title: The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings.
abstract: OBJECTIVE
  To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome.
  
  
  METHODS
  Comparison of diagnostic tests with neurophysiologic testing.
  
  
  METHODS
  Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies.
  
  
  METHODS
  Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses.
  
  
  RESULTS
  Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55, CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome.
  
  
  CONCLUSIONS
  With the exceptions of age, Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies.
authors.affiliation: Robert B. Brigham Multipurpose Arthritis Center, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
authors.forename: M G
authors.initials: MG
authors.lastname: Larson
authors.forename: A
authors.initials: A
authors.lastname: Sabra
authors.forename: C
authors.initials: C
authors.lastname: Krarup
authors.forename: C R
authors.initials: CR
authors.lastname: Stirrat
authors.forename: R
authors.initials: R
authors.lastname: Sethi
authors.forename: H M
authors.initials: HM
authors.lastname: Eaton
authors.forename: A H
authors.initials: AH
authors.lastname: Fossel
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009431:Neural Conduction; D009460:Neurologic Examination; D010808:Physical Examination; D011237:Predictive Value of Tests; D011336:Probability; D012307:Risk Factors; D011795:Surveys and Questionnaires