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

Ann Marie Dale, Alexis Descatha, Justin Coomes, Alfred Franzblau, Bradley Evanoff

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalAmerican Journal of Industrial Medicine
Volume54
Issue number1
DOIs
StatePublished - Jan 2011

Keywords

  • Carpal tunnel syndrome
  • Clinical epidemiology
  • Physical examination
  • Post-offer pre-placement examinations
  • Screening

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