[Carpal tunnel syndrome: clinical and neurophysiological correlation: review of 100 cases]. / Síndrome del túnel del carpo. Correlación clínica y neurofisiológica: revisión de 100 casos.

INTRODUCTION: The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. This study attempts to find the correlation between the subjective symptomatology and the neurophysiological affectation, establishing a diagnostic guide for the family doctor in order to recognize early CTS for referral to the specialist doctor. PATIENTS AND METHODS: After a sample of 100 cases with clinical suspicion of CTS, a clinical evaluation was made with the symptoms (paresthesias, pain, loss of strength), signs (Tinel, Phalen), and the neurophysiological evaluation with electroneurography (ENG) of the median and cubital nerve (sensory velocity (SV), motor distal latency (MDL)), and electromyography (EMG) of tenar eminence muscles. With this data an epidemiological study was made with correlation between the clinical and neurophysiological parameters. RESULTS: The patients with pain, loss of strength and Tinel's sign had significant alteration of the parameters of ENG and EMG. Tinel's sign had a sensitivity (SE) = 30.1% and a specificity (SP) = 73% for MDL, a SE = 32.5% and a SP = 88.2% for SV. Phalen's sign had a SE = 22.2% and a SP = 94.6% for MDL, a SE = 18.1% and a SP = 94.1% for SV. CONCLUSIONS: The guide to recognize clinically the patients which must be studied neurophysiologically that have a high probability to suffer CTS is: diagnosis for motor alteration, pain (SE = 79%), loss of strength (SP = 86%) and Phalen's sign (SP = 94.6%). Sensory alteration: paresthesias (SE = 97%), Tinel's sign (SP = 88.2%) and Phalen's sign (SP = 94.1%).

[Diagnosis of peripheral neuropathies: a clinical and neurophysiological study]. / Sobre el diagnóstico de las neuropatías periféricas: estudio clínico y neurofisiológico.

INTRODUCTION: The diagnosis of peripheral neuropathy is based on clinical and neurophysiological features. This study aims to establish the diagnostic validity of different symptoms and clinical signs, as well as its correlation with electroneurography (ENG), to determine its sensitivity (SE), specificity (SP), positive (PLR) and negative likelihood ratio (NLR) for every peripheral neuropathies type. PATIENTS AND METHODS: A sample of 108 patients with clinical suspicion of peripheral neuropathy (pain, paresthesias, loss of strength, areflexia) was studied. ENG (nerve conduction velocity and response amplitude values in 208 nerves [Median and Posterior Tibial]) was used to confirm the diagnosis, classifying the sample in axonal group (A), demyelinating (D) and normal (N). It was made descriptive statistics of this sample, studies of SE, SP, PLR and NLR of symptoms, and association (contingency tables [Chi square] and Odds Ratio) between symptoms and clinical features. RESULTS: The patients with paresthesias, loss of strength or pathologic reflexes have larger motor latency (p< 0.01). Those with paresthesias, areflexia or pain have fewer sensitive conduction velocity (p< 0.05). Symptoms's value for sensory damage's diagnosis is (SE= 0.92, SP= 0.48, PLR= 1.78, NLR= 0.14). For motor damage (SE= 0.72, SP= 0.68, PLR= 2.25, NLR= 0.41). For axonal damage (SE= 0.83, SP= 0.44, PLR= 1.49, NLR= 0.37). And for demyelinating damage (SE= 0.92, SP= 0.44, PLR= 1.66, NLR= 0.16). CONCLUSIONS: The symptoms's combination is much more sensitive and has fewer NLR than each isolated symptom in all neuropathic damage's types. Paresthesias's presence is more indicative of sensory damage and loss of strength of motor damage. Pain is the only symptom that can aim for axonal damage than demyelinating.