Abstract：
OBJECTIVE: We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy.
METHODS: We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand).
RESULTS: Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution.
CONCLUSIONS: Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome.
CONCLUSIONS: Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).
METHODS: We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand).
RESULTS: Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution.
CONCLUSIONS: Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome.
CONCLUSIONS: Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).
摘要：
目的：我们研究了腕管综合征临床检查中对特定症状的解释差异，以评估外科医生认为疼痛无感觉异常的中段神经病变的程度。
方法：我们邀请了变异科学小组的所有上肢外科医生完成一个基于情景的实验。外科医生阅读5-10例患者的临床插图，这些患者的人口统计学变化和症状和体征的随机变化如下：主要症状（夜间麻木和刺痛，持续麻木和失去敏感性，活动疼痛)，挑衅性测试引起的症状(Phalen，Durkan,或Tinel）（刺痛，疼痛),以及挑衅性测试引起的症状的位置(食指和中指，拇指和食指,小而无名指，整个手)。
结果：与外科医生将挑衅性试验解释为阴性相关的患者因素包括Phalen期间的疼痛而不是感觉异常，Durkan,或Tinel测试和整个手部症状的位置，而不是正中神经分布。
结论：专家不认为没有感觉异常或无特征性症状分布的疼痛是腕管综合征的特征。
结论：意识到Phalen引起疼痛，Durkan,专家认为Tinel测试相对无特征的中位神经病可帮助限制中位神经病的过度诊断和过度治疗以及精神和社会健康对疾病的贡献的诊断和治疗不足的可能性(疼痛的强度和分布显著相关)。
方法：我们邀请了变异科学小组的所有上肢外科医生完成一个基于情景的实验。外科医生阅读5-10例患者的临床插图，这些患者的人口统计学变化和症状和体征的随机变化如下：主要症状（夜间麻木和刺痛，持续麻木和失去敏感性，活动疼痛)，挑衅性测试引起的症状(Phalen，Durkan,或Tinel）（刺痛，疼痛),以及挑衅性测试引起的症状的位置(食指和中指，拇指和食指,小而无名指，整个手)。
结果：与外科医生将挑衅性试验解释为阴性相关的患者因素包括Phalen期间的疼痛而不是感觉异常，Durkan,或Tinel测试和整个手部症状的位置，而不是正中神经分布。
结论：专家不认为没有感觉异常或无特征性症状分布的疼痛是腕管综合征的特征。
结论：意识到Phalen引起疼痛，Durkan,专家认为Tinel测试相对无特征的中位神经病可帮助限制中位神经病的过度诊断和过度治疗以及精神和社会健康对疾病的贡献的诊断和治疗不足的可能性(疼痛的强度和分布显著相关)。
