WHAT’S NEW: Better results can be achieved in seconds
The addition of monofilament testing to the TPT increases the sensitivity in identifying CTS. The MPT is simple to learn (watch the video on jfponline.com) and, based on our observations, adds only about 10 to 15 seconds to the clinical exam.
CAVEATS: Modification is untested in primary care
A diagnosis of CTS is rarely made on the basis of one test, but rather on a set of signs, symptoms, and physical exam maneuvers. The added value of the MPT needs to be evaluated in the larger context of the comprehensive clinical examination for CTS.6
Notably, the study participants were seen in a neurology clinic, which suggests that they may have had more advanced CTS than typical primary care patients. That would help explain the 100% specificity of both the traditional and modified tests reported by the researchers. The sensitivity of the MPT may therefore be lower in a family physician’s office because the spectrum of disease may be wider. Another study is needed to evaluate the performance of the MPT in a primary care setting.
The monofilament used (Semmes-Weinstein 2.83) is not the same as the typical 5.07 (10-g) monofilament used in diabetic foot screenings. Using this heavier monofilament with a stronger pressure point would likely decrease the sensitivity of the MPT.
CHALLENGES TO IMPLEMENTATION: Taking the time, obtaining the monofilament
Additional time to obtain the correct monofilament and administer the MPT are the key challenges to implementation.
Acknowledgement
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
