A comparison of five tests for determining hand sensibility

Three hundred seventeen normal fingers and 612 fingers in 153 hands with carpal tunnel syndrome were tested for sensibility using the Weinstein Enhanced Sensory Test (WEST) with calibrated monofilaments, by static two-point discrimination (s2PD) and moving two-point discrimination (m2PD), using the Disk-Criminator, and by Strauch's ten test. Equivalent Semmes-Weinstein monofilament (SWM) test values were also determined as a gold standard for comparison. With both the WEST and SWM test values, the norms for interpretation have an unacceptably wide latitude because of the use of an ordinal scale of increasingly unequal intervals. With the WEST and Disk-Criminator tests, some cases of early sensory loss were missed. The SWM test apparatus, although producing relatively reliable values, is not easily portable, and its use is time-consuming in a busy office; the WEST device is prohibitively expensive. The ten test is rapid, simple, and sensitive in evaluation. It measures sensibility on a continuous analog scale, and allows for multiple points of testing in the hand, with good inter- and intra-examiner reliability. It is accurate in detecting very early loss of sensibility. In addition, the ten test requires no instrumentation.