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Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis
被引：6
作者：
Dabbagh, Armaghan
[1
]
MacDermid, Joy C.
[1
,2
,3
]
Yong, Joshua
[4
]
Packham, Tara L.
[2
]
Grewal, Ruby
[1
,5
]
Boutsikari, Eleni C.
[6
]
机构：
[1] Western Univ, Fac Hlth Sci, Sch Phys Therapy, London, ON, Canada
[2] McMaster Univ, Sch Rehabil Sci, Hamilton, ON, Canada
[3] St Josephs Hosp, Roth McFarlane Hand & Upper Limb Ctr, London, ON, Canada
[4] Sengkang Gen Hosp, Singapore, Singapore
[5] Western Univ, Dept Surg, London, ON, Canada
[6] Natl & Kapodistrian Univ Athens, Dept Hyg Epidemiol & Med Stat, Athens, Greece
来源：
PHYSICAL THERAPY
|
2023年
/
103卷
/
06期
基金：
加拿大健康研究院;
关键词：
Carpal Tunnel Syndrome;
Diagnostic Accuracy;
Phalen Test;
Provocative Tests;
Systematic Review;
Tinel Sign;
NERVE-CONDUCTION TESTS;
PHYSICAL-EXAMINATION;
COMPRESSION TEST;
PHALENS TEST;
SPECIFICITY;
SENSITIVITY;
QUESTIONNAIRES;
PREVALENCE;
STATISTICS;
UTILITY;
D O I：
10.1093/ptj/pzad029
中图分类号：
R826.8 [整形外科学];
R782.2 [口腔颌面部整形外科学];
R726.2 [小儿整形外科学];
R62 [整形外科学（修复外科学）];
学科分类号：
摘要：
Objective The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). Methods The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. Results Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. Conclusion Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. Impact Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.
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页数：13
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