Impact of technical variations on the ring-finger test for carpal tunnel syndrome

Daniel Gregor Schulze; Karl-Christian Nordby; Milada Cvancarova Småstuen; Thomas Clemm; Margreth Grotle; John Anker Zwart; Kristian Bernhard Nilsen

doi:10.1016/j.cnp.2019.11.005

Impact of technical variations on the ring-finger test for carpal tunnel syndrome

Clin Neurophysiol Pract. 2019 Dec 11:5:23-29. doi: 10.1016/j.cnp.2019.11.005. eCollection 2020.

Authors

Daniel Gregor Schulze^{1

2

3}, Karl-Christian Nordby⁴, Milada Cvancarova Småstuen^{5

6}, Thomas Clemm⁴, Margreth Grotle^{5

3}, John Anker Zwart^{1

2

3}, Kristian Bernhard Nilsen^{1

7

3}

Affiliations

¹ Department of Neurology, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway.
⁴ National Institute of Occupational Health, Oslo, Norway.
⁵ Oslo and Akershus University College, Oslo, Norway.
⁶ Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
⁷ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

Objective: To assess if recording the sensory latencies of the median and ulnar nerves one-by-one (consecutive) or at the same time (simultaneous) in the ring-finger test for carpal tunnel syndrome (CTS) will show equivalent results or if it will lead to a different clinical classification of patients.

Methods: We assessed the limits of agreement between the simultaneous and the consecutive method based on the median- ulnar sensory latency difference derived by both methods in 80 subjects and compared the number of minimal CTS cases identified by the two methods.

Results: Limits of agreement ranged from -0.23 to 0.29 ms. A significantly higher proportion of subjects with minimal CTS (only detectable by using the comparison test) was found using the simultaneous method (n = 8 and 2, respectively; p = 0.03).

Conclusion: The two methods have a poor to moderate agreement as indicated by the range of the limits of agreement (0.5 ms).

Significance: Even small methodological changes to the ring-finger test can lead to results with different clinical meaning in the same individual and one should be aware of which method was used when interpreting results.

Keywords: CTS, carpal tunnel syndrome; EMG, electromyography; HAVS, hand arm vibration syndrome; Median-ulnar nerves comparison tests; NCS, nerve conduction study; Nerve conduction study; Ring finger test.