Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies.
OBJECTIVE
We evaluated the utility of physical examination manoeuvres 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 manoeuvres 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 <50% for all strategies tested.


CONCLUSIONS
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.
Occupational Health Department, Poincaré Teaching Hospital AP-HP, University of Versailles-Saint Quentin, INSERM, U687, Garches, France. alexis.descatha@rpc.aphp.fr
A
A
Descatha
A-M
AM
Dale
A
A
Franzblau
J
J
Coomes
B
B
Evanoff
D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D009431:Neural Conduction; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D055815:Young Adult