Utilidade do teste de Phalen e do sinal de Tinel no prognóstico e o impacto na qualidade de vida de pacientes com síndrome do túnel do carpo submetidos a liberação aberta clássica do túnel do carpo*

Isabelle Spirandelli Pimentel; Victor Spirandelli Pimentel; Flavio Faloppa; João Carlos Belloti; Marcel Jun Sugawara Tamaoki; Benedito Felipe Rabay Pimentel

doi:10.1055/s-0044-1779318

Revista Brasileira de Ortopedia, Table of Contents

CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(01): e54-e59
DOI: 10.1055/s-0044-1779318

Artigo Original

Mão

Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release*

Article in several languages: português | English

Isabelle Spirandelli Pimentel

¹Faculdade de Medicina de Petrópolis, Centro Universitário Arthur Sá Earp Neto (Unifase), Petrópolis, RJ, Brasil

,

Victor Spirandelli Pimentel

²Departamento de Ortopedia e Traumatologia, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil

,

Flavio Faloppa

³Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil

,

João Carlos Belloti

³Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil

,

Marcel Jun Sugawara Tamaoki

³Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil

,

Benedito Felipe Rabay Pimentel

⁴Serviço de Ortopedia e Traumatologia, Hospital Municipal Universitário de Taubaté (HMUT), Taubaté, SP, Brasil

⁵Hospital Regional do Vale do Paraíba (HRVP), Complexo Hospitalar do Vale do Paraíba, Faculdade de Medicina, Universidade de Taubaté (Unitau), Taubaté, SP, Brasil

› Author Affiliations

Abstract

Objective: To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach.

Methods: The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment.

Results: The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95%CI]: 1.16%–8.17%), 0.88% (95%CI: 0.08%–4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%–19.18% ), 4.42% (95%CI : 1.65%–9.36%) and 2.65% (95%CI : 0.70%–6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity (p < 0.001) and of 1.6 points for functional status (p < 0.001).

Conclusion: Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.

Keywords

carpal tunnel syndrome - prognostic factor - quality of life - clinical course

Full Text

References

Referências
1 Bickel KD. Carpal tunnel syndrome. J Hand Surg Am 2010; 35 (01) 147-152
2 Szabo RM, Slater Jr RR, Farver TB, Stanton DB, Sharman WK. The value of diagnostic testing in carpal tunnel syndrome. J Hand Surg Am 1999; 24 (04) 704-714
3 Pimentel BF, Abicalaf CA, Braga L, Albertoni WM, Fernandes CH, Sernik RA, Faloppa F. Cross-sectional area of the median nerve characterized by ultrasound in patients with carpal tunnel syndrome before and after the release of the transverse carpal ligament. J Diagn Med Sonogr 2013; 29 (03) 116-121
4 Kaplan SJ, Glickel SZ, Eaton RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg [Br] 1990; 15 (01) 106-108
5 D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome?. JAMA 2000; 283 (23) 3110-3117
6 Jerosch-Herold C, Shepstone L, Wilson EC, Dyer T, Blake J. Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol. BMC Musculoskelet Disord 2014; 15: 35
7 Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006; 31 (06) 919-924
8 Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75 (11) 1585-1592
9 Rodner CM, Katarincic J. Open carpal tunnel release. Tech Orthop 2008; 23 (03) 199-207
10 Phalen GS, Gardner WJ, La Londe AA. Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg Am 1950; 32A (01) 109-112
11 Palumbo CF, Szabo RM. Examination of patients for carpal tunnel syndrome sensibility, provocative, and motor testing. Hand Clin 2002; 18 (02) 269-277 , vi
12 Machin D, Campbell MJ, Tan SB, Tan SH. Sample size tables for clinical studies. 3rd ed. Chichester, United Kingdom: Willey-Blackwell; 2009
13 Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why, and how?. BMJ 2009; 338: b375
14 Pimentel BFR, Faloppa F, Tamaoki MJS, Belloti JC. Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy. BMC Musculoskelet Disord 2018; 19 (01) 115
15 Gong HS, Oh JH, Bin SW, Kim WS, Chung MS, Baek GH. Clinical features influencing the patient-based outcome after carpal tunnel release. J Hand Surg Am 2008; 33 (09) 1512-1517
16 Fakhouri F, Alsukhni RA, Altunbi B, Hawoot Z, Dabbagh R. Factors correlated with unfavorable outcome after carpal tunnel release surgery. Asian J Neurosurg 2017; 12 (04) 670-673
17 Aversano FJ, Goldfarb CA, Gelberman RH, Calfee RP. The utility of the carpal tunnel syndrome-6 for predicting the outcomes of carpal tunnel release. J Hand Surg Am 2022; 47 (10) 944-952
18 De Kleermaeker FGCM, Meulstee J, Bartels RHMA, Verhagen WIM. Long-term outcome after carpal tunnel release and identification of prognostic factors. Acta Neurochir (Wien) 2019; 161 (04) 663-671