Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies: Table 1

Abstract

Objective We evaluated the utility of physical examination maneuvers in the prediction of carpal tunnel syndrome (CTS) in a population-based research study. Methods We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination, and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as “classic” or “probable” on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination maneuvers, in subjects with and without symptoms. Results The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was less than 50% for all strategies tested. Conclusion Our study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.

Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies?

“…A minority of studies suggest that the prevalence of CTS may be as high as 3 % or 4 % [3]; however, most publications report a prevalence of approximately 2 % of the adult population in the USA, affecting 4-10 million patients [4,5].…”

The Prevalence of Cubital Tunnel Syndrome: A Cross-Sectional Study in a U.S. Metropolitan Cohort

“…We also chose this definition on the basis of evidence that these tests both demonstrate strong correlation with electrophysiologic diagnosis 21,31 . Typically, screening for cubital tunnel syndrome relies on multiple methods (patient-reported history of symptoms, clinical examination, electrodiagnostic testing, ultrasonographic examination) that all have diagnostic limitations 1,32,33 . Descatha et al demonstrated that the prevalence of carpal tunnel syndrome varied according to the case definition employed, leading to the misclassification of 1% to 10% cases.…”

Clinical Outcomes of Electrodiagnostic Testing Conducted in Primary Care

“…Although a neurological examination is central to the workup of patients with suspected neuropathies, it may not have adequate diagnostic accuracy. [4][5][6] Therefore, objective confirmation of a neuropathy and grading of severity may benefit patient management. 7 Nerve conduction studies (NCSs) provide the most objective and reliable diagnostic assessment of neuropathies.…”