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Open Access Research article

Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome

Georgia Ntani1, Keith T Palmer1, Cathy Linaker1, E Clare Harris1, Richard Van der Star2, Cyrus Cooper1 and David Coggon1*

Author Affiliations

1 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK

2 Department of Clinical Neurophysiology, Wessex Neurological Centre, Southampton General Hospital, Southampton, UK

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BMC Musculoskeletal Disorders 2013, 14:242  doi:10.1186/1471-2474-14-242

Published: 15 August 2013

Abstract

Background

To inform the clinical management of patients with suspected carpal tunnel syndrome (CTS) and case definition for CTS in epidemiological research, we explored the relation of symptoms and signs to sensory nerve conduction (SNC) measurements.

Methods

Patients aged 20–64 years who were referred to a neurophysiology service for investigation of suspected CTS, completed a symptom questionnaire (including hand diagrams) and physical examination (including Tinel’s and Phalen’s tests). Differences in SNC velocity between the little and index finger were compared according to the anatomical distribution of symptoms in the hand and findings on physical examination.

Results

Analysis was based on 1806 hands in 908 patients (response rate 73%). In hands with numbness or tingling but negative on both Tinel’s and Phalen’s tests, the mean difference in SNC velocities was no higher than in hands with no numbness or tingling. The largest differences in SNC velocities occurred in hands with extensive numbness or tingling in the median nerve sensory distribution and both Tinel’s and Phalen’s tests positive (mean 13.8, 95% confidence interval (CI) 12.6-15.0 m/s). Hand pain and thumb weakness were unrelated to SNC velocity.

Conclusions

Our findings suggest that in the absence of other objective evidence of median nerve dysfunction, there is little value in referring patients of working age with suspected CTS for nerve conduction studies if they are negative on both Tinel’s and Phalen’s tests. Alternative case definitions for CTS in epidemiological research are proposed according to the extent of diagnostic information available and the relative importance of sensitivity and specificity.

Keywords:
Epidemiology; Evidence-based medicine; Hand; Nerve compression syndromes; Wrist