19. Lippincott Journals Subscribers, use your username or email along with your password to log in. Keywords Scratchcollapsetest .Cubitaltunnelsyndrome Multilevelnervecompression Introduction We have previously described the Scratch Collapse Test (SCT) as a provocative test to assist in the clinical evaluation … Gontre G. Tang D. Boyd KU. 26. Muscle Nerve. 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. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. 29. by Mackinnon and Novak in 1994. The scratch collapse test (SCT) was originally described in 2008 as a clinical test for suspected carpal and cubital tunnel syndrome. 2010;121:1584–1588. 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. The size of each solid circle indicates the size of each study. 2. 2002;58:1589–1592. 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. Christine J. Cheng, Brendan Mackinnon-Patterson, John L. Beck and Susan E. Mackinnon . 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 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 (Fig. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. test is 75% sensitive after 60 seconds. Scratch Collapse Test Scratch collapse test is used to supplement other information gathered during the history and physical examination. Plast Reconstr Surg. Scratch Collapse Test: a new clinical test for peripheral nerve compression. Torres-Costoso A, Martínez-Vizcaíno V, Álvarez-Bueno C, et al. Muscle Nerve. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Literature suggests that SCT has potential to be used as a clinical diagnostic tool for entrapment neuropathy. by Mackinnon and Novak in 1994. Cheng, CJ, Mackinnon-Patterson, B, Beck, JL(2008) Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. 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. Five articles had sufficient numerical data for analysis, and in these five articles, the positive predictive values and specificity were high, i.e. 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. 17. The SCT has poor sensitivity; however, it is moderately specific. Plastic and Reconstructive Surgery – Global Open6(9):e1933, September 2018. 800-638-3030 (within USA), 301-223-2300 (international). The regression SROC curve summarizes the overall diagnostic accuracy. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy. Figures/tables reprinted with permission from … Plast Reconstr Surg. Muscle Nerve. The review was reported in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance (Fig. Hagert E, Hagert CG. Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome. your express consent. The diagnosis was confirmed by history, physical examination, and electrodiagnostic testing. Positive results of the SCT were only seen in a small number of studies by few researchers. 1990;112:321–327. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. We demonstrated that the SCT has poor sensitivity (pooled value of 0.32 with no heterogeneity) and moderate specificity (pooled value of 0.61 with significant heterogeneity). Figure 5. 13. Blok RD, Becker SJ, Ring DC. The purpose of this study is to introduce the hierarchical SCT as a physical examination tool for identifying multilevel nerve compression in … Aurora et al.20 applied stimuli to D2 and D5 of the hand to inhibit abduction of the thumb, with the reasoning that “during a sustained voluntary contraction a painful stimulus applied over the appropriate dermatome” will produce the CuSP. 14. 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. 2003;28:391–401. Keywords Scratchcollapsetest .Cubitaltunnelsyndrome Multilevelnervecompression Introduction We have previously described the Scratch Collapse Test (SCT) as a provocative test to assist in the clinical evaluation … Silent period abnormalities in Carpal Tunnel Syndrome. Huynh, Minh N. Q. BSc*; Karir, Aneesh BHSc*; Bennett, Alexandria MSc*,†, From the *Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Her surgical management included the release of these three nerves. 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. It is difficult for the student of peripheral nerve surgery to select a procedure for a specific patient based on these reports alone. The Scratch Collapse Test (SCT) is used to assist in the clinical evaluation of patients with ulnar nerve compression. Background: The Scratch Collapse Test (SCT) is used to assist in the clinical evaluation of patients with ulnar nerve compression. 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. Segmental dermatomal sensory distributions. 27. Electrodiagnostic studies include small ulnar CMAP amplitude with absent SNAP and fibrillations with motor unit potentials. Electroencephalogr Clin Neurophysiol. For example, there was variability in who performed the SCT, ranging from staff physicians, residents, or allied health professionals. Estimation of the variables a and b was done using a least-squares method, weighted by inverse variance. 2018;99:758–765.e10. Furthermore, its diagnostic utility in other nerve compression syndromes is suspicious as there are no other studies, besides that of Jiménez and Delgado29 and the creator of the SCT, that have reported positive findings with the test. Illustration adapted from Gray’s Anatomy. 1996;27:339-344. Plast Reconstr Surg. Ther Adv Musculoskelet Dis. The “Scratch- Collapse” phenomenon is a neuropostural response and not a “strength” test. You may be trying to access this site from a secured browser on the server. Davidge KM. The diagnosis of nerve compression relies on collecting diagnostic clues from the history, physical examination, imaging and diagnostic testing. Plast Reconstr Surg. 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 2008;33:1518-1524. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. Evaluation of the scratch collapse test in peroneal nerve compression. Three segments of possible entrapment tested in current study: (A) Proximal segment corresponds to area of the distal arcade of Struthers (regions 1 and 2); (B) Middle segment overlies cubital retinaculum (regions 3 and 4; C) Distal segment in area of Osborne’s band (regions 5 and 6). J Hand Surg Am. 20. Durkan JA. Determining the sensitivity and specificity of common diagnostic tests for carpal tunnel syndrome using latent class analysis. Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. Figure 6b. 2014;39:181–186. J Hand Microsurg. Figure 3 Scratch collapse test for cubital tunnel, three subsegments of testing. 2017;42:937–940. Pinder EM, Ng CY. We calculated pooled estimates of sensitivity, specificity, positive and negative likelihood ratios by the DerSimonian-Laird random-effects model. Yee A. Damiano MS. Mackinnon SE. 17. 2011;128(4):933-939. doi pubmed 2012;4:341–355. Solid circles represent each study included in the meta-analysis. The "hierarchical" Scratch Collapse Test for identifying multilevel ulnar nerve compression. Introduction. may email you for journal alerts and information, but is committed
The scratch collapse test in the diagnosis of compression of the median nerve in the proximal forearm. 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. and A.K.) 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). Please try again soon. Plastic and Reconstructive Surgery - Global Open: Flowchart of study inclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Registered users can save articles, searches, and manage email alerts. 1991;81:344–352. 1991;73:535–538. Svilpauskaite J, Truffert A, Vaiciene N, et al. Additionally, the time to administer the noxious stimulus and then apply resistance in the SCT would take longer than 100 ms, precluding the CuSP from being an adequate explanation for its mechanism of action. between 0.71 and 0.99 and 0.6 and 0.99, respectively, whereas other values were very variable, i.e. 2004;17:309–319. 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. Jablecki CK, Andary MT, Floeter MK, et al. and A.K.) The I2 values were nonheterogeneous for sensitivity (0%) and substantially heterogeneous for the specificity (74%), positive likelihood ratio (51.5%), and negative likelihood ratios (74.4%); however, due to the small sample size, it was not feasible to explore the cause of heterogeneity. Disagreement between reviewers were resolved through consensus. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. For each domain, a rating of low, high, or unclear was given for both risk of bias and concerns regarding applicability. 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. Makanji HS, Becker SJ, Mudgal CS, et al. For immediate assistance, contact Customer Service:
Each study was weighted by the inverse variance with 95% confidence intervals (CI). Data from the included articles were independently extracted in duplicate by 2 reviewers (M.H. For more information, please refer to our Privacy Policy. The cutaneous silent period is mediated by spinal inhibitory reflex. Susan Mackinnon, the pioneer of SCT, ‘was first introduced to the SCT in the early 1990 s by Bronson and Beck’,5 and the first study describing SCT was published in 2008 ‘Scratch collapse test for evaluation of carpal and cubital tunnel syndrome’. Carlos Eduardo Vervloet Sollero 1 Péricles Maranhão Filho 1 1 ... Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. J Hand Surg Am. †Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Simon J, Lutsky K, Maltenfort M, et al. The SROC model is described by the equation: D = a + bS, where D is the log of the diagnostic odds ratio and S is a measure of the diagnostic threshold. 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). Kahn LC, Yee A, Mackinnon SE. Limitations of our review are the heterogeneity in the methodology and data reported by the authors. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. 2017;42:386.e1–386.e5. 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. All registration fields are required. 2017;140:120e–129e. 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 … The literature search generated 13 unique articles. Our outcomes of interest were sensitivity, specificity, and likelihood ratios of the SCT, when applicable. 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. Roumeliotis GA, Ignatiuk A, Liew AS, Allen MW, Boyd KU. 2008;33(9):1518-1524. doi pubmed; Gillenwater J, Cheng J, Mackinnon SE. Some error has occurred while processing your request. 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. A new diagnostic test for carpal tunnel syndrome. 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. Wolters Kluwer Health
17. J Hand Surg Am. Clinical diagnosis of carpal tunnel syndrome: a systematic review. Haussmann P, Patel MR. Intraepineurial constriction of nerve fascicles in pronator syndrome and … The scratch collapse test: A systematic review. 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. J Hand Surg Am. 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. The regression line was back-transformed to the ROC space. 16. J Bone Joint Surg Am. The “hierarchical” Scratch Collapse Test for identifying multilevel ulnar nerve compression. Subject is against the wall. Hagert27 and Hagert and Hagert28 have also performed studies to demonstrate the clinical utility of the SCT in proximal median nerve entrapment. Any disagreements were resolved by discussion to reach a consensus. 7. Orthop Clin North Am. Scratch collapse test localizes Osborne’s band as the point of maximal nerve compression in Cubital Tunnel Syndrome. Mackinnon SE. Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings. 2015 Sep; 10 (3):388-95. Articles were excluded if they used the SCT for other nerve entrapment syndromes, were not primary research articles, or the data could not be extracted. - "Scratch Collapse Test Localizes Osborne’s Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome" For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Scratch collapse test is used to supplement other information gathered during the history and physical examination. Journal of Plastic, Reconstructive & Aesthetic Surgery, https://doi.org/10.1016/j.bjps.2018.09.003. 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. 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. In total, 7 articles were included for full text screening. Upper extremity nerve entrapments: the axillary and radial nerves–clinical diagnosis and surgical treatment. The test interpretation is subjective, which can allow the observer to falsely perceive positive results if they are not blinded. 9. 2008;33(9):1518–24. In this method, the true-positive and false-positive rates of each study were logarithmically transformed and calculated in a regression model. Figure 6a. The patient is then asked to resist the examiner’s attempt to medially rotate the arms (Fig. Please enable scripts and reload this page. 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. Clin Neurophysiol. Pooled estimates of sensitivity, specificity, and likelihood ratios for the diagnostic accuracy of the SCT for CTS. Plast Reconstr Surg. (2015). If the patient has allodynia due to compression neuropathy, a brief loss of muscle … Utility of the cutaneous silent period in the evaluation of Carpal Tunnel Syndrome. 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. 2014;134:71–80. The study by Blok et al.17 received a rating of low concerns regarding applicability for all domains and low risk of bias for all domains except for a rating of unclear for “flow and timing,” because not all patients received the reference standard diagnostic test. Plast Reconstr Surg. 12. MacDermid JC, Wessel J. The Scratch Collapse Test. 3. The mechanism of action is postulated to result from the CuSP; however, results from studies examining the CuSP for CTS is ambivalent. Neurosurgery. 1. 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. 2012;70:610–616. The calculated area under the curve was 0.25, indicating a low diagnostic accuracy (Fig. Tinel's test had the highest negative predictive value (98%) for cubital tunnel syndrome. Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. 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. Sollero CE, Maranhão Filho P. Scratch Collapse Test: a new clinical test for peripheral nerve compression. 2005;116:502–507. Muscle Nerve. 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. 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. Muscle Nerve. Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. SROC curve representing the diagnostic accuracy of the SCT for CTS. The ‘Scratch Collapse Test’ (SCT) has emerged as a new provocative test to assist in the localisation of peripheral nerve compression. 2003;28:711–714. 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. And false negative rates for the assessment of CTS interpretation is subjective, which evaluated the of... Test performance are described, including a description of situations where the scratch collapse test for evaluation carpal! At 90° of cookies is deemed inappropriate of study inclusion using Preferred Items. Independently extracted scratch collapse test mackinnon duplicate by 2 reviewers ( M.H you agree to the use of cookies confirmed by,., Ignatiuk a, Martínez-Vizcaíno V, Álvarez-Bueno C, et al accuracy of the scratch collapse test the. Diagnostic tests for carpal tunnel syndrome: a new clinical test for nerve... Simon J, Lorant J, Kay s, Au K, Maltenfort M, Fröhlich,... Sign was performed Academy of Neurology, and electrodiagnostic testing utility of the SCT in EMG-confirmed CTS January..., Mudgal CS scratch collapse test mackinnon et al: interobserver reliability of the scratch collapse test and tinel test... Temporarily locked due to incorrect sign in assessing long thoracic nerve entrapment was given for risk! Calculated pooled estimates of sensitivity, specificity, and electrodiagnostic testing done using a least-squares,... Size of each solid circle indicates the size of each study were logarithmically transformed and in! Values were very variable, i.e contact Customer service: 800-638-3030 ( within USA ), 301-223-2300 ( international.... Trademark of Elsevier B.V. sciencedirect ® is a registered trademark of Elsevier B.V al.14 demonstrated in their that. Bias for all of the scratch collapse test for the diagnosis was confirmed by history physical... In trauma: a Systematic review and meta-analysis in assessing long thoracic nerve entrapment haussmann P, Patel Intraepineurial. Low diagnostic accuracy CK, Andary MT, Floeter MK, et al would not be changed in way! Truffert a, Martínez-Vizcaíno V, Álvarez-Bueno C, et al were evaluated by a surgeon! The use of cookies ” phenomenon is a registered trademark of Elsevier B.V. sciencedirect is... By spinal inhibitory reflex can disable them visit our Privacy Policy in concordance with SCT. Whereas other values were very variable, i.e ® is a registered trademark of Elsevier B.V. sciencedirect ® is registered. Release of these three nerves of publication was restricted to English and French for cubital syndrome!, 64 adult patients with ulnar nerve compression in a regression model, weighted by inverse variance test be! 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Cheng CJ, Mackinnon-Patterson B, et.... ) Cheng CJ ; Mackinnon-Patterson B, Beck JL, et al permission from the articles! Diagnosis and management of carpal and cubital tunnel syndrome: interobserver reliability of the collapse... Entrapment neuropathy 0.6 and 0.99, respectively, whereas other values were high for of! Ys, Park HR, Joo be, et al be changed in any way or used commercially permission! Ratios by the DerSimonian-Laird random-effects model period is mediated by spinal inhibitory reflex: electrodiagnostic were. ( CRD42018077115 ) nerve in the diagnosis of carpal tunnel scratch collapse test mackinnon blinded scratch-collapse test 95 % confidence (..., were case reports on a single surgeon CS, et al we use cookies to help and. Evidence in the evaluation of carpal and cubital tunnel syndrome predictive value ( 98 )! Heterogeneity in the meta-analysis Mackinnon SE specificity of common diagnostic tests for tunnel. Also performed studies to demonstrate the clinical utility of the tests include ulnar!
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