Great video! The only thing that I find hard to understand is how number 3, the SSS score, is calculated. Can you guys tell me? Thank you very much. Keep up the good work!
@@Physiotutors Isn't there 11 items plus additional 8 items below in questionnaire? In total there is 19 items. Are you sure we shall use 11 items score divided by 11 or maybe sum of all 19 items score divided by it's amount of 19? EDIT: Nevermind. I actually made a mistake. SSS (Symptom Severity Scale) is a first table with 11 items. Second is FSS (Functional Status Scale) which isn't taken in exam of Wainner Clinical Prediction Rule (CPR).
With carpal tunnel compression you mean the Phalen's test? We have found a lot of different sensitivity and specificity values for this test so we're not surprised that this test didn't find it's way into the CPR in this case. Still something that might be valuable to add to your hypothesis.
Hi, thanks for your reply. I first learned of the carpal tunnel compression test from Clinical Orthopaedic Rehabilitation, 2nd EditionFeb 7, 2003 by S. Brent Brotzman MD and Kevin E. Wilk PT DPT, where it lists known efficacy of tests for diagnosing CTS on a single page, which shows the test to have similar value to NCV testing. I don't have the book with me now, so I copied this from www.thestudentphysicaltherapist.com : "Carpal Compression Test Purpose: To assess for carpal tunnel syndrome (CTS). Test Position: Sitting. Performing the Test: With the patient's arm in supination, the examiner applies pressure with his/her thumbs over the median nerve within the carpal tunnel. This is located just distal to the wrist crease. A positive test occurs when the patient complains numbness and tingling in the median nerve distribution within 30 seconds. The examiner records the time of onset for the symptoms. Diagnostic Accuracy: Sensitivity: .87; Specificity: .9 ("A new diagnostic test for carpal tunnel syndrome"). Sensitivity: .525; Specificity: .618 ("Carpal compression test and pressure provocative tests in veterans with median-distribution paresthesias")." However, I think the answer is probably in the difference of efficacy of the test in the two studies above. It looks really good in the first study and not so good in the second. I was only aware of the first study. I'm an orthopedic physician assistant in a practice with in-house electrodiagnostics, and I can refer any of my patients for EMG/NCV testing. My personal experience of 13 years is that the carpal tunnel compression test is golden. Could it be that the second study showed decreased value because clinicians participating in the study couldn't find the carpal tunnel? (And, in fact, in the US there have been a great many carpal tunnel surgeries performed where the surgical scar is nowhere near the carpal tunnel.) Inability of a non-orthopedic provider to find the carpal tunnel would be an excellent reason to exclude the test from the cluster.
I scored 5 out of 5. However I also took neck x-rays and results were “minimal anterior endplate spondylosis C6 - C7”. How can I tell which of the two is causing the tingling, numbness and pain in my hand up to my shoulder? Symptoms are the same right?
Get an MRI to determine if there is any nerve root impingement from your neck. What you're describing sounds bit like a problem coming from the neck, not so much purely at the wrist i.e. Carpal tunnel syndrome. but better get that checked out by a healthcare professional
![Carpal Tunnel Syndrome - Everything You Need To Know [Diagnosis & Natural Treatment]](http://i.ytimg.com/vi/EaUfxiRw3EQ/mqdefault.jpg)
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In the video you stated that the study done by Wainner et al. showed the values for Negative Likelihood Ratio at 0.14 for
Will check and fix. Thanks for the info
Great video!
The only thing that I find hard to understand is how number 3, the SSS score, is calculated. Can you guys tell me?
Thank you very much. Keep up the good work!
Happy to hear Duncan!
Just take the score of all 11 items and divide it through 11.
@@Physiotutors Isn't there 11 items plus additional 8 items below in questionnaire? In total there is 19 items. Are you sure we shall use 11 items score divided by 11 or maybe sum of all 19 items score divided by it's amount of 19?
EDIT: Nevermind. I actually made a mistake. SSS (Symptom Severity Scale) is a first table with 11 items. Second is FSS (Functional Status Scale) which isn't taken in exam of Wainner Clinical Prediction Rule (CPR).
carpal tunnel compression test didn't make the cut? Isn't that about equal to NCV test in sensitivity for CTS? By the way, thanks for great videos.
With carpal tunnel compression you mean the Phalen's test?
We have found a lot of different sensitivity and specificity values for this test so we're not surprised that this test didn't find it's way into the CPR in this case. Still something that might be valuable to add to your hypothesis.
Hi, thanks for your reply. I first learned of the carpal tunnel compression test from Clinical Orthopaedic Rehabilitation, 2nd EditionFeb 7, 2003
by S. Brent Brotzman MD and Kevin E. Wilk PT DPT, where it lists known efficacy of tests for diagnosing CTS on a single page, which shows the test to have similar value to NCV testing. I don't have the book with me now, so I copied this from www.thestudentphysicaltherapist.com :
"Carpal Compression Test
Purpose: To assess for carpal tunnel syndrome (CTS).
Test Position: Sitting.
Performing the Test: With the patient's arm in supination, the examiner applies pressure with his/her thumbs over the median nerve within the carpal tunnel. This is located just distal to the wrist crease. A positive test occurs when the patient complains numbness and tingling in the median nerve distribution within 30 seconds. The examiner records the time of onset for the symptoms.
Diagnostic Accuracy: Sensitivity: .87; Specificity: .9 ("A new diagnostic test for carpal tunnel syndrome"). Sensitivity: .525; Specificity: .618 ("Carpal compression test and pressure provocative tests in veterans with median-distribution paresthesias")."
However, I think the answer is probably in the difference of efficacy of the test in the two studies above. It looks really good in the first study and not so good in the second. I was only aware of the first study. I'm an orthopedic physician assistant in a practice with in-house electrodiagnostics, and I can refer any of my patients for EMG/NCV testing. My personal experience of 13 years is that the carpal tunnel compression test is golden. Could it be that the second study showed decreased value because clinicians participating in the study couldn't find the carpal tunnel? (And, in fact, in the US there have been a great many carpal tunnel surgeries performed where the surgical scar is nowhere near the carpal tunnel.) Inability of a non-orthopedic provider to find the carpal tunnel would be an excellent reason to exclude the test from the cluster.
I believe Daniel was talking about the Durkan test aka Carpal Compression test
I scored 5 out of 5. However I also took neck x-rays and results were “minimal anterior endplate spondylosis C6 - C7”. How can I tell which of the two is causing the tingling, numbness and pain in my hand up to my shoulder? Symptoms are the same right?
Get an MRI to determine if there is any nerve root impingement from your neck. What you're describing sounds bit like a problem coming from the neck, not so much purely at the wrist i.e. Carpal tunnel syndrome. but better get that checked out by a healthcare professional
When I click the link for the SSS test form I get a high risk warning from my google chrome browser that it's unsafe. Does anyone else get that too?
Could be that there is a problem with their website
We can check if there is another link to the file
please make a video on Clinical Prediction Rule for Cervical spondylitis
+Mustafa Ajmerwala do you have a specific one in mind? We don't know of any...
Physiotutors Spurling, Compression, Depression ULTT , these are present, don't know the rest
Thanks
You are talking about the Cluster of Wainner: th-cam.com/video/QKc1BV-BErs/w-d-xo.html
Do we need a doctorate to understand you???