Forearm Flexor Tenosynovitis: Likelihood Ratios

Introduction: As a differential diagnosis for Carpal Tunnel Syndrome. Most physical exam tests actually pick up tenosynovitis much more sensitively/specifically than they do Carpal Tunnel (i.e. actual neuropathy). Thus, the exam will pick up irritation in the carpal tunnel that can be managed medically.

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The likelihood ratios of findings for Forearm Flexor Tenosynovitis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Carpal Tunnel Compression	+ 0 -	31.7	0.1
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
[ + ] Phalen's Test	+ 0 -	7.1	0.1
complete palmer wrist flexion for 60 s Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945
[ + ] Reverse Phalen's Test	+ 0 -	5	0.3
complete dorsal wrist flexion for 60 s Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Tinel's Sign	+ 0 -	3.1	0.6
percussion of the median nerve at the wrist Study: Joint Bone Spine. 2008 Jul;75(4):451-7. PMID: 18455945