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The Carpal Tunnel Syndrome: Diagnostic Utility of the History and Physical Examination Findings

Jeffrey N. Katz, MD; Martin G. Larson, ScD; Amin Sabra, MD; Christian Krarup, MD; Craig R. Stirrat, MD; Rajesh Sethi, MD; Holley M. Eaton, RN; Anne H. Fossel; and Matthew H. Liang, MD, MPH
[+] Article and Author Information

Grant Support: By NIH Grants AR36308 and AR07530 and the Kellogg Program for Training in Research in Clinical Effectiveness.

Requests for Reprints: Jeffrey N. Katz, MD, Arthritis Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Current Author Addresses: Dr. Katz: Arthritis Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Liang: Department of Rheumatology-Immunology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.Dr. Larson, Ms. Eaton, and Ms. Fossel: Robert B. Brigham Multi-purpose Arthritis Center, 221 Longwood Avenue, Boston, MA 02115.Dr. Stirrat: Longwood Hand Center, 830 Boylston Street, Chestnut Hill, MA 02167.

Dr. Sethi: 317 Patrick Street Southwest, Vienna, VA 22180.Dr. Sabra: Department of Medicine, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120.

Dr. Krarup: Department of Neurophysiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.


© 1990 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1990;112(5):321-327. doi:10.7326/0003-4819-112-5-321
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Study Objective: To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome.

Design: Comparison of diagnostic tests with neurophysiologic testing.

Setting: Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies.

Methods: Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses.

Results: Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55; CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome.

Conclusions: With the exceptions of age, Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies.

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