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Evaluation of the Scratch Collapse Test for the Diagnosis of Carpal Tunnel Syndrome
Heeren S. Makanji, MS1; Stéphanie J.E. Becker, MD1; Chaitanya S. Mudgal, MD2; Jesse B. Jupiter, MD1; David C. Ring, MD, PhD1; (1)Massachusetts General Hospital, (2)Mass General Hospital / Harvard Medical School
Massachusetts General Hospital, Boston, MA, USA

Introduction:There is no consensus reference standard for the diagnosis of carpal tunnel syndrome, and the utility of various physicial examination maneuvers to provoke symptoms varies between studies. This prospective study measured and compared the diagnostic performance characteristics of the scratch collapse test to various clinical signs and physical examination maneuvers for carpal tunnel syndrome.

Materials and Methods:Eighty eight adult patients in the practice of four hand surgeons that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Patients completed a demographic questionnaire, and attending surgeons documented symptoms and the results of standard clinical maneuvers including the scratch collapse, Phalen’s, Durkan’s, and Tinel’s tests and other examination findings including thenar atrophy and thumb abduction weakness.

Results:The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen’s test (67%), Durkan’s test (77%), Tinel’s test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan’s test (18%) and CTS-6 (13%). In sub-group analysis, there was no difference in the diagnostic performance of the scratch collapse test based on severity of CTS. There was a large discrepancy in performance of the scratch collapse test between one surgeon (surgeon A) and other surgeons (group B surgeons).

Discussion:The sensitivity of the scratch collapse test was not statistically superior to other clinical signs and physical examination maneuvers for CTS. The specificity of the scratch collapse test was superior to that of Durkan’s test and CTS-6 lax. Further studies should seek to limit the influence of a patient’s clinical presentation on scratch test performance and prospectively assess the scratch test’s inter-rater reliability.


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