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American Journal of Physical Medicine & Rehabilitation
Issue: Volume 76(6), November/December 1997, pp 451-457
Copyright: © Williams & Wilkins 1997. All Rights Reserved.
Publication Type: [Research Articles]
Keywords: Carpal Tunnel Syndrome,Electrodiagnosis, Hoffmann-Tinel, Median Nerve, Phalen, Physical Examination, S
SENSITIVITY AND SPECIFICITY OF CARPAL TUNNEL SYNDROME SIGNS1
Kuhlman, Kurt A. DO2; Hennessey, William J. MD
1From the Physical Medicine Associates of Northwest Ohio, The Ohio State University, Lima, Ohio (K.A.K.), and Rehabilitation Services, Latrobe Area Hospital, Latrobe, Pennsylvania (W.J.H.).
2 Allcorrespondence and requests for reprints should be addressed to: Physical Medicine Associates of NW Ohio, 658 West Market Street, Suite 106, Lima, Ohio 45801.
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ABSTRACT | |
The sensitivity and specificity of six carpal tunnel syndrome (CTS) signs were determined by evaluating 143 subjects (228 hands) with symptoms of CTS. Immediately after performing the six physicalexamination tests, standard nerve conduction studies were performed on all 228 hands to determine the presence or absence of CTS. CTS was present in 142 hands and absent in 86 hands. The signs were not very sensitive (23-69%), but were fairly specific(66-87%) for CTS. A square-shaped wrist and abductor pollicis brevis weakness were the most sensitive signs (69 and 66%, respectively), and are recommended aspart of the examination of CTS. Median nerve hypesthesia and the Phalen sign both have fair sensitivity (51%) but good specificity (85 and 76%, respectively). The median nerve compression sign and the Hoffmann-Tinel sign both have poor sensitivity (28 and 23%, respectively), and thus are less helpful in evaluating subjects with suspected CTS. | |
Multiple signs have been advocatedfor the diagnosis of carpal tunnel syndrome (CTS).1-7 Standard nerve conduction studies (NCSs) are the most definitive tests used to diagnose CTS, and they are the only tests to objectively confirm median nerve dysfunction within the carpal tunnel.8-11 However, most authors have not used standard electrodiagnostic criteria to determine the presence or absence of CTS before or after performing thephysical examination tests.1, 2, 5, 7, 12-14 This contributes to the wide variability of the sensitivity and specificity of these signs in the medical literature and significantly limits the clinical validity of these studies. The purpose of this study was to determine the sensitivity and specificity of six signs used to determine the presence or absence of CTS compared with the results ofstandard NCSs. | |
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METHODS | |
One hundred eighty consecutive subjects referred for electrodiagnostic consultation with suspected CTS were evaluated. All subjects had at least one symptom indicative of possible CTS (Table 1). Thirty-seven subjects were excluded from the study because they were found to have a generalized peripheral neuropathy, previous carpal tunnel surgery,cervical radiculopathy, or some other neuromuscular disorder that could account for their signs and symptoms. Subjects with diabetes were not excluded unless their NCSs demonstrated a generalized peripheral neuropathy. A total of 143 subjects was included in the study. Eighty-five subjects had bilateral symptoms of CTS; therefore, 228 hands were included in the study. | Table 1 | | |
Thesix signs evaluated in this study were chosen because they are well known and all can be easily and quickly performed. The six physical examination tests were performed by the first author (KAK) on all 228 hands before performing the electrodiagnostic studies. Each sign was recorded as either positive or negative for CTS. The following signs were evaluated. | |
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