TY - JOUR
T1 - Physical examination has a low yield in screening for carpal tunnel syndrome
AU - Dale, Ann Marie
AU - Descatha, Alexis
AU - Coomes, Justin
AU - Franzblau, Alfred
AU - Evanoff, Bradley
PY - 2011/1
Y1 - 2011/1
N2 - 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 edian 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.
AB - 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 edian 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.
KW - Carpal tunnel syndrome
KW - Clinical epidemiology
KW - Physical examination
KW - Post-offer pre-placement examinations
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=78650056176&partnerID=8YFLogxK
U2 - 10.1002/ajim.20915
DO - 10.1002/ajim.20915
M3 - Article
C2 - 21154516
AN - SCOPUS:78650056176
SN - 0271-3586
VL - 54
SP - 1
EP - 9
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 1
ER -