title: Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome.
abstract: OBJECTIVE
  To determine the utility of the flick maneuver (flicking motion of hands and wrists when most symptomatic) in the clinical evaluation of carpal tunnel syndrome (CTS).
  
  
  METHODS
  Review of standardized data collection on 142 subjects referred for electrodiagnostic evaluation of possible CTS at a university hospital electrodiagnostic clinic. Subjects were first clinically evaluated with the flick, Phalen, and Tinel maneuvers. Subsequently, they all underwent nerve conduction studies. Electrodiagnostic results were used as the gold standard for patient group assignments. Sensitivities, specificities, and predictive values for individual and combined clinical tests were determined. McNemar chi square values were calculated to determine whether one test identified more patients with CTS. The sensitivities of clinical maneuvers were also evaluated in relation to electrodiagnostic severity of CTS.
  
  
  RESULTS
  Of the 142 subjects, 67% had CTS. The sensitivities of the flick, Tinel, and Phalen signs were 37%, 27%, and 34%, respectively. False-positive results ranged from 8% (Tinel) to 26% (flick and Phalen). Positive predictive values for the flick, Tinel, and Phalen maneuvers were 74%, 87%, and 73%, respectively, and negative predictive values were 37%, 39%, and 35%. McNemar chi square results revealed that the flick maneuver detected more subjects with CTS than the Tinel sign. With increasing electrodiagnostic severity, the sensitivity of all clinical tests tended to improve slightly.
  
  
  CONCLUSIONS
  The flick sign is of limited clinical utility in diagnosing CTS, with low sensitivity and specificity.
authors.affiliation: Department of Rehabilitation Medicine, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Hansen
authors.forename: Paula
authors.initials: P
authors.lastname: Micklesen
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis*; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity