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

摘要

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.