So How Does One Really Test For Carpal Tunnel?

One speaker I heard made very big about how eliciting a Tinel’s sign at the wrist was worthless for diagnosing carpal tunnel – so how does one do that? Given that sensitivities of Nerve Conduction sutdies can be from 49% – 84%, they aren’t necessarily great either…

Does This Patient Have Carpal Tunnel Syndrome? [The Rational Clinical Examination]
JAMA 283(23)21 June 2000; 3110-3117
D’Arcy, Christopher A. MD; McGee, Steven MD free full article here

Carpal tunnel is initially a tendonitis where the tendons become inflamed and swell. Nerve compression of varying degree follows but the degree of nerve compression does not necessarily reflect degree of pain.

Three tests were found most valuable:

  • symptom diagrams –

Well duhhh – if pain is in ulnar nerve distribution, then it is not carpal tunnel…

  • Hypalgesia – sensation less in index finger versus little finger
  • weak thumb abduction strength testing

Lots of others that need more study mentioned in article..

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