title: The serial use of two provocative tests in the clinical diagnosis of carpal tunel syndrome.
abstract: OBJECTIVE
  1) To examine the diagnostic value of the newly proposed manual carpal compression test (mCCT). 2) To evaluate the test efficacy of a serial use of mCCT and Phalen's test (PT) in the clinical diagnosis of carpal tunnel syndrome (CTS) in comparison with standard nerve conduction studies.
  
  
  METHODS
  Prospective, controlled study of 47 patients with 63 symptomatic CTS hands according to clinical as well as electrophysiological criteria. In the control group, 39 hands of 20 healthy volunteers were examined. Clinical neurological examination including mCCT and PT and standard nerve conduction studies were always performed: sensory nerve conduction velocity third and fifth digit to wrist, median distal motor latency. Calculation of sensitivity, specificity, positive and negative predictive value for the mCCT, PT and mCCT+PT, i.e. at least one of both tests positive after sequential application.
  
  
  RESULTS
  Sensitivity 83% for mCCT, 79% for PT and 92% for mCCT+PT. Specificity 92% for all three conditions. Excellent positive predictive value of 95% and good negative predictive value of 88% for mCCT+PT.
  
  
  CONCLUSIONS
  The serial application of mCCT and PT is very useful in the clinical diagnosis of CTS. This finding facilitates the clinical diagnosis by the primary physician, it helps to improve referral decisions to electrophysiological departments and other ancillary examinations and may reduce costs.
authors.affiliation: University Clinic of Neurology, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Fertl
authors.forename: C
authors.initials: C
authors.lastname: Wöber
authors.forename: J
authors.initials: J
authors.lastname: Zeitlhofer
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis*; D019245:Compressive Strength; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009460:Neurologic Examination / Q000379:methods*; D012680:Sensitivity and Specificity