Hand (N Y). A new diagnostic test for carpal tunnel syndrome. We use cookies to help provide and enhance our service and tailor content and ads. 2008;33:1518-1524. The original search terms included “scratch collapse test” and “carpal tunnel syndrome” or “median nerve entrapment”; however, articles were missed with these search terms; therefore, the authors performed a broader search using only “scratch collapse test” to ensure articles were not overlooked. The test interpretation is subjective, which can allow the observer to falsely perceive positive results if they are not blinded. 2005;116:502–507. Cheng, CJ, Mackinnon-Patterson, B, Beck, JL(2008) Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. Figure 6a. The Scratch Collapse Test (SCT) is used to assist in the clinical evaluation of patients with ulnar nerve compression. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. 2017;140:120e–129e. 17. The original study by Cheng et al.24 reported sensitivity and specificity of 69% and 99%; however, their study was not included in our analysis as we were unable to extract the data. Christine J. Cheng, Brendan Mackinnon-Patterson, John L. Beck and Susan E. Mackinnon . 8. The purpose of this study was to evaluate the clinical usefulness of a new test, the scratch collapse test, for the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome. 12. LaJoie AS, McCabe SJ, Thomas B, et al. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Therefore, we conclude that the SCT would not be a diagnostically useful test for CTS. The review was reported in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance (Fig. These examination findings can be used in combination to best diagnose cubital tunnel syndrome.13 Recently, the “scratch collapse” test has been de-scribed (Fig. J Hand Surg [Am]. Cutaneous silent periods. For each article, the Quality Assessment Tool for Diagnostic Accuracy Studies tool was used to assess the risk of bias and concerns regarding applicability of the studies in 4 key domains: (1) patient selection; (2) index test; (3) reference standard; and (4) flow and timing. Haussmann P, Patel MR. Intraepineurial constriction of nerve fascicles in pronator syndrome and anterior interosseous nerve syndrome. Utility of the cutaneous silent period in the evaluation of Carpal Tunnel Syndrome. 18. Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. Two reviewers (M.H. Accuracy of ultrasonography for the diagnosis of carpal tunnel syndrome: a systematic review and meta-analysis. It is unclear how stimulation of a dermatome on the fifth digit would affect the motor potential of the abductor pollicis brevis of the thumb as they are based off of 2 different peripheral nerves, the ulnar and median nerve, respectively. Five articles had sufficient numerical data for analysis, and in these five articles, the positive predictive values and specificity were high, i.e. Evaluation of the scratch collapse test in peroneal nerve compression. 6 The SCT is based on the theory that stimulation of the skin around the area of nerve injury (‘Scratch’) results in a brief period of inhibition of voluntary … Some error has occurred while processing your request. Hand, 10(3), 388-95. Pooled sensitivities, specificities, positive likelihood ratio, and negative likelihood ratios were 0.32 [95% CI (0.24–0.41)], 0.62 [95% CI (0.45–0.78)], 0.75 [95% CI (0.33–1.67)], and 1.03 [95% CI (0.61–1.74)], respectively. J Hand Surg Eur Vol. 2010;121:1584–1588. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. 800-638-3030 (within USA), 301-223-2300 (international). Evaluation of the scratch collapse test in peroneal nerve compression. By continuing to use this website you are giving consent to cookies being used. A literature search was performed using PubMed (1966 to April 2018); Ovid MEDLINE (1966 to April 2018); EMBASE (1988 to April 2018); and Cochrane Central Register of Controlled Trials (The Cochrane Library, to April 2018). Since its publication, Mackinnon has published several other articles with similar results using the SCT for cubital tunnel syndrome,10 multilevel ulnar nerve compression detection,11 and peroneal nerve compression.12 Several other authors have also reported positive findings with the SCT. Illustration adapted from Gray’s Anatomy. Based on the current literature and their variable quality of the evidence, we conclude that the SCT is not an adequate screening test for detecting CTS. However, after 60 seconds, the pressure test is 89% sensitive, and the combined elbow flexion-pressure test is 98% sensitive. It can provide one more clue or confirmation of the level of nerve injury, in addition to providing insight to the hierarchy of nerve injuries within multiple levels. Both these studies, however, were case reports on a single patient. Conclusions: The scratch collapse test had significantly higher sensitivity than Tinel's test and the flexion/nerve compression test for carpal tunnel and cubital tunnel syndromes. 29. 1). 1. Wolters Kluwer Health, Inc. All rights reserved. Solid circles represent each study included in the meta-analysis. Brown JM, Mokhtee D, Evangelista MS, et al. 15. Hand (N Y). The “hierarchical” Scratch Collapse Test for identifying multilevel ulnar nerve compression. 23. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. 2018;99:758–765.e10. Jiménez I, Delgado PJ. Reprinted with permission [14]. 4. However, even though the CuSP may be a testable and reproducible phenomenon using EMG, it does not seem clinically transferable. to maintaining your privacy and will not share your personal information without Scratch Collapse Test Scratch collapse test is used to supplement other information gathered during the history and physical examination. Scratch Collapse Test is a useful clinical sign in assessing long thoracic nerve entrapment. In total, 7 articles were included for full text screening. The Wall Test. Scratch collapse test localizes Osborne’s band as the point of maximal nerve compression in Cubital Tunnel Syndrome. Please try after some time. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Positive results of the SCT were only seen in a small number of studies by few researchers. ; American Association of Electrodiagnostic Medicine; American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation. Conversely, our results demonstrate the studies that compared the SCT to a reference standard, the EMG, unlike in proximal nerve entrapment where there is no diagnostic standard. The calculated area under the curve was 0.25, indicating a low diagnostic accuracy (Fig. 30 mins. By extension, the utility of the SCT in identifying other nerve compression syndromes is dubious. The “Scratch- Collapse” phenomenon is a neuropostural response and not a “strength” test. 2015;10:388–395. If more studies are included in future reviews, it is possible that the results may be different than ours and have greater statistical significance. The scratch collapse test in the diagnosis of compression of the median nerve in the proximal forearm. The scratch collapse test with ethyl chloride hierarchy revealed positive provocations in the order of the cubital tunnel, Guyon’s canal, and Struthers’ ligament. 3). The accuracy of the scratch collapse test performed by blinded examiners on patients with suspected Carpal Tunnel Syndrome assessed by electrodiagnostic studies. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Plastic and Reconstructive Surgery - Global Open: Flowchart of study inclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data is temporarily unavailable. 2011;128(4):933-939. doi pubmed The cutaneous silent period is mediated by spinal inhibitory reflex. However, up to 16–34% of affected patients can still be missed, creating false negatives.9 In patients with suspected CTS and ambivalent test results, there remains a clinical equipoise on treatment. We identified 3 articles that met our inclusion criteria, all of which were level II evidence, according to the American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations, with low risk of bias (Tables 1, 2). Despite the fact that carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, the diagnostic accuracy of clinical screening examinations for CTS is controversial. 16. 16. The “hierarchical” Scratch Collapse Test for identifying multilevel ulnar nerve compression. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. Clinical diagnosis of carpal tunnel syndrome: a systematic review. This review has been registered with PROSPERO (CRD42018077115). Her surgical management included the release of these three nerves. Uncini et al.14 demonstrated in their study that the CuSP phenomenon can affect completely unrelated different nerve roots. Moreover, the studies applied nociceptive stimuli to the D2 and D5 of the hand with miraculous and disputable inhibitory effects to the abductor pollicis brevis muscle. 2. Please try again soon. Pinder EM, Ng CY. Aurora SK, Ahmad BK, Aurora TK. Muscle Nerve. The patient is then asked to resist the examiner’s attempt to medially rotate the arms (Fig. Corresponding video content is provided to improve performance and interpretation of the scratch collapse test. 2013;8:41–46. The literature search generated 13 unique articles. Lippincott Journals Subscribers, use your username or email along with your password to log in. Diagnostic, II. Upper extremity nerve entrapments: the axillary and radial nerves–clinical diagnosis and surgical treatment. 2006;33:487–493. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. The Scratch Collapse Test. Please enable scripts and reload this page. by Mackinnon and Novak in 1994. Floeter MK. J Hand Surg Am. Gillenwater J, Lorant J, Kay S, Au K, Magee W 2014;6:5–7. The scratch collapse test (SCT) was originally described in 2008 as a clinical test for suspected carpal and cubital tunnel syndrome. Subject is free-standing. 2015 Sep; 10 (3):388-95. Presented at the American Society of Plastic Surgeons, September 30, 2018, Chicago, Ill. Disclosure: The authors have no financial interest to declare in relation to the content of this article. Jiménez and Delgado29 are the only other authors besides Mackinnon who has demonstrated positive results with the SCT. Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome Justin M. Brown, David Mokhtee, Maristella S. Evangelista, and Susan E. Mackinnon HAND 2009 5 : 2 , 141-147 The Wall Test. Ultrasonography is another diagnostic tool that is gaining popularity and has demonstrated promising results, but it still remains in its nascent stage.6–8 The current gold standard to diagnose CTS is the electromyography (EMG). Kofler et al.,21 Koo et al.,22 and Svilpauskatie et al.,23 have performed similar studies examining the CuSP with conflicting results. For more information, please refer to our Privacy Policy. Logigian EL, Plotkin GM, Shefner JM. This study aims to perform a systematic review of literature to assess the data on the reliability of the SCT as a diagnostic test for entrapment neuropathy. Another main finding was the versatility of the test in that it can be used for various nerve entrapments and to localise the exact level of compression. You may be trying to access this site from a secured browser on the server. Carlos Eduardo Vervloet Sollero 1 Péricles Maranhão Filho 1 1 ... Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Electroencephalogr Clin Neurophysiol. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy. The study by Simon et al.19 received a rating of low concerns regarding applicability and low risk of bias for all domains. (2015). Pooled estimates of sensitivity, specificity, and likelihood ratios for the diagnostic accuracy of the SCT for CTS. 1). Yee A. Damiano MS. Mackinnon SE. Neurosurgery. Specificity and positive predictive values were high for all of the tests. For example, they produced the CuSP in the opponens pollicis, abductor digiti minimi, flexor carpi ulnaris, extensor carpi radialis, biceps brachialis, tibialis anterior, gastrocnemius lateralis, orbicularis oculi, and masseter simply from finger stimuli alone.14 Clearly, there is a body of literature demonstrating that noxious stimulation of cutaneous nerves can induce a silent period across various nerve roots and peripheral nerves that seem to contradict fundamental anatomical constraints. Originally developed by Susan Mackinnon, it is performed by applying a stimulus over an area of nerve compression while the patient is exerting bilateral external shoulder rotation.24 A positive test is noted if there is transient loss of muscle resistance resulting in the arm collapsing, thus, coining the term of this provocative test “the scratch collapse test.” This concept can also be applied to other nerve compression syndromes. Our results demonstrate that the SCT is not a useful diagnostic tool for the assessment of CTS. Plast Reconstr Surg. 24. The language of publication was restricted to English and French. and A.K.). Orthop Clin North Am. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. The SCT has poor sensitivity; however, it is moderately specific. It can provide one more clue or confirmation of the level of nerve injury, in addition to providing insight to the hierarchy of nerve injuries within multiple levels. 17. Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test. METHODS: The scratch collapse test was studied prospectively in 24 consecutive patients with a diagnosis of common peroneal nerve compression neuropathy. The scratch collapse examination involves having the patient take a seated posture with the arms at the sides and elbows bent at 90°. J Hand Surg Am 33: 1518 – 24 . J Hand Surg Am. Neurology. The purpose of this study is to introduce the hierarchical SCT as a physical examination tool for identifying multilevel nerve compression in … Scratch Collapse Test: um novo teste clínico para nervos periféricos comprimidos Carlos Eduardo Vervloet Sollero, Péricles Maranhão-Filho A 70-year-old woman presented left hand neuropathic pain and nocturnal paresthetic brachialgia. Estimation of the variables a and b was done using a least-squares method, weighted by inverse variance. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. There are several provocative tests to aid in the diagnosis of nerve compression. In this method, the true-positive and false-positive rates of each study were logarithmically transformed and calculated in a regression model. Davidge KM, Gontre G, Tang D, Boyd KU, Yee A, Damiano MS, Mackinnon SE. J Hand Surg Am. provocative examination modality, the scratch collapse test (SCT), in precisely localizing the region of entrapment in J. M. Brown: D. Mokhtee: M. S. Evangelista S. E. Mackinnon Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, USA M. S. Evangelista Muscle Nerve. 7. 1991;81:344–352. The scratch collapse test had the highest negative predictive value (73%) for carpal tunnel syndrome. 2). J Hand Ther. Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), September 2018 - Volume 6 - Issue 9 - p e1933, Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis, Articles in PubMed by Minh N. Q. Huynh, BSc, Articles in Google Scholar by Minh N. Q. Huynh, BSc, Other articles in this journal by Minh N. Q. Huynh, BSc, The Low DIEP Flap for Breast Reconstruction, A New Technique for the Correction of Tear Trough Deformity via Filler Injections, Eyebrow Height Changes with Aging: A Systematic Review and Meta-analysis, Treatment of Neuroma-induced Chronic Pain and Management of Nerve Defects with Processed Nerve Allografts. 2017;42:386.e1–386.e5. CONCLUSION: The scratch collapse test is a sensitive and specific provocative test that compares favorably to existing clinical tests and aids in the diagnosis of common peroneal neuropathy. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage to identify nerve compression when the diagnosis is unclear. Plast Reconstr Surg. 3. 1996;27:339-344. Received for publication June 22, 2018; accepted July 13, 2018. Keywords Scratchcollapsetest .Cubitaltunnelsyndrome Multilevelnervecompression Introduction We have previously described the Scratch Collapse Test (SCT) as a provocative test to assist in the clinical evaluation … Hagert E, Hagert CG. test is 75% sensitive after 60 seconds. We included all full text articles, which evaluated the use of the SCT to diagnose CTS in patients of all ages. Accuracy for this test … 25. 2008;33(9):1518-1524. doi pubmed; Gillenwater J, Cheng J, Mackinnon SE. 2008;33(9):1518-1524. doi pubmed; Gillenwater J, Cheng J, Mackinnon SE. 2018;141:399–407. Data from the included articles were independently extracted in duplicate by 2 reviewers (M.H. 2008;33:1518-1524. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. Aurora et al.20 originally demonstrated that the cutaneous silent period was prolonged in patients with CTS, while the CuSP was absent in severe CTS. Plast Reconstr Surg. The study by Makanji et al.18 received a rating of low concerns regarding applicability for all domains, but had unclear risk of bias for “index test” and “flow and timing.” It was not clarified whether the index test (SCT) results were interpreted without knowledge of the reference test results and why 7 patients never underwent EMG testing and had to be excluded. Evaluation of the scratch collapse test in peroneal nerve compression. Minh N. Q. Huynh, BSc, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5, E-mail: [email protected]. Seven articles were included for full text screening and 3 articles met our inclusion criteria, all of which were level II evidence with low risk of bias (165 patients). 22. SROC curve representing the diagnostic accuracy of the SCT for CTS. In total, 165 patients were included in the meta-analysis. 2016;8:122–124. Plast Reconstr Surg. All registration fields are required. For immediate assistance, contact Customer Service: 2002;58:1589–1592. Patil P, Dasgupta B. Hand (N Y). The purpose of this study is to introduce the hierarchical SCT as a physical examination tool for identifying multilevel nerve compression in patients with cubital tunnel syndrome. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. However, none of the studies examined the efficacy of the SCT, as the data on the sensitivity and specificity were not published or collected. Muscle Nerve. Katz JN, Larson MG, Sabra A, et al. Ten articles were reviewed. Susan E. Mackinnon. Plast Reconstr Surg. Plast Reconstr Surg. Uncini A, Kujirai T, Gluck B, et al. 21. Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. They demonstrated a 100% sensitivity and specificity with the SCT for diagnosis of proximal median nerve entrapment on 3 consecutive visits before their operation and a negative SCT 5–7 days after their operation. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. The purpose of our study was to determine the diagnostic accuracy of the SCT in patients with CTS, using EMG as the reference standard, by summarizing the current literature. Figure 3 Scratch collapse test for cubital tunnel, three subsegments of testing. Kofler M, Fröhlich K, Saltuari L. Preserved cutaneous silent periods in severe entrapment neuropathies. Provocative testing by the scratch collapse test and Tinel's sign was performed. J Hand Surg Am. The scratch collapse test with ethyl chloride revealed provocation, first at the CPN at the fibular head, then second at the saphenous nerve in the thigh, and then third at the superficial peroneal nerve. Pinder and Ng26 similarly reported a positive SCT with EMG-confirmed long thoracic nerve compression. 2015;73:64. 2011;128(4):933-939. doi pubmed For each domain, a rating of low, high, or unclear was given for both risk of bias and concerns regarding applicability. Originally developed by Susan Mackinnon, it is performed by applying a stimulus over an area of nerve compression while the patient is exerting bilateral external shoulder rotation. Hagert only used the SCT as one of 3 criteria to operate on suspected proximal median nerve entrapment; the study did not examine the diagnostic accuracy of the SCT. Extracted data included the true positive, false positive, true negative, and false negative rates for the SCT in diagnosing EMG-confirmed CTS. Mackinnon has demonstrated diagnostic utility for ulnar nerve entrapment in cubital syndrome10,11 and peroneal nerve compression.12 Since its inception, several refinements have been suggested by the creator, such as the addition of ethyl chloride spray to assist in detecting multiple levels of nerve compression, which are outlined in detail by Kahn et al.13, Current theories postulate that the findings of the SCT are explained by the cutaneous silent period (CuSP).14–16 The CuSP has been described since 1919 by Hoffman, who defined it as a transient decrease in EMG activity during voluntary contraction resulting from a noxious stimulus to a cutaneous nerve. Analyses were performed using Microsoft Excel (2013) and Meta-DiSc Version 1.4 for Windows (Hospital Ramón y Cajal, Madrid, Spain). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Electrodiagnostic studies include small ulnar CMAP amplitude with absent SNAP and fibrillations with motor unit potentials.