Validity of Using the Scratch Collapse Test in the Lower Extremities.

ABSTRACT

BACKGROUND: The scratch collapse test is a provocative test that has been successfully used for peripheral neuropathies. The elbow is the main testing site, but there may be times when use of the upper extremities is contraindicated. This study sought to determine the sensitivity of using the scratch collapse test on the lower extremity for upper extremity neuropathies. METHODS: One hundred patients with an electromyographically confirmed diagnosis of carpal tunnel or cubital tunnel syndrome were prospectively enrolled. As a control, the scratch collapse test was conducted normally using the elbow as a testing site. After a baseline was established, the test was repeated using eversion of the foot and ankle against an inversion force. RESULTS: Of the 100 study patients, 89 had a positive scratch collapse test on the upper extremity and 84 had a positive test on the lower extremity. In the 51 patients with carpal tunnel syndrome, 45 had a positive test on the upper extremity (sensitivity, 88.2 percent; 95 percent CI, 76.13 to 95.56 percent), and 42 had a positive test of the lower extremity (sensitivity, 82.35 percent; 95 percent CI, 69.13 to 91.60 percent). In the 49 patients with cubital tunnel syndrome, 44 had a positive test on the upper extremity (sensitivity, 89.8 percent; 95 percent CI, 77.77 to 96.6 percent), and 42 had a positive test on the lower extremity (sensitivity, 85.7 percent; 95 percent CI, 72.76 to 94.06 percent). CONCLUSION: There were no statistically significant differences in the sensitivities of the scratch collapse test on the upper or lower extremities, suggesting that the lower extremity could serve as an alternative site for the scratch collapse test. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.