影响（疼痛强度和分布的显著相关因素）的漏诊和治疗不足。
