Physical examination has a low yield in screening for carpal tunnel syndrome

✍ Scribed by Ann Marie Dale; Alexis Descatha; Justin Coomes; Alfred Franzblau; Bradley Evanoff

• Book ID: 101439738
• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 197 KB
• Volume: 54
• Category: Article
• ISSN: 0271-3586
• DOI: 10.1002/ajim.20915

✦ Synopsis

Background Physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly hired workers, we evaluated the yield of such screening. Methods Our study population included 1,108 newly hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy.

Results Of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing. Conclusion Physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.