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

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.