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

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

doi:10.1055/s-0044-1779318

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Original Article • Rev. bras. ortop. 59 (1) • Jan-Feb 2024 • https://doi.org/10.1055/s-0044-1779318 copy

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^* * Work developed at the Hospital Regional do Vale do Paraíba (HRVP), Complexo Hospitalar do Vale do Paraíba, Faculdade de Medicina, Universidade de Taubaté (Unitau), Taubaté, SP, Brazil.

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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

Preoperative period	Phalen test		Tinel sign		p
Preoperative period	n(%)	95% confidence interval	n (%)	95% confidence interval	p
2 weeks	111 (96.5)	91.3–99.0	101 (87.8)	80.4–93.1	0.006
4 weeks	113 (98.3)	93.9–99.8	108 (93.9)	87.9–97.5	0.180
16 weeks	113 (98.3)	93.9–99.8	110 (95.7)	90.1–98.6	0.453

	Accumulated percentage of test remission
	2 weeks postoperatively	4 weeks postoperatively	16 weeks postoperatively
Phalen test	3.54 ± 1.74	0.88 ± 0.88	0.88 ± 0.88
Tinel sign	12.39 ± 3.10	4.42 ± 1.93	2.65 ± 1.51

	Phalen test		Tinel sign
	n	%	n	%
2 weeks PO	115	100.0%	115	100.0%
No remission	4	3.5%	14	12.2%
Remission	111	96.5%	101	87.8%
4 weeks PO	115	100.0%	115	100.0%
No remission	2	1.7%	7	6.1%
Remission	113	98.3%	108	93.9%
16 weeks PO	115	100.0%	115	100.0%
No remission	2	1.7%	5	4.3%
Remission	113	98.3%	110	95.7%

Boston Carpal Tunnel Questionnaire	Postoperative: mean ± standard deviation	Preoperative: mean ± standard deviation	Post- and Preoperative difference: mean ± standard deviation	p
Symptom severity scale	1.7 (0.7)	3.5 (0.7)	–1.8 (0.9)	< 0.001
Functional status scale	2.0 (1.0)	3.6 (0.9)	1.6 (1.1)	< 0.001

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Benedito Felipe Rabay Pimentel, PhD, Rua Francisco de Barros 239, Centro, Taubaté, SP, 12020–230, Brazil (e-mail: befecil@gmail.com).