Simple clinical tests in severe carpal tunnel syndrome

Patients with severe carpal tunnel syndrome may be characterised by an atypical clinical picture. They assess complaints as becoming less bothersome than in the past. It seems that this may influence the diagnostic value of some clinical tests used in physical examinations. The aim of the study was the selection of the most reliable clinical tests in a group of patients with severe carpal tunnel syndrome.

The material comprised 38 cases of severe form of the disease in a group of 37 prospective patients. The methods consisted in the evaluation of the rate of positive results of selected clinical tests, and in the comparison of their statistical correlation with selected parameters of median nerve conduction.

The study results indicated that high incidence of two-point discrimination disorders showed a correlation with the sensory conduction parameters, including the median-ulnar sensory latency difference. The Durkan's and Phalen's tests were positive in almost all patients with advanced carpal tunnel. The Katz hand diagram revealed significantly enhanced sensitivity in the "probable" pattern.

We speculate that the two-point discrimination, evaluated with the use of a simple paper clip, enables the selection of a group of patients with severe form of the syndrome for further differentiation. The tool used for facilitating the differential diagnosis is the Katz hand diagram. The Durkan's and Phalen's tests have an equally high value. However, they show no correlation with the conduction parameters, as measured by EMG.