title: Physical examination has a low yield in screening for carpal tunnel syndrome.
abstract: BACKGROUND
  physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly hired workers, we evaluated the yield of such screening.
  
  
  METHODS
  our study population included 1,108 newly hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy.
  
  
  RESULTS
  of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing.
  
  
  CONCLUSIONS
  physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.
authors.affiliation: Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA. adale@dom.wustl.edu
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Dale
authors.forename: Alexis
authors.initials: A
authors.lastname: Descatha
authors.forename: Justin
authors.initials: J
authors.lastname: Coomes
authors.forename: Alfred
authors.initials: A
authors.lastname: Franzblau
authors.forename: Bradley
authors.initials: B
authors.lastname: Evanoff
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009460:Neurologic Examination / Q000379:methods*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology