Carpal tunnel syndrome: evaluation of its provocative clinical tests

Abstract

The diagnosis of carpal tunnel syndrome (CTS) is established mainly on a clinical basis, and diagnosis is done after careful history taking and examination including known provocative tests with varying efficacy and reliability. A prospective clinical study of 123 patients with 171 hands presenting with classical symptoms of carpal tunnel syndrome were included in this study, from October 2013 to October 2015, and they underwent open surgical release of flexor retinaculum at the Neurosurgery Department of Benha University Hospital. ART is positive in 88.3%. This is compared to 75, 81.3, 79.7, and 83.6% of positive results in Tinel’s test, compression test, Phalen’s test, and combined Phalen’s and compression test. ART is the most sensitive and specific test and has the highest positive predictive value of 98.3%, negative predictive value of 81.9%, and accuracy of 91.4%. ART is a simple, reliable, and easily performed test for evaluating carpal tunnel syndrome; it is superior to other tests and could be used also to assess improvement after surgery.