Primerjava psihometričnih lastnosti provokacijskih testov za osebe s sindromom zapestnega prehoda - pregled literature : diplomsko delo

Gliebe, Katja (author), Kacin, Alan (mentor), Hlebš, Sonja (reviewer)

Uvod: Sindrom zapestnega prehoda je najpogostejša periferna nevropatija na zgornjem udu, pri katerem gre za utesnitev medialnega živca v predelu zapestja. V večini primerov je diagnoza postavljena že iz anamneze in pregleda pacienta, za potrditev diagnoze pa se uporabljajo tudi elektromiografske diagnostične metode in provokacijski testi. Med klinične teste spadajo Tinelov test (udarjanje po palmarni strani zapestja), karpalni kompresijski test (pritisk na medialni živec), Phalenov test (fleksija zapestja) in test dviga zgornjih udov. Med seboj se razlikujejo po psihometričnih lastnostih. Namen: s pregledom literature želimo oceniti ter primerjati psihometrične lastnosti (veljavnost, specifičnost, občutljivost) kliničnih provokacijskih testov, za oceno oseb s sindromom zapestnega prehoda. Metode dela: v diplomskem delu smo uporabili deskriptivno metodo s sistematičnim pregledom literature. Pri izdelavi diplomske naloge so bile za iskanje literature oz. člankov uporabljene podatkovne zbirke PubMed, Researchegate, Springeropen, Cobiss in brskalnik Google Scholar. Iskanje je bilo omejeno na rendomizirane kontrolirane poskuse v slovenskem ali angleškem jeziku, prosto dosegljive celotne članke. Iskanje ni bilo omejeno na določeno časovno obdobje objave virov. Rezultati: v začetni fazi diagnosticiranja sindroma zapestnega prehoda je ključna dobra anamneza ter klinična slika pacienta. Za stopnjo utesnitve medianega živca se priporoča uporaba elektromiografskih diagnostičnih metod, v kombinaciji s kliničnimi provokacijskimi testi. Pregled literature je pokazal, da je test dviga zgornjih udov bolj občutljiv in specifičen provokativni test (s 86,6 % specifičnostjo in 89,5 % občutljivostjo) kot Phalenov in Tinelov test. Karpalni kompresijski test ima podobno občutljivost in specifičnost kot test dviga zgornjih udov, hkrati pa je tudi najbolj veljaven test (z 89,8 % veljavnostjo). Razprava in zaključek: Phalenov in Tinelov test sta označena za najbolj uporabljena testa za klinično oceno pacientov s sindromom zapestnega prehoda, vendar veljata za srednje občutljiva, specifična ter veljavna provokacijska testa. Prihodnje študije bi morale hkrati primerjati vse štiri klinične provokacijske teste na isti skupini preiskovancev.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, sindrom karpalnega kanala, diagnostika, klinični provokacijski testi, Tinelov test, Phalenov test, test dviga rok
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [K. Gliebe]
• Year: 2020
• Number of pages: 21 str.
• PID: 20.500.12556/RUL-118021
• UDC: 615.8
• COBISS.SI-ID: 25555459
• Publication date in RUL: 13.08.2020

Secondary language

• Language: English
• Title: Comparision of psychometric properties of provocative clinical tests for persons with carpal tunnel syndrome - literature review : diploma work

Abstract

Carpal tunnel syndrome is the most common peripheral neuropathy of the upper limb, caused by compression of the medial nerve at the wrist. The diagnosis can be set from medical history and clinical patient’s examination in most cases, which can be further confirmed with electromyographic diagnostic methods and provocative tests. These clinical tests are Tinel's test (tapping on the palmar side of the wrist), carpal compression test (pressure on the medical nerve), Phalen's test (wrist flexion) and hand elevation test, which all have different psychometrical characteristics. Purpose: To review literature on psychometrical characteristics (validity, specificity, sensitivity) of the clinical provocative tests for detecting carpal tunnel syndrome. Methods: In this degree paper we used a descriptive method with a systematic review of scientific literature. Articles were searched in PubMed, Researchgate, Google schooler, Springeropen and Cobiss databases. The search was limited to randomized controlled studies in both Slovenian and English language, freely accessible in full text. The search was not limited on a specific time frame. Results: Well established anamnesis and clinical examination of the patient are key for successful diagnostics in the early phase of the carpal tunnel syndrome. For establishing degree of medial nerve compression, it is recommended to use electrodiagnostic methods combined with clinical provocative tests. He literature review has shown that hand elevation test is more sensitive and specific provocative test (with 86,63% specific and 89,53% sensitive) than Phalen's and Tinel's tests. The carpal compression test has similar sensitivity and specificity than hand elevation test, while it is also the most valid test (with 89,77% validity). Discussion and conclusion: Although the Phalen's and Tinel's tests are the most frequently used for patients with carpal tunnel syndrome, they are not the most sensitive, specific and valid provocative tests available. Future studies should simultaneously compare all four clinical tests on the same patient samples.

• Keywords: diploma theses, physiotherapy, carpal tunnel syndrome, diagnostics, clinical provocative tests, hand elevation test, Tinel's test, Phalen's test, hand elevation test