Abstract
A variety of screening procedures for carpal tunnel syndrome (CTS) were applied among workers in a manufacturing plant, and results were compared. The test procedures included a symptom survey, physical examination, limited electrodiagnostic testing at the wrists, quantitative vibratory threshold testing, 2-point discrimination, palmar pinch grip, and hand grip strength testing. When electrodiagnostic testing alone was used as “gold standard,” the sensitivity and positive predictive value (PPV) of physical examination findings and quantitative test procedures were no better than, and usually worse than, the results on the symptom survey alone. Variation of the constellation of symptoms (i.e., numbness, tingling, pain or burning) and the anatomic distribution of reported symptoms (i.e., fingers, hand, wrist, or forearm) for inclusion in the screening symptom definition of CTS yielded modest changes in the sensitivity and PPV of the symptom survey. However, addition of the requirement for nocturnal symptoms as part of the screening symptom definition for CTS resulted in substantially higher PPV with only slight reduction in sensitivity. These results suggest that, in the absence of electrodiagnostic testing, the simplest test, and the procedure with the highest sensitivity and PPV for CTS is a symptom survey alone. Quantitative test procedures (vibrometry, pinch grip strength, hand grip strength) and physical examination for findings consistent with CTS (e.g., Phalen's test, Tinel's test, thenar muscle wasting, 2-point discrimination) appear to contribute little, if any, additional information when screening subjects in the work setting.
Similar content being viewed by others
References
Baker EL, Honchar PA, Fine LJ. Surveillance in occupational illness and injury: Concepts and content.Am J Pub Health 1989; 79 (suppl): 9–11.
Landrigan PJ. Improving the surveillance of occupational disease.Am J Pub Health 1989; 79: 1601–1602.
Stock SR. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: A meta-analysis.Am J Ind Med. 1991; 19: 87–107.
Stock SR. Epidemiology of work-related musculoskeletal disorders of the neck and upper limbs: A response (letter to the editor).Am J Ind Med. 1992; 21: 899–901.
Cummings K, Maizlish N, Rudolph L, Dervin K, Ervin A. Occupational disease surveillance: Carpal tunnel syndrome.MMWR 1989; 38 (28): 485–489.
Katz JN, Larson MG, Fossel AH, Liang MH. Validation of a surveillance case defintion of carpal tunnel syndrome.Am J Pub Hlth 1991; 81: 189–193.
Silverstein BA, Fine LJ.Evaluation of upper extremity and low back cumulative trauma disorders: A screening manual. Ann Arbor, MI: The University of Michigan School of Public Health, 1984.
Gerr FE, Hershman D, Letz R. Vibrotactile threshold measurement for detecting neurotoxicity: Reliability and determination of age- and height-standardized normative values.Arch Environ Health 1990; 45 (3): 148–154.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and Pinch Strength: Normative data for adults.Arch Phys Med Rehab 1985; 66: 69–74.
Kimura J. Principles and pitfalls of nerve conduction studies.Ann Neurol 1984; 16: 415–429.
Barnhart S, Demers PA, Miller M, Longstreth WT, Rosenstock L. Carpal tunnel syndrome among ski manufacturing workers.Scand J Work Environ Hlth 1991; 17: 46–52.
Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R, Eaton HM, Fossel AH, Liang MH. The carpal tunnel syndrome: Diagnostic utility of the history and physical examination findings.Ann Int Med. 1990; 112: 321–327.
Katz JN, Stirrat CS. A self-administered hand diagram for diagnosis of carpal tunnel syndrome.J Hand Surg [Am]. 1990; 15: 360–363.
De Krom MCTFM, Knipschild PG, Kester ADM, Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome.Lancet 1990; 335: 393–395.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Franzblau, A., Werner, R., Valle, J. et al. Workplace surveillance for carpal tunnel syndrome: A comparison of methods. J Occup Rehab 3, 1–14 (1993). https://doi.org/10.1007/BF01076738
Issue Date:
DOI: https://doi.org/10.1007/BF01076738