Sensitivity and Specificity of Examination Maneuvers for Carpal Tunnel Syndrome: A Meta-Analysis

Abstract

Our purpose was to assess the diagnostic validity (sensitivity (Sn) and specificity (Sp)) of physical examination maneuvers for carpal tunnel syndrome (CTS). This meta-analysis utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Studies assessing exam maneuvers (including components of the CTS-6) for CTS were identified in MEDLINE (Medical Literature Analysis and Retrieval System Online) and Embase (Excerpta Medica Database) databases. Assessed maneuvers assessed included: Phalen's test, Tinel's sign, Durkan test, scratch-collapse test, Semmes-Weinstein monofilament (SWM), and static 2-point discrimination (2PD) test. Data extracted included: article name, total number of subjects/hands, type of exam, and exam Sn/Sp. Forest plots were presented to display the estimated Sn/Sp and boxplots were used to demonstrate the locality, spread, and skewness of the Sn/Sp through the quartiles. After screening 570 articles, 67 articles involving 8924 hands were included. Forty-eight articles assessed Phalen's test, 45 assessed Tinel's sign, 21 assessed the Durkan test, seven assessed the scratch-collapse test, 11 assessed SWM, and six assessed the static 2PD test. Phalen's test demonstrated the greatest median Sn (0.70, (Q1, Q3): (0.51, 0.85)), followed by the Durkan test (0.67, (Q1, Q3): (0.46, 0.82)). 2PD demonstrated the highest median Sp (0.90, (Q1, Q3): (0.88, 0.90)), followed by SWM (0.85, (Q1, Q3): (0.51, 0.89)). There is considerable variability with respect to the validity of physical exam tests used in the diagnosis of CTS. Upper-extremity surgeons should be aware of inherent limitations for individual exam maneuvers. In the absence of a uniformly accepted diagnostic gold standard, a combination of exams, along with pertinent patient history, should guide the diagnosis of CTS.

Mapping Neurophysiological Patterns in Carpal Tunnel Syndrome: Correlations With Tinel’s and Phalen’s Signs

“…Zhang et al [26] reported a sensitivity and specificity of 47% and 56% for Tinel's test and 50% and 33% for Phalen's test, respectively. A meta-analysis by Ozdag et al [27] revealed median sensitivity and specificity for Tinel's sign as 59% and 80% and for Phalen's sign as 70% and 80%, respectively. These findings highlight considerable variability in sensitivity and specificity among tests for CTS in various studies and prior literature.…”

Updates to the Physiologic Mechanism, Anatomical Sites, and Diagnostic Utility of the Scratch Collapse Test: A Systematic Review

“…The SCT is still novel in its use for diagnosing compression neuropathy; however, the SCT faces criticism, given its history of variable reliability and accuracy in published reports. 5,[34][35][36] This review seeks to evaluate the diagnostic utility and applicability of the SCT by assessing the current literature and providing an updated report regarding its clinical utility, physiologic mechanism, and anatomic locations for use.…”