An evaluation of provocative testing in the diagnosis of carpal tunnel syndrome

Carpal tunnel syndrome is a commonly known neurological entrapment disorder seen by primary care providers and occupational therapists. The purposes of this pilot study were to (1) identify the evaluation methods that primary care providers and occupational therapists use to diagnose carpal tunnel syndrome; (2) describe the procedures for evaluations that practitioners use in common; and (3) compare the frequencies of diagnostic results achieved with nerve conduction velocity testing vs. provocative testing. Three family care practitioners, two physician assistants, and four occupational therapists at four clinical sites participated over 4 months. Fifty-five subjects' hands (77 hands; 22 bilateral) were examined. Patients' ages ranged from 24 to 61 years, with mean of 42.5 years. Chi2 and Fisher's exact tests were used to examine diagnostic results. Practitioners differed slightly in evaluation methods and procedures used. The Tinel's sign results agreed with 57% (motor) and 64% (sensory) of positive nerve conduction velocity results (p > 0.05), whereas Phalen's test agreed with 83% (motor) and 85% (sensory) (p < 0.05). Although these results indicate that Phalen's test is more sensitive, they also accentuate the need for standardized testing based on the proposed use of the test results (screening vs. treatment).