Abstract:
STUDY OBJECTIVE:To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome. DESIGN:Comparison of diagnostic tests with neurophysiologic testing. SETTING:Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies. METHODS:Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses. RESULTS:Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55, CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome. CONCLUSIONS:With the exceptions of age, Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Katz JN,Larson MG,Sabra A,Krarup C,Stirrat CR,Sethi R,Eaton HM,Fossel AH,Liang MHdoi
10.7326/0003-4819-112-5-321subject
Has Abstractpub_date
1990-03-01 00:00:00pages
321-7issue
5eissn
0003-4819issn
1539-3704journal_volume
112pub_type
杂志文章abstract:BACKGROUND:In previous open-label noncomparative clinical trials, both fluconazole and itraconazole were effective therapy for progressive forms of coccidioidomycosis. OBJECTIVE:To determine whether fluconazole or itraconazole is superior for treatment of nonmeningeal progressive coccidioidal infections. DESIGN:Rando...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-133-9-200011070-00009
更新日期:2000-11-07 00:00:00
abstract:BACKGROUND:Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM. OBJECTIVE:To assess whether APM impr...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/M15-0899
更新日期:2016-04-05 00:00:00
abstract:BACKGROUND:Adiponectin and resistin are recently discovered adipokines that may provide a molecular link between adiposity and type 2 diabetes. OBJECTIVE:To evaluate whether total and high-molecular-weight adiponectin and resistin are associated with future risk for type 2 diabetes, independent of obesity and other kn...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-149-5-200809020-00005
更新日期:2008-09-02 00:00:00
abstract::Platelets may have a role in the development of animal tumor metastases. Ultrastructural studies in vivo have shown arrested tumor emboli surrounded by platelets. Several tumor cell lines induce thrombocytopenia in vivo. Certain tumor cells aggregate platelets in vitro. Correlations exist between the ability of some t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-95-5-636
更新日期:1981-11-01 00:00:00
abstract:BACKGROUND:Benign reductions in neutrophil counts may be more common at certain ages and in certain ethnic groups and may be affected by sex and smoking status. OBJECTIVE:To determine differences in neutrophil counts in the U.S. population according to ethnicity, age, sex, and smoking status. DESIGN:Population-based,...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-146-7-200704030-00004
更新日期:2007-04-03 00:00:00
abstract::Advances have recently been made in understanding the pharmacokinetics of theophylline. To correlate the new knowledge of theophylline pharmacokinetics with the drug's current status in therapy, we have critically reviewed the relevant investigations of the last 5 years. We consider data on its presumed mechanisms of ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-101-1-63
更新日期:1984-07-01 00:00:00
abstract::Recent national recommendations have proposed that physicians should titrate lipid therapy to achieve low-density lipoprotein (LDL) cholesterol levels less than 1.81 mmol/L (<70 mg/dL) for patients at very high cardiovascular risk and less than 2.59 mmol/L (<100 mg/dL) for patients at high cardiovascular risk. To exam...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-145-7-200610030-00010
更新日期:2006-10-03 00:00:00
abstract:OBJECTIVE:To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those without cognitive impairment. DESIGN:Prospective cohort study. SETTING:Academic primary care group practice. PATIENTS:3954 pa...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-122-6-199503150-00004
更新日期:1995-03-15 00:00:00
abstract:BACKGROUND:Little evidence exists to support the theory that small-bore nasogastric tubes prevent gastroesophageal reflux and microaspiration in intubated patients. OBJECTIVE:To determine whether gastroesophageal reflux and microaspiration in intubated patients can be reduced by the use of a small-bore nasogastric tub...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-130-12-199906150-00007
更新日期:1999-06-15 00:00:00
abstract::In addition to gonorrhea and syphilis, both of which may develop primarily at anorectal or pharyngeal sites, a number of conditions, including Neisseria meningitidis urethritis, nonspecific urethritis, anorectal herpes, condyloma acuminatum, amebiasis, giardiasis, shigellosis, typhoid fever, enterobiasis, and hepatiti...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-92-6-805
更新日期:1980-06-01 00:00:00
abstract:Background:Acute pancreatitis (AP) varies in severity, prompting development of systems aimed at predicting prognosis to help guide therapy. Although several prediction approaches are available, their test characteristics and clinical utility are not completely understood. Purpose:To evaluate the test characteristics ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-0650
更新日期:2016-10-04 00:00:00
abstract:OBJECTIVE:To determine the necessity of posteroanterior chest roentgenography for the identification of pneumothorax and other complications after thoracentesis. DESIGN:Prospective cohort study. SETTING:Tertiary care teaching hospital. PATIENTS:67 men and 43 women (mean age +/- SD, 62.4 +/- 13.2 years). Exclusion cr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-9-199605010-00005
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Poor patient attendance to scheduled flexible sigmoidoscopy or colonoscopy may contribute to deficient colorectal cancer screening. OBJECTIVE:To examine the association of physician appointment-keeping behavior with attendance to scheduled endoscopic studies of the colon. DESIGN:Retrospective cohort. SETT...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-140-7-200404060-00013
更新日期:2004-04-06 00:00:00
abstract:BACKGROUND:Several studies show an inverse association between self-reported physical activity and type 2 diabetes. It is not known whether physical activity or cardiorespiratory fitness is associated with the onset of objectively determined impaired fasting glucose and type 2 diabetes. OBJECTIVE:To determine whether ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-130-2-199901190-00002
更新日期:1999-01-19 00:00:00
abstract:BACKGROUND:Impressive decreases in cardiovascular mortality have been achieved through risk factor reduction and clinical intervention, yet cardiovascular disease remains a leading cause of death nationally. OBJECTIVE:To estimate up-to-date preventable fractions of cardiovascular mortality associated with elimination ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-1753
更新日期:2015-08-18 00:00:00
abstract:PURPOSE:To review the electropharmacology, clinical applications, side effects, and hemodynamic profile of intravenous amiodarone. DATA SOURCES:The MEDLINE database was searched for English-language material, including reports of clinical trials and in vivo studies, review articles, and abstracts presented at national...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-127-4-199708150-00007
更新日期:1997-08-15 00:00:00
abstract:BACKGROUND:Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effect...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-0692
更新日期:2015-02-03 00:00:00
abstract:BACKGROUND:Women treated with therapeutic chest radiation may develop breast cancer. PURPOSE:To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer. DATA SOURCES:Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-152-7-201004060-00009
更新日期:2010-04-06 00:00:00
abstract:BACKGROUND:Use of proton-pump inhibitors in the management of peptic ulcer bleeding is controversial because discrepant results have been reported in different ethnic groups. OBJECTIVE:To determine whether intravenous esomeprazole prevents recurrent peptic ulcer bleeding better than placebo in a multiethnic patient sa...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-150-7-200904070-00105
更新日期:2009-04-07 00:00:00
abstract::Cardiovascular disease is the leading cause of death among women in the United States, and stroke is third. This article uses a case scenario to examine female sex-specific cardiovascular risk factors across the lifespan and describes a precision medicine-based approach to risk factor modification and primary preventi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M19-1601
更新日期:2019-12-03 00:00:00
abstract::In a prospective study, mortality ratios were computed in relation to overweight, cancer, and other diseases. The study included 750 000 men and women followed for 12 years. Each person was given a weight index. Death rates for overweight and underweight persons were compared with rates for persons of average weight. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-6-1034
更新日期:1985-12-01 00:00:00
abstract::Of 476 patients with multiple myeloma treated during a 9-year period, 11 developed acute myelogenous leukemia or sideroblastic anemia. In all, the myeloma was in remission from chemotherapy with melphalan-prednisone combinations that had been continued for a median duration of 3 years. The incidence of acute leukemia ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-4-440
更新日期:1977-04-01 00:00:00
abstract::The clinical significance of anatomic substage was assessed in 130 patients with Hodgkin's disease in pathologic stage III-A: stage III1-A includes involvement of spleen, or splenic, celiac, or portal nodes, or any combination of these; stage III2-A includes involvement of para-aortic, iliac, or mesenteric nodes, with...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-2-159
更新日期:1980-02-01 00:00:00
abstract:STUDY OBJECTIVE:To assess respiratory muscle fatigue in acute respiratory failure in patients with chronic obstructive pulmonary disease and evaluate its influence on weaning patients from mechanical ventilation. DESIGN AND PATIENTS:We studied the time course of tracheal occlusion pressure (P0.1) and high-to-low ratio...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-108-6-800
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:In AIDS, nodular skin disease can result from various causes. OBJECTIVE:To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis. DESIGN:Case report. SETTING:Tertiary-care military medical center in Washington, D.C. PATIENT:A 36-year-old w...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-11-199806010-00009
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:To provide a rational strategy for the evaluation and long-term management of epilepsy. DATA SOURCES:Articles written between 1964 and 1993, obtained from a MEDLINE search on epilepsy-related topics as well as from the author's personal files, major reference books on antiepileptic drugs, and references iden...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-120-5-199403010-00010
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:Studies suggest that vitamin D supplementation may reduce cancer and fracture risks. PURPOSE:To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults. DATA SOURCES:English-language studies identified from MEDLINE and the C...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-155-12-201112200-00005
更新日期:2011-12-20 00:00:00
abstract:BACKGROUND:Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. OBJECTIVE:To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adult...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-151-9-200911030-00004
更新日期:2009-11-03 00:00:00
abstract::In April 1976 the attack rate of chills and fever with or without falls in blood pressure increased in association with cardiac catheterizations. Fevers were associated with coronary angiography and right and left heart catheterizations. Blood cultures were negative, and reactions did not correlate with amounts of con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-1-32
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:To determine whether depressed mood or life events are associated with an exacerbation of inflammatory bowel disease. DESIGN:A prospective study of a consecutive sample of patients with relapsing inflammatory bowel disease, followed by monthly questionnaires and periodic office visits. SETTING:A referral-ba...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-5-381
更新日期:1991-03-01 00:00:00