Carpal compression test and pressure provocative test in veterans with median-distribution paresthesias.
We investigated the value of the carpal compression test (CCT) and the pressure provocative test (PPT) in predicting carpal tunnel syndrome (CTS) in a predominantly male population of veterans. We performed a prospective, blinded comparison of these clinical diagnostic tests with neurophysiological testing. One cohort of 135 consecutive patients was assessed with the CCT; a separate cohort of 134 consecutive patients was assessed with the PPT. Of these 269 patients, 58.4% had electrodiagnostically confirmed CTS. The sensitivity of the CCT was 52.5%, specificity was 61.8%, positive predictive value was 66.6%, and the negative predictive value was 47. 2%. The sensitivity of the PPT was 54.5%, specificity was 68.4%, positive predictive value was 70%, and the negative predictive value was 52.7%. The CCT and PPT had minimal utility in predicting electrodiagnostically confirmed CTS. In a subset of the CCT cohort, 86 consecutive veterans were also evaluated in relation to a clinical gold standard. Of these patients, 60% had CTS based on this gold standard. CCT sensitivity was 53.8%, specificity was 61.8%, positive predictive value was 68.3%, and negative predictive value was 46.7%. The CCT thus had marginal utility in predicting CTS based on a clinical gold standard.
Kaul
M P
MP
Department of Physical Medicine and Rehabilitation, Portland Veterans Administration Medical Center, 3710 SW US Veterans Hospital Road, Portland, Oregon 97207, USA. mkaul9@aol.com
Pagel
K J
KJ
Wheatley
M J
MJ
Dryden
J D
JD
D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D010292:Paresthesia / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014728:Veterans