The responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression

BMC Musculoskeletal Disorders

Research Article

Lee Shepstone¹  Christina Jerosch-Herold¹  Leanne Miller²  Peter Chapman³ 

[1] Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK;Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK;Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK;Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK;

关键词: Median Nerve;    Carpal Tunnel Syndrome;    Carpal Tunnel;    Manual Muscle Testing;    Power Grip;   

DOI  :  10.1186/1471-2474-12-244

 received in 2011-07-18, accepted in 2011-10-27,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundSeveral clinical measures of sensory and motor function are used alongside patient-rated questionnaires to assess outcomes of carpal tunnel decompression. However there is a lack of evidence regarding which clinical tests are most responsive to clinically important change over time.MethodsIn a prospective cohort study 63 patients undergoing carpal tunnel decompression were assessed using standardised clinician-derived and patient reported outcomes before surgery, at 4 and 8 months follow up. Clinical sensory assessments included: touch threshold with monofilaments (WEST), shape-texture identification (STI™ test), static two-point discrimination (Mackinnon-Dellon Disk-Criminator) and the locognosia test. Motor assessments included: grip and tripod pinch strength using a digital grip analyser (MIE), manual muscle testing of abductor pollicis brevis and opponens pollicis using the Rotterdam Intrinsic Handheld Myometer (RIHM). The Boston Carpal Tunnel Questionnaire (BCTQ) was used as a patient rated outcome measure.ResultsRelative responsiveness at 4 months was highest for the BCTQ symptom severity scale with moderate to large effects sizes (ES = -1.43) followed by the BCTQ function scale (ES = -0.71). The WEST and STI™ were the most responsive sensory tests at 4 months showing moderate effect sizes (WEST ES = 0.55, STI ES = 0.52). Grip and pinch strength had a relatively higher responsiveness compared to thenar muscle strength but effect sizes for all motor tests were very small (ES ≤0.10) or negative indicating a decline compared to baseline in some patients.ConclusionsFor clinical assessment of sensibility touch threshold assessed by monofilaments (WEST) and tactile gnosis measured with the STI™ test are the most responsive tests and are recommended for future studies. The use of handheld myometry (RIHM) for manual muscle testing, despite more specifically targeting thenar muscles, was less responsive than grip or tripod pinch testing using the digital grip analyser (MIE). When assessing power and pinch strength the effect of other concomitant conditions such as degenerative joint disease on strength needs to be considered.

【 授权许可】

CC BY   
© Jerosch-Herold et al; licensee BioMed Central Ltd. 2011