Elektroneurografska procjena pouzdanosti Wormserovoga i Phalenovoga testa u dijagnostici sindroma karpalnoga tunela [Electroneurographic assessment of Wormser's and Phalen's tests reliability in the diagnosis of carpal tunnel syndrome]

Čerimagić, Denis (2012) Elektroneurografska procjena pouzdanosti Wormserovoga i Phalenovoga testa u dijagnostici sindroma karpalnoga tunela [Electroneurographic assessment of Wormser's and Phalen's tests reliability in the diagnosis of carpal tunnel syndrome]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Carpal tunnel syndrome, a symptomatic focal median neuropathy at the wrist, is the most common focal nerve compression and a frequent reason for electrodiagnostic consultation. Many clinical tests have been described in the literature as being more or less characteristic of the syndrome. Data on the validity of these tests are quite contradictory, because they are founded only on examinee’s subjective impression (the sensory symptoms after variable latency). The aim of this study was to analyse the objective electroneurographic parameters variations during standardized wrist positions (neutral position, dorsal flexion – Wormser's test and palmar flexion – Phalen's test) in 50 patients with carpal tunnel syndrome and in 50 healthy individuals. The study found that the parameters obtained durign Wormser’s test are the most sensitive in the diagnosis of carpal tunnel syndrome. There was a statistically significant effect on test results during Wormser’s test for all parameters of median nerve, where the prolongation of distal motor and sensory “peak” latency, amplitude reduction CMAP and SNAP, and slowing of motor and sensory conduction velocity were observed. The above shows that the ENG parameter of Wormser’s test are more reliable in the diagnosis of carpal tunnel syndrome than the ENG parameters in Phalen’s test. This modification of standard ENG examination allows the diagnosis of latent syndrome in patients with normal or borderline results of classic electroneurographic examination in a neutral position. The results of this research may be additional support for modification of standard ENG examination in patients with suspected carpal tunnel syndrome and may present a kind of rehabilitation for Wormser’s test in everyday electrophysiologic practice.

Abstract in Croatian

Sindrom karpalnog tunela je najčešća kompresivna mononeuropatija i čest razlog elektroneurografske obrade. U literaturi su opisani brojni klinički testovi, znakovi i manevri za dijagnosticiranje ovog sindroma. Podaci o validnosti ovih testova često su kontradiktorni jer se temelje na subjektivnom doživljaju ispitanika (pojava osjetnih senzacija nakon različito duge latencije). Cilj ovog istraživanja je objektivno i neinvazivno, modifikacijom standardne elektroneurografske obrade, utvrditi utjecaj različitih položaja šake (neutralni položaj, Wormserov i Phalenov test) na rezultate elektroneurografske analize 50 bolesnika sa sindromom karpalnoga tunela i 50 zdravih kontrola. Istraživanjem je utvrđeno da su elektroneurografski parametri dobiveni pri Wormserovom testu najosjetljiviji u dijagnostici sindroma karpalnoga tunela. Utvrđen je statistički značajan utjecaj Wormserovoga testa na rezultate svih elektroneurografskih parametara n.medianusa, pri čemu su zabilježena produljenja distalne motorne i senzorne „peak“ latencije, redukcija amplitude CMAP i SNAP te usporenje motornih i senzornih brzina provodljivosti. Iz navedenog proizlazi da je s ENG aspekta Wormserov test pouzdaniji od Phalenovoga u dijagnostici sindroma karpalnoga tunela te da omogućuje dijagnosticiranje latentnog sindroma u pacijenata s urednim ili graničnim rezultatima elektroneurografske obrade u neutralnom položaju. Rezultati istraživanja predstavljaju i svojevrsnu rehabilitaciju u literaturi inferiornog Wormserovoga testa koji bi trebao zauzeti mjesto u dijagnostici sindroma karpalnoga tunela, koje mu po važnosti pripada.

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