Carpal Tunnel Syndrome: Likelihood Ratios

Introduction: Actual median nerve neuropathy. See also Forearm Flexor Tenosynovitis - most physical exam findings for Carpal Tunnel Syndrome actually pick up Tenosynovitis in the carpal tunnel (i.e. from flexor tendonitis) far better than they do 'Carpal Tunnel' (i.e. median neuropathy). Tendonitis should be managed medically, while neuropathy would be treated by surgical decompression.

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The likelihood ratios of findings for Carpal Tunnel Syndrome are listed below. See the left navigation bar to change the display.

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Tinel's Sign	0.9	1.1	percussion of the median nerve at the wrist Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945
Reverse Phalen's Test	0.6	1.7	complete dorsal wrist flexion for 60 s Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945
Carpal Tunnel Compression	0.6	2.2	even pressure exerted by the examiner on the space between thenar and hypothenar eminence for 30 s while arm is supinated. The patient was questioned with regard to symptoms at 15-s intervals during the 30-s period Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945
Durkan's Test	0.9	1.3	Study: Dafang Zhang, Cassandra M. Chruscielski, Philip Blazar, Brandon E. Earp, Accuracy of Provocative Tests for Carpal Tunnel Syndrome, Journal of Hand Surgery Global Online, Volume 2, Issue 3, 2020, Pages 121-125, ISSN 2589-5141, https://doi.org/10.1016/j.jhsg.2020.03.002. (https://www.sciencedirect.com/science/article/pii/S2589514120300189)
Phalen's Test	0.6	3.1	complete palmer wrist flexion for 60 s Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945