Faculty Collaboration Database

Predicting electrodiagnostic outcome in patients with upper limb symptoms: are the history and physical examination helpful? Arch Phys Med Rehabil 2000 Apr;81(4):436-41

Date

04/18/2000

Pubmed ID

10768532

DOI

10.1053/mr.2000.4426

Scopus ID

2-s2.0-0034110856 (requires institutional sign-in at Scopus site)   46 Citations

Abstract

OBJECTIVE: To determine the effectiveness of medical history and physical examination in predicting electrodiagnostic outcome in patients with suspected cervical radiculopathy.

METHODS: Data on 183 subjects prospectively collected at five different electrodiagnostic laboratories were analyzed (96 cervical radiculopathies, 45 normal studies, and 42 abnormal electrodiagnostic findings other than radiculopathy). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratios were determined for symptoms and neurologic signs.

RESULTS: Symptoms of numbness, weakness, and tingling were associated with twice the probability of having abnormal electrodiagnostic study results in general, yet were not helpful in identifying a cervical radiculopathy. All single and combined physical examination components had poor sensitivities, with the exception of weakness, but much higher specificities. Patients with either weakness or reduced reflexes on physical examination were up to five times more likely to have abnormal electrodiagnostic findings. In subjects with any abnormal neurologic sign, the sensitivity improved to 84%, the positive predictive value was 79%, but the specificity was low (44%). Of those subjects with normal physical examination results, almost one half had an abnormal electrodiagnostic study result (negative predictive value 52%).

CONCLUSIONS: In a population of patients with suspected cervical radiculopathy, medical history and physical examination are helpful yet not sufficient to predict the electrodiagnostic outcome.

Author List

Lauder TD, Dillingham TR, Andary M, Kumar S, Pezzin LE, Stephens RT, Shannon S

Author

Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Electromyography
Humans
Medical History Taking
Middle Aged
Physical Examination
Prospective Studies
Radiculopathy
Sensitivity and Specificity