[Golosa]

Сообщение от cramp

По-моему, достаточно. Сколько еще можно доказательств? Приведите мне хоть одну статью-опровержение именно неврологического профиля.

Уважаемый доктор, давайте-ка я сначала отвечу Вам примерно тем же. Вводим в окошко для поиска, например в гугле, следующий пароль 11 DE Reg 1337 04-01-08 - Delaware Regulations Открываем файл и смотрим страницу 18 в ПДФ версии этого документа. Так вот на этой странице написано следующее: “Electrodiagnostic tests may be negative in surgically confirmed cases. Conversely, electrodiagnostic testing may be positive in asymptomatic individuals. The diagnosis of CTS, therefore, remains a clinical diagnosis based on a preponderance of supportive findings”.

На стр.23 после небольших разъяснений по поводу причин и факторов риска при СКЗ написано: “Most studies' limitations tend to attenuate, rather than inflate, associations between workplace exposures and CTS”.

А теперь еще несколько цитат. Kyle D. Bickel. Current concept: Carpal Tunnel Syndrome//The Journal of Hand Surgery.-Volume 35.-Issue 1.-January 2010.-Pages 147-152 . – “Carpal tunnel syndrome remains a clinical diagnosis, and the role of diagnostic testing is still unclear. Electrodiagnostic tests are routinely performed, yet the validity of these tests is still largely unproved. A gold-standard test is lacking, and overreliance on electrodiagnostic test results can obscure clinical findings and may even lead to the withholding of effective treatment for patients with clear clinical criteria for CTS whose electrodiagnostic test results are in the normal range. Graham showed that the value added by electrodiagnostic testing to the clinical determination of CTS by use of the CTS-6 criteria was small(5). This was largely because the probability of accurately diagnosing the condition based on the clinical presentation alone was already quite high. Electrodiagnostic tests were also shown to have no predictive value in determining the functional status or symptom severity in patients with CTS(6). The role of electrodiagnostic testing, therefore, appears to be questionable. The tests are probably most appropriately used as a baseline for monitoring unexpected outcomes, such as incomplete release and nerve injury, and excluding other associated neurologic conditions, such as cervical radiculopathy. In the medico-legal arena, the overreliance on electrodiagnostic test results creates a tacit expectation of test validity that is not borne out by the available evidence in the literature.(5) and (6).” Кстати, обратите внимание на последнюю строчку приведенной цитаты: там кое-что интересное сказано про medico-legal проблемы. Вы помните, к чему это я? Помните про электродиагностику СКЗ before operation и почему она делается? Так вот еще одна цитата про влияние страховой-денежной медицины на диагностику и лечение.

C. K. KITSIS , O.SAVVIDOU , A. ALAM , R. J. CHERRY. CARPAL TUNNEL SYNDROME DESPITE NEGATIVE NEUROPHYSIOLOGICAL STUDIES // Acta Orthopædica Belgica, Vol. 68 - 2 – 2002. – Р.135-140. – “ Our results support the view that CTS is a clinical diagnosis….. Both are invaluable in our diagnostic armamentarium. In a world of cost efficiency and managed care it would be fair to say that nerve conduction studies significantly increase the cost of treatment and may prolong the waiting time for the operation. Consequently, one might consider them unnecessary in cases with typical features of CTS. However, within the present climate of litigation, the nerve conduction studies are increasingly being used for purposes of documentation. We establish our diagnosis on clinical grounds supported, if possible, by positive nerve conduction studies, not the reverse”.
Мнения разные бывают. Хотелось бы избегать маргинальных: либо только клиника, либо только электродиагностика.