Effective Diagnostic Screening Tests for Carpal Tunnel Syndrome

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Investigators found that many people with carpal tunnel syndrome wake up at night with tingling and numbness in their fingers.

In patients with carpal tunnel syndrome (CTS), the best sensitivity for a case definition of the disorder is a history of nocturnal awakenings with paresthesia in median nerve-served digits, and the specificity of continuous tingling/numbness is high, at 97.5%, according to the results of a cross-sectional analysis from a prospective cohort study. Findings from the analysis were published in the Journal of the American Academy of Orthopaedic Surgeons.

The investigators evaluated a cross-section of working adults, using standardized assessment of signs and symptoms of CTS, combined with nerve conduction velocity testing, to explore the relationship between symptoms and electrocardiographic abnormalities. The following 2 hypotheses were proposed: What is the prevalence of paresthesias and CTS in a large, multistate population? How do signs and symptoms used to diagnose CTS differ among those in 4 groups of patients (ie, patients with and without symptoms and patients with and without nerve conduction study abnormalities)?

Baseline analyses from a large, prospective cohort study conducted in Utah and Wisconsin were reported to evaluate the relative value of symptoms, the Phalen sign, the Hoffman-Tinel sign, and electrophysiologic studies in the assessment of CTS. The prevalence of symptoms, findings from physical examinations, and electrophysiologic abnormalities was also reported.

A total of 1194 patients participated in the analysis. Mean patient age was 42.2±11.4 years, and mean body mass index was 29.5±7.0 kg/m2. Specificity, sensitivity, and positive and negative predictive values (NPVs) were calculated. The prevalence of CTS was 8.9% according to a definition of tingling/numbness in ≥2 median nerve-served digits. The following findings were reported with respect to sensitivity: paresthesias with nocturnal awakening: 77.4%; the Phalen sign: 52.8%; and the Hoffman-Tinel sign: 37.7%.

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In this study, the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign had an NPV of 95%, which suggests that as a diagnostic tool, the use of NPVs is of particular diagnostic value. The Hoffman-Tinel sign had an NPV of 93.7%. The prevalence of right-hand median nerve conduction abnormalities was reported in 189 (15.8%) of 1194 participants.

Researchers noted that using positive results from either the Phalen or the Hoffman-Tinel sign over the median nerve at the wrist to verify the presence of CTS has the significant potential to be unreliable. Oftentimes, clinicians should ignore patient-reported positive findings because of their potential to be misleading.


Hegmann KT, Merryweather A, Thiese MS, et al. Median nerve symptoms, signs, and electrodiagnostic abnormalities among working adults. J Am Acad Orthop Surg. 2018;26:576-584.