COMPARISON OF AWAKENING FROM SLEEP WITH PHALEN TEST AND TINEL’S SIGN IN PATIENTS WITH CARPAL TUNNEL SYNDROME

Abstract

Introduction: Carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies. Paresthesia and pain are confined to the medianinnervated first three and half digits (thumb, index, middle and radial half of the ring finger) of the involved hand. These symptoms are usually most severe at night, and awaken the patients from sleep. This task has not been widely studied in the literature against the common clinical tests and this is our objective in this article to make a comparison among them.
Patients and methods: We inquired 188 cases (346 hands) who had received definite electrophysiologic diagnosis of CTS about waking up due to severe symptoms, and clinically examined the patients with Phalen test and Tinel’s sign. Anemnesis of awakening from sleep was compared to Phalen test, Tinel’s sign, duration of symptoms, intensity and bilaterality and statistical analysis was performed using chi-square test.
Results: Anamnesis of awakening from sleep were present in 163 cases with CTS (86.7%). Phalen test and Tinel’s sign was positive in 218 (63%) and 204 (59%) hands with CTS. Although presence of awakening from sleep correlated with positive Phalen test and bilaterality (p<0.05), correlation with the duration of symptoms, intensity and Tinel’s sign was not statistically significant (p>0.05).
Conclusion: In the establishment of the diagnosis of CTS, awakening from sleep due to nocturnal pain and paresthesia has appeared more sensitive than Phalen test and Tinel’s sign. We think that inquiry about awakening from sleep will enhance the clinical diagnosis of CTS.