Provocative Sensory Testing in Carpal Tunnel Syndrome

Abstract

This study reports the relationship between three clinical tests in the diagnosis of carpal tunnel syndrome and the stages of nerve compression. Assessments of 158 patients with carpal tunnel syndrome were reviewed retrospectively. 77% of patients had at least one of the clinical signs present. The incidence of positive pressure-provocative and Phalen's tests were similar and more likely to occur in combination than separately. Tinel's sign was more likely to be positive in the later stages of nerve compression. Our results suggest that the presence or absence of a provocative test is dependent upon the severity of the nerve compression.

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

“…With prolonged compression, Wallerian degeneration produces changes in 2-point discrimination and muscle atrophy. While many clinical studies 11,97,101 confirm the association between clinical presentation and pathophysiology, this interpretation is not uniform. 90 The implication of this clinical spectrum is that certain tests are more relevant in certain grades of compressive injury.…”

“…82 One of the most consistently studied and supported tests is Phalen's wrist flexion test. 19,35,38,47,92,97,148 As originally described by Phalen, 110,111 the wrists were dropped by gravity assistance into flexion and CTS was indicated by symptoms that were reproduced. A number of variations on this test can be seen in the clinic (Table 2), and an overall estimate of sensitivity (68%) and specificity (73%) was obtained across 4855 studied patients in our systematic review.…”

“…2,19,28,39,47,91,123 It has been demonstrated that Tinel's test is more commonly positive with moderate to severe CTS, which is consistent with its mechanism. 2,97,127 It has also been suggested that use of a Queen's square reflex hammer and wrist extension increases the sensitivity of the test; but the effect of this practice on specificity was not studied. 91 A single study has reported using therapeutic ultrasound along the course of the nerve to elicit symptoms.…”

Upper Extremity Work-Related Musculoskeletal Disorders: A Treatment Perspective

“…8,10,17,19,31,41,43,48,50,54,55,57,67,73,76,77 At different stages of nerve compression, different clinical tests are most useful in detecting and quantifying the severity of nerve compression. In the early stages of FIGURE 2.…”

“…53,54 Since that time, many provocative tests have been described in the evaluation of carpal tunnel syndrome. 8,10,15,17,19,25,43,48,50,68,76,77 (Refer to MacDermid's paper in this issue for a complete discussion.) This concept of increasing tension or pressure on the nerve to identify sites of nerve compression can be extrapolated to the other sites of entrapment in the upper extremity (Table).…”