The Utility of Semmes-Weinstein Monofilament Test in Detecting Carpal Tunnel Syndrome with Clinical Stage, Nerve Conduction Study, and Sonography Correlations

Semmes-Weinstein氏單絲測試在偵知腕隧道症候群的用途及與臨床分期、神經傳導檢查、及超音波之相關

王琳毅(Lin-Yi Wang) ； 李俊瑩(Jyun-Ying Li) ； 黃郁琦(Yu-Chi Huang) ； 廖美雲(Mei-Yun Liaw) ； 楊宗勳(Tsung-Hsun Yang) ； 辛宜蓉(Yi-Jung Hsin) ； 李炎諭(Willie Lee) ； 張瑞昆(Jui-Kun Chang) ； 彭亞蘋(Ya-Ping Pong)

《台灣復健醫學雜誌》 43卷1期 (2015/03) Pp. 9-18

https://doi.org/10.6315/2015.43(1)02

摘要

背景與目的：神經傳導檢查（nerve conduction study, NCS）與超音波可支持腕隧道症候群（carpal tunnelsyndrome, CTS）的診斷。Semmes-Weinstein單絲測試（Semmes-Weinstein monofilament test、SWMT），一種感覺閥值檢查，用於偵測CTS、及與臨床嚴重度、NCS、與超音波的關係仍有爭議。為釐清爭議而進行研究。方法：納入33位有典型CTS症狀與徵象的病人與20位正常人。我們執行食指的SWMT、NCS、及以超音波量測正中神經在豆狀骨平面上的截面積（cross-sectional area of the median nerve at pisiform level, PCSA）。畫出SWMT、NCS變數、與PCSA的接收者操作特徵（receiver operating characteristic, ROC）曲線以分析辨別力。以kappa統計分析以SWMT、NCS、及PCSA診斷CTS的一致性。並計算其敏感性、特異性、陽性預測率、陰性預測率、精確性，與其之間的相關係數。結果：SWMT與PCSA之ROC 曲線下面積分別是0.852和0.71。三種NCS變數之曲線下面積為0.822至0.902。這些變數皆可辨別CTS且辨別力並無差別。SWMT之敏感性、特異性、陽性預測率、陰性預測率、精確性分別為82%、70%、82%、70%與77%；且在偵測CTS，與NCS有顯著的一致性（kappa=0.575,p＜0.001）。SWMT與PCSA間、以及NCS與PCSA間的kappa分別為0.305及0.427（p=0.025與0.002）。SWMT與臨床分期、NCS、和PCSA皆有顯著相關（r 0.381-0.581, p＜0.01）。結論：在偵測CTS，SWMT有與NCS及超音波相似的辨別力，與臨床分期、NCS、和超音波上PCSA皆有中度相關。SWMT是方便無痛又便宜的檢查，可能在診斷CTS有其用途，需再研究。

關鍵字

Semmes-Weinstein氏單絲測試 ； 腕隧道症候群 ； 神經傳導檢查 ； 超音波 ； 相關

並列摘要

Background and purpose: Nerve conduction study (NCS) and ultrasonography (US) are used to support the diagnosis of carpal tunnel syndrome (CTS). The ability of the Semmes-Weinstein monofilament test (SWMT), a sensibility threshold test, to detect CTS, and its relationship to clinical severity, NCS, and US, remain controversial. We conducted this study to address this controversy. Method: Thirty-three patients presenting with typical symptoms and signs of CTS and 20 normal subjects were enrolled. SWMT on the index finger, NCS, and US of the cross-sectional area of the median nerve at the pisiform level (PCSA) were performed. Receiver operating characteristic (ROC) curves of SWMT, variables of NCS, and PCSA were plotted to analyze their discriminative utilities. The diagnostic agreement for CTS among SWMT, NCS, and PCSA were analyzed by kappa statistics. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies, as well as the correlation coefficients among SWMT, NCS measures, and PCSA, were calculated. Results: The areas under the ROC curve (AUC) for SWMT and PCSA were 0.852 and 0.71, respectively. AUCs for three NCS variables ranged from 0.822 to 0.902. All these variables were discriminative for CTS and were not significantly different in their discriminative power. SWMT yielded sensitivity, specificity, PPV, NPV, and accuracy of 82%, 70%, 82%, 70%, and 77%, respectively. There is significant agreement in detection of CTS using SWMT and NCS (kappa=0.575, p＜0.001). The kappas between SWMT and PCSA, as well as NCS and PCSA, were 0.305 and 0.427, respectively (p=0.025 and 0.002). SWMT significantly correlates with not only clinical stage, but also NCS measures and PCSA (r ranged from 0.381 to 0.581, p＜0.01). Conclusion: SWMT shows discriminative power similar to NCS and US for detection of CTS. SWMT also has a moderate correlation with clinical stage, NCS measures, and PCSA on US. As a painless, convenient, and inexpensive modality, SWMT may have the ability to diagnose CTS, but further research is needed.

並列關鍵字

Semmes-Weinstein monofilament test ； carpal tunnel syndrome ； nerve conduction study ； sonography ； correlation

參考文獻

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