Local corticosteroid injection versus placebo for carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a very common clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Direct and indirect costs of CTS are substantial, with estimated costs of two billion US dollars for CTS surgery in the USA in 1995 alone. Local corticosteroid injection has been used as a non-surgical treatment for CTS many years, but its effectiveness is still debated. OBJECTIVES: To evaluate the benefits and harms of corticosteroids injected in or around the carpal tunnel for the treatment of carpal tunnel syndrome compared to no treatment or a placebo injection. SEARCH METHODS: We used standard, extensive Cochrane search Methods. The searches were 7 June 2020 and 26 May 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-randomised trials of adults with CTS that included at least one comparison group of local injection of corticosteroid (LCI) into the wrist and one group that received a placebo or no treatment. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcome was 1. improvement in symptoms at up to three months of follow-up. Our secondary outcomes were 2. functional improvement, 3. improvement in symptoms at greater than three months of follow-up, 4. improvement in neurophysiological parameters, 5. improvement in imaging parameters, 6. requirement for carpal tunnel surgery, 7. improvement in quality of life and 8. ADVERSE EVENTS: We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included 14 trials with 994 participants/hands with CTS. Only nine studies (639 participants/hands) had useable data quantitatively and in general, these studies were at low risk of bias except for one quite high-risk study. The trials were conducted in hospital-based clinics across North America, Europe, Asia and the Middle East. All trials used participant-reported outcome measures for symptoms, function and quality of life. There is probably an improvement in symptoms measured at up to three months of follow-up favouring LCI (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.94 to -0.59; 8 RCTs, 579 participants; moderate-certainty evidence). Up to six months this was still evident favouring LCI (SMD -0.58, 95% CI -0.89 to -0.28; 4 RCTs, 234 participants/hands; moderate-certainty evidence). There is probably an improvement in function measured at up to three months favouring LCI (SMD -0.62, 95% CI -0.87 to -0.38; 7 RCTs, 499 participants; moderate-certainty evidence). We are uncertain if there is a difference in median nerve DML at up to three months of follow-up (mean difference (MD) -0.37 ms, 95% CI -0.75 to 0.02; 6 RCTs, 359 participants/hands; very low-certainty evidence). The requirement for surgery probably reduces slightly in the LCI group at one year (risk ratio 0.84, 95% CI 0.72 to 0.98; 1 RCT, 111 participants, moderate-certainty evidence). Quality of life, measured at up to three months of follow-up using the Short-Form 6 Dimensions questionnaire (scale from 0.29 to 1.0; higher is better) probably improved slightly in the LCI group (MD 0.07, 95% CI 0.02 to 0.12; 1 RCT, 111 participants; moderate-certainty evidence). Adverse events were uncommon (low-certainty evidence). One study reported 2/364 injections resulted in severe pain which resolved over "several weeks" and 1/364 injections caused a "sympathetic reaction" with a cool, pale hand that completely resolved in 20 minutes. One study (111 participants) reported no serious adverse events, but 65% of LCI-injected and 16% of the placebo-injected participants experienced mild-to-moderate pain lasting less than two weeks. About 9% of participants experienced localised swelling lasting less than two weeks. Four studies (229 participants) reported that they experienced no adverse events in their studies. Three studies (220 participants) did not specifically report adverse events. AUTHORS' CONCLUSIONS: Local corticosteroid injection is effective for the treatment of mild and moderate CTS with benefits lasting up to six months and a reduced need for surgery up to 12 months. Where serious adverse events were reported, they were rare.

Reducing prescribing of benzodiazepines in older adults: a comparison of four physician-focused interventions by a medical regulatory authority.

BACKGROUND: The inappropriate and/or high prescribing of benzodiazepine and 'Z' drugs (BDZ +) is a major health concern. The purpose of this study was to determine whether physician or pharmacist led interventions or a simple letter or a personalized prescribing report from a medical regulatory authority (MRA) was the most effective intervention for reducing BDZ + prescribing by physicians to patients 65 years of age or older. METHODS: This was a four-armed, one year, blinded, randomized, parallel-group, investigational trial in Alberta, Canada. Participants were fully licensed physicians (n = 272) who had prescribed 4 times the defined daily dose (4 + DDD) or more of any BDZ + to an older patient at least once in the 3rd quarter of 2016. All physician-participants were sent a personalized prescribing profile by the MRA. They were then randomized into four groups that received either nothing more, an additional personal warning letter from the MRA, a personal phone call from an MRA pharmacist or a personal phone call from an MRA physician. The main outcomes were prescribing behavior change of physicians at one year in terms of: change in mean number of older patients receiving 4 + DDD BDZ + and mean dose BDZ + prescribed per physician. To adjust for multiple statistical testing, we used MANCOVA to test both main outcome measures simultaneously by group whilst controlling for any baseline differences. RESULTS: All groups experienced a significant fall in the total number of older patients receiving 4 + DDD of BDZ + by about 50% (range 43-54%) per physician at one year, and a fall in the mean dose of BDZ + prescribed of about 13% (range 10-16%). However, there was no significant difference between each group. CONCLUSIONS: A personalized prescribing report alone sent from the MRA appears to be an effective intervention for reducing very high levels of BDZ + prescribing in older patients. Additional interventions by a pharmacist or physician did not result in additional benefit. The intervention needs to be tested further on a more general population of physicians, prescribing less extreme doses of BDZ + and that looks at more clinical and healthcare utilization outcomes.

2b or not 2b? Shoulder function after level 2b neck dissection: A double-blind randomized controlled clinical trial.

BACKGROUND: Selective neck dissection (SND) is a mainstay of head and neck cancer treatment. A common sequela is shoulder syndrome from spinal accessory nerve (SAN) trauma. Extensive dissection in neck levels 2 and 5 leads to SAN dysfunction. However, it is not known whether limited level 2 dissection reduces SAN injury. The purpose of this double-blind randomized controlled trial was to determine whether omitting level 2b dissection would improve shoulder-related quality of life and function. METHODS: Patients with head and neck cancers undergoing surgery were randomized 1:1 to SND without level 2b dissection (group 1) or with it (group 2) on their dominant-hand side. Patients, caregivers, and assessors were blinded. The primary outcome was the change in the Neck Dissection Impairment Index (NDII) score after 6 months. An a priori calculation of the minimally important clinical difference in the NDII score was determined to establish a sample size of 15 patients per group (power = 0.8). Secondary outcomes included shoulder strength and range of motion (ROM) and SAN nerve conduction. The trial was registered at ClinicalTrials.gov (NCT00765791). RESULTS: Forty patients were enrolled, and 30 were included (15 per group). Six months after the surgery, group 2 demonstrated a significant median decrease in the NDII from the baseline (30 points) and in comparison with group 1, whose NDII dropped 17.5 points (P = .02). Shoulder ROM and SAN conduction demonstrated significant declines in group 2 (P ≤ .05). No adverse events occurred. CONCLUSIONS: Level 2b should be omitted in SND when this is oncologically safe and feasible. This allows for an optimal balance between function and cancer cure.

Laterality and risk factors for ulnar neuropathy at the elbow.

BACKGROUND: Ulnar neuropathy at the elbow (UNE) is the second commonest entrapment neuropathy after carpal tunnel syndrome (CTS) and yet the laterality is not well delineated. Our aim was to establish the laterality of UNE in a large cohort of patients. METHODS: All new patients with clinical and electrodiagnostic (EDX) confirmed UNE over a 13-year period were included. We used multivariate analysis to examine potential predictors of laterality, and unilateral vs bilateral UNE. RESULTS: Of 880 cases, 61% were left-sided and 39% right-sided. These proportions did not change regardless of the handedness of the patient. Patients with bilateral UNE were much more likely to be older male and have a variety of comorbidities. CONCLUSIONS: UNE appears to be present on the left 50% more often than on the right, regardless of the patient's handedness.

The usefulness of electrodiagnostic studies in the diagnosis and management of neuromuscular disorders.

INTRODUCTION: This study seeks to evaluate the usefulness of electrodiagnostic (EDX) studies in terms of the patient's diagnosis and subsequent management and to identify patient groups in which EDX is particularly useful. METHODS: The records of new patients referred to a single tertiary hospital EDX laboratory during 1 calendar year were reviewed to determine whether results of EDX studies led to a changed diagnosis and/or management plan. Logistic regression was used to determine whether any factors were associated with changed diagnosis or management. RESULTS: Results of EDX studies led to a change in diagnosis and a confirmation in diagnosis in 51.5% and 46.5% of the cases, respectively. Results of EDX studies led to a change in the management plan in 63.4% of all cases. The diagnosis and management plan were more likely to be changed in older patients and patients referred in hospital. DISCUSSION: EDX studies seem useful for confirming or changing the diagnosis and in guiding management in patients with suspected neuromuscular disorders. Muscle Nerve 58: 191-196, 2018.

Comparing Class-Based and Home-Based Exercise for Older Adults With Chronic Health Conditions: 12-Month Follow-Up of a Randomized Clinical Trial.

OBJECTIVE: To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period. METHODS: A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations. RESULTS: Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p < .01], lower body flexibility [2.8 cm vs. 0.4 cm, p < .05], and dynamic agility [14% vs. 7%, p < .05]). CONCLUSION: The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice.

Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework.

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults.

Electrodiagnostic Testing and Treatment for Carpal Tunnel Syndrome in Canada.

OBJECTIVES: 1) Assess which electrodiagnostic studies Canadian clinicians use to aid in the diagnosis of carpal tunnel syndrome (CTS). 2) Assess whether Canadian clinicians follow the American Association of Neuromuscular & Electrodiagnostic Medicine/American Academy of Neurology/American Academy of Physical Medicine and Rehabilitation Practice Parameter for Electrodiagnostic Studies in CTS. 3) Assess how Canadian clinicians manage CTS once a diagnosis has been established. METHODS: In this prospective observational study, an electronic survey was sent to all members of the Canadian Neuromuscular Group (CNMG) and the Canadian Association of Physical Medicine and Rehabilitation (CAPM&R) Neuromuscular Special Interest Group. Questions addressed which electrodiagnostic tests were being routinely used for the diagnosis of carpal tunnel syndrome. Management recommendations for CTS was also explored. RESULTS: Of the 70 individuals who completed the survey, fourteen different nerve conduction study techniques were reported. Overall, 36/70 (51%) of participants followed the AANEM/AAN/AAPM&R Practice Parameter. The standard followed by the fewest of our respondents with 64% compliance (45/70) was the use of a standard distance of 13 to 14 cm with respect to the median sensory nerve conduction study. Regarding management, 99% would recommend splinting in the case of mild CTS. In moderate CTS, splinting was recommended by 91% of clinicians and 68% would also consider referral for surgery. In severe CTS, most recommended surgery (93%). CONCLUSIONS: There is considerable variability in terms of which electrodiagnostic tests Canadian clinicians perform for CTS. Canadian clinicians are encouraged to adhere to the AANEM/AAN/AAPM&R Practice Parameter for Electrodiagnostic Studies in CTS.

Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis.

AIM: To compare the accuracy of ultrasound (US)-guided versus landmark-guided hip joint injections. METHODS: PubMed, Medline and Cochrane libraries were searched up to 31 July 2014. Two independent authors selected studies assessing accuracy of intra-articular hip injections based on predetermined inclusion and exclusion criteria. Selected papers were then evaluated for quality and a meta-analysis of accuracy was performed using random effects models. RESULTS: 4 US-guided (136 hip injections) and 5 landmark-guided (295 hip injections) studies were reviewed. The weighted means for US-guided and landmark-guided hip injection accuracies were 100% (95% CI 98% to 100%) and 72% (95% CI 56% to 85%), respectively. US-guided hip injection accuracy was significantly higher than landmark-guided accuracy (p<0.0001). SUMMARY: This is the first systematic review and meta-analysis of the accuracy of US-guided versus landmark-guided hip joint injections that has revealed that US-guided injections are significantly more accurate than those that are landmark guided. Future studies should compare US with fluoroscopic-guided hip joint injections for accuracy, efficacy, safety profile, cost-effectiveness and patient satisfaction.

Honorary authorship in postgraduate medical training.

OBJECTIVES: To determine whether postgraduate medical trainees are exposed to honorary authorship, whether they are aware of the topic and if they believe that further support and education concerning this issue is needed. METHODS: Postgraduate medical trainees were contacted by email with a link to our questionnaire on two occasions (2 and 26 February 2014) and then contacted in person (June-November 2014). The questionnaire topics included demographics, authorship practice beliefs and experience, and authorship policy-related questions. We also determined the proportion of perceived, International Committee of Medical Journal Editors (ICMJE)-defined and unperceived honorary authorship in the respondent group. RESULTS: The response rate was 27.7%. The prevalence of perceived, ICMJE-defined and unperceived honorary authorship was 38.1%, 57.3% and 24.2%, respectively; 90.1% were unaware of the ICMJE authorship criteria, 92.6% were unaware of a support system for authorship disputes, but 91.8% believed such a system should be implemented and 93.3% believed medical trainees and faculty should be instructed on authorship guidelines. CONCLUSIONS: A paradigm shift from the current system is needed, where enforcement of ethical authorship practices is shifted away from journal editors. Instruction on the topic should be provided to medical trainees throughout medical school and continued during further training. A process should also be outlined to resolve authorship disputes. These measures may encourage researchers to have an open discussion on the topic prior to the commencement of a research project, and to resolve authorship conflicts in a constructive manner. We also hope this paper encourages further work on the topic.

Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis.

OBJECTIVE: To compare the accuracy and efficacy of ultrasound (US)-guided injections versus landmark-guided injections of the subacromial space, biceps tendon sheath, acromioclavicular (AC) joint and glenohumeral (GH) joint. METHODS: PubMed, Medline and Cochrane libraries were searched up to 31 July 2013. Two independent authors selected and evaluated randomised controlled trials comparing the accuracy and/or efficacy of US versus landmark-guided injection of the shoulder girdle. A meta-analysis of accuracy, pain Visual Analog Scale (VAS), function score and reported adverse events were performed. RESULT: Four cadaveric studies (300 cadaveric shoulders) and nine live human studies (514 patients) were reviewed. Based on three studies for AC joint, the accuracy of US versus a landmark-guided injection was 93.6% vs 68.2% (p<0.0001). Based on single studies, the accuracy of US versus a landmark-guided injection was 65% vs 70% for the subacromial space (p>0.05), 86.7% vs 26.7% for the biceps tendon sheath (p<0.05), and 92.5% vs 72.5% for the GH joint (p=0.025). Based on three studies for the subacromial space, the US group had a significantly greater reduction in pain (mean difference (MD)=1.47, 95% CI 1.0 to 1.93), and improvement in function (standardised MD=0.70, 95% CI 0.39 to 1.01) at 6 weeks postinjection. Based on a single study for the biceps tendon sheath, the US group had a significantly greater reduction in pain (MD 1.9, 95% CI 1.2 to 2.6) and improvement in function (MD=10.9, 95% CI 6.57 to 15.23). CONCLUSIONS: US-guided injections showed greater accuracy for all shoulder girdle injections, with the exception of the subacromial space. There was improved efficacy for the subacromial space and biceps tendon sheath injections.

Suprascapular nerve injury during arthroscopic superior labral repair: a prospective evaluation.

PURPOSE: This prospective study evaluated suprascapular nerve injury risk during arthroscopic superior labral repair in patients of average height or shorter. METHODS: From 2009 to 2011, 12 patients <179 cm tall undergoing arthroscopic superior labral repair were prospectively enrolled. Portal location, tear and anchor characteristics, and surgeon impression of medial glenoid wall perforation were collected. Suprascapular nerve conduction studies were obtained postoperatively. A musculoskeletal radiologist evaluated medial glenoid wall perforation and the distance from the anchor to the suprascapular neurovascular bundle on postoperative magnetic resonance images (MRI). DASH scores were recorded preoperatively and 6 months postoperatively. RESULTS: Medial wall perforation occurred in five (42 %) patients, with 3 patients having a single perforation and two patients having two perforations. Eight of 38 (21 %) anchors drilled into the superior half of the glenoid, and 6 of 20 (30 %) anchors inserted into the postero-superior quadrant of the glenoid, perforated the medial wall. Perforations occurred both through the portal of Wilmington and the antero-superior portal. The distance to the suprascapular neurovascular bundle from the perforating anchors ranged from 0 to 4 mm. Nerve conduction studies revealed subclinical signs of an incomplete nerve injury in one patient. DASH scores improved on average 29.3 points postoperatively (SD = 27.0, p = 0.007). CONCLUSION: Medial wall perforation is common in smaller patients during arthroscopic superior labral repairs; the suprascapular nerve can be injured if perforation occurs. The clinical significance of these findings is unclear. In spite of a high drill-out rate, the nerve is rarely injured; however, an anchor designed for implantation into bone that is instead lodged in the soft tissues has the potential to harm these tissues and surrounding structures. LEVEL OF EVIDENCE: Prospective cohort study, treatment study, Level III.

Effectiveness of second corticosteroid injections for carpal tunnel syndrome.

INTRODUCTION: A single local corticosteroid injection is an effective treatment for carpal tunnel syndrome. No study has specifically examined the effectiveness of a second injection on relapse after primary injection. METHODS: We identified a cohort of patients who had received an initial corticosteroid injection into 1 wrist and then, at a later date, a second injection into the same wrist. We compared the change in the Boston Symptom Severity Scale (SSS) and Functional Status Scale (FSS) between first and second injections. RESULTS: In 229 patients who received 2 injections the mean improvement on the SSS was 1.2 (SD = 0.8) for the first injection and 1.3 (SD = 0.9) for the second, which was not statistically significant. Improvement in FSS for the first injection was 0.4 (SD = 0.8) and 0.7 (SD = 0.8) for the second, which was statistically significant (P < 0.001). CONCLUSION: Second corticosteroid injections appear to be at least as effective as the first.

Cross-sectional study of rapid tapering of opioid prescriptions following medical regulatory intervention in Alberta from 2013 to 2020.

OBJECTIVE: To determine if inappropriate tapering/discontinuation of opioids to Alberta patients occurred from mid-2013-2020, as unintended consequences of prescribing guidelines, regulations and policies in response to the North American opioid crisis. DESIGN: A population-based, repeated cross-sectional time-series study. SETTING: Alberta, Canada. PARTICIPANTS: Residents of Alberta, Canada aged 18 and older who received an opioid dispense from a community pharmacy from 2013 to 2020. MAIN OUTCOME MEASURES: The prevalence of potential rapid tapering was measured at a given date (reference day), enveloped by a data window. Dose changes were measured as oral morphine equivalents (OME) per patient, at multiple time points ('data window' around a reference day). Chronic recipients were identified, and their prescriptions were contrasted 90 days before and after the reference day to measure OME/day changes. RESULTS: Approximately 9000 dispenses (totalling ~6 million OME) per day were analysed from 2013 to 2020. The total number of opioid recipients was highly cyclic in nature (peaking in winter). The number of chronic opioid recipients remained somewhat stable from ~70K in 2013 to ~86K at the end of 2020. The number of chronic high and very high dose recipients presented a significant decrease after 2017. Approximately 11%-12% of chronic high-dose recipients experienced potential rapid dose tapering at a rate of 50% or more prereference to postreference day at any given point of time. For chronic very high dose recipients, approximately 11.5% experience potential rapid dose tapering at a rate of 50% or more prereference to postreference day at any given point of time. Potential discontinuation remained constant and the interventions did not have a significant impact on the trend. CONCLUSION: The evidence suggests that changes in prescribing guidelines were not associated with an increase of rapid opioid tapering/discontinuation in Alberta.

Treatment for spasticity in amyotrophic lateral sclerosis/motor neuron disease.

BACKGROUND: Spasticity commonly affects patients with motor neuron disease. It is likely to contribute to worsening muscle dysfunction, increased difficulty with activities of daily living and deteriorating quality of life. This is an update of a review first published in 2003 and previously updated in 2005 and 2008. OBJECTIVES: The objective of this review is to systematically review treatments for spasticity in amyotrophic lateral sclerosis, also known as motor neuron disease. SEARCH METHODS: We searched the Cochrane Neuromuscular Disease Group Specialized Register (4 July 2011), CENTRAL (2011, Issue 2), MEDLINE (January 1966 to July 2011), EMBASE (January 1980 to July 2011 ), CINAHL Plus (January 1937 to July 2011), AMED (January 1985 to July 2011) and LILACS (January 1982 to July 2011 ). We reviewed the bibliographies of the randomized controlled trials identified, and contacted authors and experts in the field. SELECTION CRITERIA: We included quasi-randomized or randomized controlled trials of participants with probable or definite amyotrophic lateral sclerosis according to the El Escorial diagnostic criteria (or a revised version) or the Airlie House revision. We would have included trials of physical therapy, modalities, prescription medications, non-prescription medications, chemical neurolysis, surgical interventions, and alternative therapies. Our primary outcome measure was reduction in spasticity at three months or greater as measured by the Ashworth (or modified Ashworth) spasticity scale. Our secondary outcome measures were: validated measures based on history, physical examination, physiological measures, measures of function, measures of quality of life, all adverse events, and measures of cost. DATA COLLECTION AND ANALYSIS: Two authors independently screened the abstracts of potential trials retrieved from the searches. Two authors extracted the data. We also contacted the author of the paper and obtained information not available in the published article. All three authors assessed the methodological quality of all included trials independently. MAIN RESULTS: We identified only one randomized controlled trial that met our inclusion criteria and no further trials were identified in subsequent updates. The included study was a trial of moderate intensity, endurance type exercise versus 'usual activities' in 25 patients with amyotrophic lateral sclerosis. The risk of bias was high and no adverse events were reported. At three months patients performing the 15 minute twice daily exercises had significantly less spasticity overall (mean reduction of -0.43, 95% confidence interval (CI) -1.03 to +0.17 in the treatment group versus an increase of +0.25, 95% CI -0.46 to +0.96 in control) but the mean change between groups was not significant (-0.68, 95% CI -1.62 to +0.26), as measured by the Ashworth scale (possible scores 0 to 5, where higher is worse). AUTHORS' CONCLUSIONS: The single trial performed was too small to determine whether individualized moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No other medical, surgical or alternative treatment and therapy has been evaluated in a randomized fashion in this patient population. More research is needed.

Validity and reliability of the Purdue Pegboard Test in carpal tunnel syndrome.

There is a paucity of validated tests to quantify hand function impairment due to carpal tunnel syndrome (CTS). The aim of this study was to test the validity and reliability of the Purdue Pegboard Test (PPT) in CTS patients. We compared 190 CTS patients with 122 healthy, age-matched controls. CTS severity was determined based on electrophysiologic parameters and the Levine Self-Assessment Questionnaire. The time to complete the PPT and the test-retest reliability were tested. The test-retest reliability was high with an intraclass correlation coefficient of 0.91. Compared to healthy controls, the CTS patients were significantly slower. Although the functional performance generally declined with increasing severity of electrophysiologic abnormalities, the correlation between hand function decline and symptom severity in the young and middle-aged groups was low. We conclude that the PPT is a valid and reliable tool to quantify functional impairment caused by CTS. It can be a useful outcome measure in young and middle-aged patients.

Discriminative validity and test-retest reliability of the Dellon-modified Moberg pick-up test in carpal tunnel syndrome patients.

There is a scarcity of validated hand performance tests with proven reliability for quantifying functional deficits in patients with carpal tunnel syndrome (CTS). The Dellon-modified Moberg pick-up test (DMMPUT), composed of commonly used daily objects, is potentially well suited for that purpose. This study was designed to evaluate the test-retest reliability and discriminative validity of the DMMPUT in CTS patients. We compared 162 CTS patients with 116 age-matched controls. CTS severity was determined based on electrophysiological parameters and Levine's Self-Assessment Questionnaire. The mean time to complete each subset of the DMMPUT by the CTS patients was compared with that by the healthy subjects. Test-retest reliability was examined in 46 CTS patients. Discriminative validity was demonstrated through a significant difference in test completion time between the CTS subjects and their age-matched controls. With few exceptions, the test scores declined with increasing severity of electrophysiological abnormalities and subjective symptom severity. Test-retest reliability of the DMMPUT was high with an intra-class correlation coefficient of 0.91. The DMMPUT has discriminative validity and high test-retest reliability in patients with CTS. It can be a useful standardized outcome measure to gauge disease severity.