Related Experiment Video
Updated: Sep 27, 2025
Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
Accuracy of Provocative Tests for Carpal Tunnel Syndrome
Dafang Zhang1,2, Cassandra M Chruscielski1, Philip Blazar1,2
1Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.
Purpose:
Prior literature on the diagnostic accuracy of commonly used provocative tests for suspected carpal tunnel syndrome (CTS) is affected by research biases. The objectives of our study were to measure and compare the diagnostic accuracy of 4 commonly used provocative tests for CTS using electrodiagnostic study as the reference standard.
Methods:
We prospectively evaluated 85 hands in 55 patients with suspected CTS. Tinel sign, Phalen's test, Durkan's test, and Phdurkan test (a combination of wrist flexion and carpal compression) and subsequent electrodiagnostic testing were performed on all patients. Sensitivity and specificity were calculated using electrodiagnostic findings as the reference standard. McNemar test was used to compare differences in paired outcomes between provocative tests.
Results:
Tinel sign had a sensitivity of 0.47 and specificity of 0.56. Phalen's test had a sensitivity of 0.50 and specificity of 0.33. Durkan's test had a sensitivity of 0.71 and specificity of 0.22. Phdurkan test had a sensitivity of 0.84 and specificity of 0.11. Median time to a positive Phdurkan test result was 3 seconds. McNemar tests showed significant differences (P < .05) in the proportions of positive results among all CTS provocative tests except between Tinel sign and Phalen's test.
Conclusions:
Commonly performed provocative tests for suspected CTS differ in sensitivity and specificity. As the examination maneuver becomes more provocative, the test becomes more sensitive and less specific for CTS.
Type Of Study/Level Of Evidence:
Diagnostic III.
