Assessing the accuracy of a combination of clinical tests for identifying carpal tunnel syndrome

Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, Sydney, NSW, Australia.
Journal of Clinical Neuroscience (Impact Factor: 1.38). 04/2009; 16(7):929-33. DOI: 10.1016/j.jocn.2008.09.004
Source: PubMed


The aim of the study was to investigate whether a combination of selected provocative manoeuvres and sensory testing could improve the accuracy of clinical diagnosis of carpal tunnel syndrome (CTS). Prospective studies were undertaken in 43 of 296 consecutive patients who were referred with suspected CTS and had undergone nerve conduction studies (NCS). Responses to Phalen's test, a modified carpal compression test (MCCT), and sensory testing over the thenar eminence were assessed for each patient. For each test (Phalen's; MCCT), sensitivity (0.64; 0.14), specificity (0.75; 0.96), positive likelihood ratio (PLR) (2.54; 3.64) and negative likelihood ratio (NLR) (0.49; 0.89) were calculated. The inclusion of sensory testing did not improve sensitivity (0.55; 0.13), specificity (0.75; 0.96), PLR (2.22; 3.29) or NLR (0.60; 0.91). These data indicate that assessment of thenar sensation does not improve the diagnostic accuracy of CTS. However, a positive Phalen's test is more likely to be associated with NCS changes that are consistent with CTS.

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    • "Screening programs have also been implemented for early detection of CTS [Murata et al., 1996; Lundstrom et al., 1992]. A variety of physical exam procedures involving inspection, palpation, provocation maneuvers, and tests of strength and resistance have been used for the diagnosis of this disease [Boland and Kiernan, 2009; Szabo et al., 1999; Sesto et al., 2003; D'Arcy and McGee, 2000; Graham et al., 2006; Phalen, 1966]. Most of these measures address one or more characteristics of the syndrome, such as sensory or motor loss. "
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