Physician Practices in the Diagnosis of Carpal Tunnel Syndrome at a Medial Center in Southern Taiwan

腕隧道症候群是上肢最常被診斷的神經壓迫症候群。然而，有關腕隧道症候群的診斷標準仍存有許多爭議。這些紛歧往往源自於個人或一群在腕隧道症候群的診斷與治療具有不同專業程度的專家學者之實驗結果，僅有極少數研究是建立在實際的臨床資料。本文的主要目的即是探討南台灣一家醫學中心的各科醫師診斷腕隧道症候群的模式。在2001至2002年這一年期間，共有1,050位被診斷為腕隧道症候群的病人，其中只有622位病人符合收案標準，亦即第一次罹患腕隧道症候群以及病歷中有完整的看診紀錄。研究結果發現，在病人的第一次求診時間，34.9%的腕隧道症候群診斷只根據病人主訴症狀而定，欠缺相關的Tinel或Phalen測試；此外，有8.7%的診斷也只依據主訴症狀而定，雖然Tinel或Phalen的測試結果是正常；55%的病人之診斷則是同時建立於主訴症狀以及Tinel或Phalen的測試結果。另一方面，27.3%的腕隧道症候群診斷被沒有因神經電學檢查結果顯示正常而有所變更。腕隧道症候群病人平均接受1.6種的診斷檢查，其中以神經電學檢查的總次數最高(516次)，其次為Tinel測試(350)次和Phalen測試(102次)。總結而論，臨床醫師診斷腕隧道症候群主要是以主訴症狀和理學檢查為主。神經電學檢查的使用時機應建立明確之規範，以有效運用醫療資源。

關鍵字

腕隧道症候群； Phalen 測試； Tinel 測試；神經傳導檢查

並列摘要

Carpal tunnel syndrome (CTS) is the most common neurologic entrapment disorder diagnosed in the upper limb. Nevertheless, there is still debate about the most reliable test that should be performed to diagnose CTS. Much of the argument has been drawn from the opinions of individuals or groups with varying degrees of expertise in the field; little has been based on actual data. The purpose of this study was to investigate the diagnostic patterns of CTS in an academic medical setting in southern Taiwan. The charts of 1,050 patients with a diagnosis of CTS over a 1-year period (2001-2002) were retrospectively reviewed. Data on 622 patients with new-onset CTS were included in the analysis. On the patient’s initial visit, physicians made a diagnosis of CTS in 34.9% of cases solely on the basis of the history of symptoms without resort to provocative tests, while 8.7% of cases were diagnosed on the basis of symptom characteristics alone in spite of negative provocative tests. A CTS diagnosis was given according to symptoms and positive provocative tests in 55% of cases. Apart from these, CTS diagnosis remained unchanged in 27.3% of cases without electrodiagnostic signs of CTS during follow-up visits. An average of 1.6 diagnostic maneuvers were conducted for CTS patients, with nerve conduction velocity (NCV)studies (516 cases) being the most frequently performed, followed by Tinel’s sign(350cases) and Phalen’s test (102cases). Our findings imply that physicians are inclined to base their diagnosis on clinical history and physical examination for patients with suspected CTS. Clear guidelines regarding the indications for referral for NCV studies should be established in response to the increased concerns about the cost effectiveness of diagnostic tests.

並列關鍵字

carpal tunnel syndrome ； Phalen's test ； Tinel's sign ； nerve conduction studies

國際替代計量

Physician Practices in the Diagnosis of Carpal Tunnel Syndrome at a Medial Center in Southern Taiwan

未授權

主題瀏覽