Carpal tunnel syndrome: reappraisal of five clinical tests

A combination of 5 clinical tests: Tinel (9, 10), Phalen (wrist flexion) (1, 2, 17), reverse Phalen (wrist extension) (4), carpal compression (11, 18), vibration (13, 14) was used in 74 hands with symptoms of carpal tunnel syndrome and proved by median sensory conduction velocity and distal latency across wrist and compared with 58 normal hands. Tinel test was the most specific and the least sensitive, vibration test was the most sensitive and the least specific. Carpal compression test was less sensitive and specific compared to Durkan's study. There was no correlation between Phalen time, reverse Phalen time, carpal compression time, and nerve conduction measurements. Cases with positive Tinel and vibration tests has slower sensory nerve conduction velocity (SNCV) compared to cases with negative results. Also patients with positive vibration tests had longer duration of symptoms in comparison to patients with negative test results. Up to now electrodiagnostic studies are the standard in diagnosing carpal tunnel syndrome and determining severity of median nerve involvement at wrist.