It is an easy test to perform, no equipment needed or examiner work. In the arm raising test, it is done only by giving an instruction to the patient. Patients usually experienced pain in hand elevation position such as holding mobile to the ear, combing their hair, writing on a board, and painting of ceilings.
#Carpal tunnel syndrome test manual#
However, compression test had some personal variety as some of our patients had delicate hands easily compressed and others had tough hands especially manual workers. In this study, Phalen’s test was done as usual with flexion of the wrist to 90° in an unforced manner, but we performed Tinel’s test using gentle percussion using a rubber hammer to uniform the shape and force of the percussion tip. Īnd others suggested combining results of both Tinel’s and Phalen’s tests to obtain up to 90% sensitivity. Tinel’s test was described as a non-useful test in comparison to Phalen’s in diagnosing CTS. This difference in results may be due to the fact that these tests depend on the way they are performed, and this varied between examiners. Sensitivity and specificity of Tinel’s and Phalen’s tests were variable in different studies (Tinel’s test had a sensitivity of 48–77% and a specificity of 47–84%, and Phalen’s test had a sensitivity of 28–61% and a specificity of 80–94%). However, electrodiagnostic studies can confirm the clinical impression of CTS, which is reassuring for both the patient and physician.
Meticulous history and physical examination are usually sufficient to have a sure clinical diagnosis of CTS and make initial treatment decisions. Electrodiagnostic studies are routinely used in our department before a decision for surgery is employed. Provocative tests were performed in a sequence with a 1-min interval between each test, then tests were done with an examiner using only a single hand as in Table 1.Ĭarpal tunnel syndrome is usually diagnosed in a clinical basis after taking history that suggests the condition, common provocative easy tests as Phalen’s and Tinel’s tests are usually used to ascertain the diagnosis. History was standardized by using K-S questionnaire for both groups in which a score of 50 or more was considered clinically diagnostic of CTS. The control group consists of 35 patients with 70 hands, and NCS were not conducted in this group, but same exclusion criteria were applied. Patients who had symptoms and signs of a proven diagnosis of cervical radiculopathy and other upper limb entrapment neuropathy were excluded, also patients with diabetes, thyroid disease, peripheral neuropathy, and peripheral vascular disease were excluded hence, 18 patients were excluded leaving 105 patients with 128 hands of them, 23 patients had bilateral disease. One hundred twenty-three patients with 171 hands presented with classical symptoms of carpal tunnel syndrome, with pain and numbness that worsened with exertion and at night in the distribution of medial nerve, and with positive nerve conduction studies (NCS) and electromyography results suggesting median nerve entrapment. We aim to compare this test to commonly used provocative tests, and to confirm its reliability in diagnosing CTS and evaluating improvement after carpal tunnel release surgery. This is a prospective clinical study of 123 patients with 171 hands presenting with classical symptoms of carpal tunnel syndrome who were included in this study, from October 2013 to October 2015, and they underwent open surgical release of flexor retinaculum at the Neurosurgery Department of Benha University Hospital. ConclusionĪRT is a simple, reliable, and easily performed test for evaluating carpal tunnel syndrome it is superior to other tests and could be used also to assess improvement after surgery. ART is the most sensitive and specific test and has the highest positive predictive value of 98.3%, negative predictive value of 81.9%, and accuracy of 91.4%. This is compared to 75, 81.3, 79.7, and 83.6% of positive results in Tinel’s test, compression test, Phalen’s test, and combined Phalen’s and compression test. MethodsĪ prospective clinical study of 123 patients with 171 hands presenting with classical symptoms of carpal tunnel syndrome were included in this study, from October 2013 to October 2015, and they underwent open surgical release of flexor retinaculum at the Neurosurgery Department of Benha University Hospital.
The diagnosis of carpal tunnel syndrome (CTS) is established mainly on a clinical basis, and diagnosis is done after careful history taking and examination including known provocative tests with varying efficacy and reliability.
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