Accuracy of clinical tests used in the detection of carpal tunnel syndrome: A literature review

doi:10.1016/S0894-1130(12)80090-1

Journal of Hand Therapy

Volume 4, Issue 4, October–December 1991, Pages 169-176

https://doi.org/10.1016/S0894-1130(12)80090-1 Get rights and content

Abstract

Literature pertaining to the accuracy of clinical tests used in the examination and diagnosis of carpal tunnel syndrome (CTS) was reviewed. This review suggests that, while no test is 100% accurate, clinical examination has an important role in the diagnosis of CTS, Phalen's test had respectable levels of sensitivity and specificity. Tinel's sign may be present only in certain stages of CTS, but when present is quite specific. Other provocative tests have been described but insufficiently researched to determine their levels of usefulness. Early sensory changes can be assessed with either vibration perception testing or Semmes-Weinstein monofilaments. The tourniquet test is not a useful test. Loss of either 2-point discrimination or motor function should be anticipated only in more severe cases of CTS.

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Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies
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Citation Excerpt :
Therefore these tests are not regarded as the diagnostic gold standard. The reported sensitivity (a proportion of true positive tests to all diseased subjects) and specificity (a proportion of true negative tests to all healthy subjects) of these tests vary from 30% to 100% (MacDermid, 1991; Wiesman et al., 2003). Some physicians feel that these tests are more helpful in diagnosing CTS in young patients (El Miedany et al., 2008).
Evaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS).
ONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests.
ONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1–2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3–6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%).
ONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS.
Oxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.
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She concluded that “No test for CTS is 100% accurate. Electrodiagnostic testing, although a valuable aid in the diagnosis of CTS does not replace a carefully executed clinical assessment.”38 In this study, participants with bilateral untreated carpal tunnel were excluded.
Exploratory cohort study.
To compares the outcome of self-administered questionnaires and physical measures in assessing change in function for participants after carpal tunnel surgery.
The self-administered questionnaires were the Carpal Tunnel Questionnaire (CTQ), the Disabilities of the Arm, Shoulder, and Hand (DASH), and Short Form-36. The physical measures were grip, pinch, range of motion, sensibility, and dexterity. Twenty-nine participants from five hand clinics were enrolled in the study.
The results revealed that self-administered questionnaires were sensitive to change in function and three of ten physical measures showed a change in function.
The authors concluded that select physical measures coupled with a disease-specific assessment, such as the CTQ and a region-specific questionnaire, such as the DASH would result in a comprehensive assessment of outcomes. This combination of assessments provides both physical measures of recovery and measures of perceived level of function.
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In the early stages of nerve compression, provocation testing may be the only positive finding (Figure 1). Clinical evaluation for carpal tunnel syndrome using Tinel's sign, Phalen's test and other provocation tests have been well described and this concept of increasing nerve tension and compression to provoke symptoms may be extrapolated to other sites of nerve compression.11,26–37 The importance of the double crush mechanism cannot be under estimated in evaluating patients with suspected nerve compression.
Evaluation of the patient with nerve compression and/or nerve injury should include a complete motor and sensory evaluation to establish the level and degree of injury and/or compression. No one test has been accepted as the standard procedure for the evaluation of sensibility. The various sensory tests available for patient assessment will yield different information regarding the integrity of the quickly and slowly adapting sensory receptors. Tests such as provocative maneuvers and sensory thresholds (cutaneous and vibration) will be more sensitive in the evaluation of patients with nerve compression, and other discriminatory measures will yield better functional information in patients with nerve injury.

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Accuracy of clinical tests used in the detection of carpal tunnel syndrome: A literature review

Abstract

Lancet

J Hand Surg

Arch Phys Med Rehabil

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Ther

Pain

J Hand Surg

J Hand Surg

Arch Phys Med Rehabil

J Hand Surg

J Hand Surg

Pain

The carpal tunnel syndrome: Seventeen years experience in diagnosis and treatment of six hundred and fifty-four

J Bone Joint Surg

Carpal tunnel syndrome: The new “industrial epidemic.”

AAOHN J

Carpal tunnel syndrome

Hand Clin

Carpal tunnel syndrome: An evaluation of the provocative diagnostic tests

J Bone Joint Surg

Evaluation of Tinel's and Phalen's signs in diagnosis of the carpal tunnel syndrome

Eur J Neurol

Clinical tests for carpal tunnel syndrome: An evaluation

Br J Rheum

Tinel's sign and the carpal tunnel syndrome

Br Med J

Carpal tunnel syndrome in Rochester, Minnesota 1961 to 1980

Neurology

Carpal tunnel syndrome: Contribution of flexor tendons

Arch Phys Med Rehabil

The carpal tunnel syndrome: A clinical and anatomical study

J Bone Joint Surg