Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies
- 1Occupational Health Department, Poincaré Teaching Hospital AP-HP, University of Versailles-Saint Quentin (UVSQ), INSERM, U687, Garches, France
- 2Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
- 3Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Correspondence to Dr Alexis Descatha, Unité de pathologie professionnelle, CHU Poincaré, 104 bd R. Poincaré, 92380 Garches, France;
- Accepted 24 September 2009
- Published Online First 22 October 2009
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.
- Carpal tunnel syndrome
- case definition
- likelihood ratio
- health screening
- health surveillance
Funding This study was supported by a research grant from the Centers for Disease Control/National Institute of Occupational Safety and Health (R01 OH008017-01). This publication was also supported by Grant Number UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Other funders: NIH; CDC NIOSH.
Competing interests None.
Ethics approval The Washington University School of Medicine Institutional Review Board approved this study.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.