Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies. Issue 2 (22nd October 2009)

• Record Type: Journal Article
• Authors: Descatha, A; Dale, A-M; Franzblau, A; Coomes, J; Evanoff, B
• Is Part Of: Occupational and environmental medicine. Volume 67:Issue 2(2010)
• Page Start: 133
• Page End: 135
• Publication Date: 2009-10-22
• Subjects: Carpal tunnel syndrome -- epidemiology -- case definition -- musculoskeletal -- likelihood ratio -- health screening -- health surveillance; Medicine, Industrial -- Periodicals; Environmental health -- Periodicals; 616.980305
• DOI: 10.1136/oem.2009.047431
• Languages: English
• ISSNs: 1351-0711

Abstract

Abstract : 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. Conclusion: 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.