Clinical Characteristics And Electrophysiological Characteristics Of Carpal Tunnel Syndrome

Objective:1.To evaluate the diagnostic value of the Tinel test and the Phalen test for carpal tunnel syndrome;2.Analyze the relationship between the Tinel and Phalen tests and neuroelectrophysiology;3.Neuroelectrophysiological characteristics of patients with simple carpal tunnel syndrome and patients with cervical spondylotic radiculopathy and carpal tunnel syndrome.Method:Screening and collecting patients diagnosed as carpal tunnel syndrome?CTS?,radiculopathy with cervical spondylosis with carpal tunnel syndrome?DCS?and control group of 234 cases,from November 2016 to February 2019 at the outpatient and inpatient hospital of Yan'an University Hospital,according to clinical manifestations,median nerve conduction velocity,needle electromyography and imaging examination.The 234patients were divided into three groups,69 in the CTS group,45 in the DCS group,and120 in the control group.The patient's gender,age,Tinel test and Phalen test results,median nerve sensation and motor conduction parameters were included,including sensory conduction velocity?SCV?,sensory potential amplitude?SNAP?,motor conduction velocity?MCV?,and terminal motion latency?DML?.),the proximal composite muscle action potential?pCMAP?amplitude and the action potential amplitude?dCMAP?of the distal composite muscle.1.Analyze and compare the gender and age distribution of patients in CTS group,DCS group and control group;2.Analyze and compare the results of the Tinel and Phalen trials of the CTS group,the DCS group and the control group;3.Analyze the relationship between the results of the Tinel and Phalen test and the median nerve conduction velocity in patients with carpal tunnel syndrome?CTS and DCS?;4.To compare the relationship between the median nerve conduction velocity of the patients in the CTS group and the DCS group,and to draw a box plot to observe the distribution.Excel and SPSS19.0 statistical software were used for data management and statistical processing.The data conforming to the normal distribution was represented by x±s,and the data of non-normal distribution was represented by the median and interquartile range;the normal distribution measurement The t test was used to compare the data between the two groups.The variance analysis was used to compare the measurement data among the groups.The rank sum test was used for the non-normal distribution measurement data.The chi-square test was used to compare the count data between the groups.P<0.05 The difference was statistically significant.Results:1.The ratio of females in CTS,DCS and control group was higher than that in male patients?71.0%vs 29.0%,68.9%vs 31.1%,62.5%vs.37.5%?.There was no significant difference in gender between CTS group,DCS group and control group?P>0.05?.There was no significant difference in the mean age between the CTS group,the DCS group and the control group?P>0.05?.2.The positive signs of the Tinel test and the Phalen test between the CTS group,the DCS group and the control group were most common in patients with CTS?88.9%vs.80.2%?,followed by DCS patients?80.3%vs.77.3%?.The difference between the Tinel test and the Phalen test between the CTS group,the DCS group and the control group was statistically significant?P<0.05?.There was no significant difference between the Tinel test and the Phalen test between the CTS group and the DCS group.Patients with carpal tunnel syndrome?CTS and DCS?had higher sensitivity?85.0%,78.9%?and lower specificity?69.1%,66.2%?.The parallel results of the Tinel test/Phalen test showed that the carpal tunnel syndrome group?CTS and DCS?had a sensitivity of 97.3%and a specificity of 60.4%.3.The difference of SCV₂ in Phalen test of patients with carpal tunnel syndrome?CTS and DCS?was statistically significant?P<0.05?.There was no significant difference between the results of SNAP₂,DML,dCMAP,MCV,pCMAP and Phalen test?P>0.05?.The SCV₂ of the patients with carpal tunnel syndrome?CTS and DCS?had statistical significance?P<0.05?.There was no significant difference between the results of SNAP₂,DML,dCMAP,MCV,pCMAP and Tinel test?P>0.05?.4.The differences of SCV2,SNAP2,MCV,DML,dCMAP and pCMAP between CTS group and DCS group were statistically significant?P<0.05?.The median and interquartile range of SCV2 in CTS patients was 39.40?6.20?;the median and interquartile range of SCV2 in the DCS group was 34.80?10.50?.The median and interquartile range of SNAP2 in the CTS group was 9.60?7.90?;the median and interquartile range of SNAP2 in the DCS group was 5.15?6.40?.The MCV median and interquartile range of the CTS group was 54.80?6.90?,and the MCV median and interquartile range of the DCS group was 52.90?9.42?.The median and interquartile range of DML in the CTS group was 7.10?2.20?,and the median and interquartile range of the DML in the DCS group was 7.80?1.23?.The median and interquartile range of dCMAP in the CTS group was 13.30?7.90?,and the median and interquartile range of the dCMAP in the DCS group was 10.45?5.25?.The median and interquartile range of pCMAP in the CTS group was 12.90?5.90?,and the median and interquartile range of the pCMAP in the DCS group was 9.10?4.35?.The box plots can be seen to show that the SCV2,SNAP2 and DML indicators are significantly different in the distribution interval between the two groups.The neurophysiological examination has a certain predictive effect on the identification of CTS and DCS.Conclusion:1.The age and sex distribution of CTS group,DCS group and control group?The patients with similar symptoms?were similar;2.The Tinel test combined with the Phalen test can be used for initial screening of carpal tunnel syndrome;3.From the perspective of neuroelectrophysiology,DCS patients have a greater degree of damage to the median nerve than CTS patients,supporting a double compression mechanism.