Evaluation of different physical examination methods for the diagnosis of carpal tunnel syndrome

Abstract

In the present study, to evaluate the diagnostic value of different physical examination methods for diagnosing carpal tunnel syndrome (CTS), the scratch collapse test (SCT) and hand elevation test were compared with other traditional tests, such as Tinel's, Phalen's and reverse Phalen's tests, in an aim to improve the current diagnostic standards for CTS. The present study examined 236 (465 hands) patients with CTS and 96 (170 hands) controls who were enrolled in the study from December, 2019 to January, 2021. The participants in both groups were of the same age range, with equal male-to-female ratios. An examiner who was familiar with all maneuvers performed the Tinel's, Phalen's and reverse Phalen's tests, as well as the SCT and the hand elevation test in the two groups. The examiner was blinded to the patient histories and diagnoses. The sensitivities and specificities of all the tests were as follows: Tinel's test, 0.4194 and 0.7706; Phalen's test, 0.5613 and 0.7353; reverse Phalen's test, 0.5527 and 0.7882; SCT, 0.6774 and 0.7176; and hand elevation test, 0.7548 and 0.6059, respectively. The sensitivities of the SCT and hand elevation test were significantly higher than those of the other three tests. The areas under the receiver operating characteristic curve of the SCT and hand elevation test were 0.6975 and 0.6804, respectively, both of which were higher than those of Tinel's (0.5950), Phalen's (0.6483) and reverse Phalen's (0.6705) tests. On the whole, the present study demonstrates that the SCT is objective, reliable and has a high sensitivity. Furthermore, the hand elevation test is easy to perform, reproducible and has a high sensitivity. These newer tests are valuable for the diagnosis of CTS and can improve the current diagnostic standard system.