Objective: To determine the individual and combined specificities and sensitivities of Tinel’s and Phalen’s tests and a Hand Symptom Diagram relative to the widely accepted Criterion Standard Nerve Conduction Studies (NCS) testing for Carpal Tunnel Syndrome (CTS). Design: Correlation study with blind comparison of three clinical examination findings to a Criterion Standard. Setting: Single center, out-patient orthopedic electrodiagnostic laboratory in eastern North Carolina, with patients referred from primary care physicians, orthopedic and specialty physicians. Participants: One hundred three patients, referred for electrodiagnostic examination for any of the following referral diagnoses; CTS, hand numbness or weakness, or arm pain, numbness or weakness. Interventions: Not applicable. Main Outcome Measures: Sensitivity, specificity. Results: Sensitivities and specificities were calculated for the following seven combinations of clinicla tests vs. NCS: Hand Diagram/Tinel’s/Phalen’s, Hand Diagram/Tinel’s Hand Diagram/Phalen’s, Tinel’s/Phalen’s, Hand Diagram alone, Tinel’s alone, and Phalen’s alone. The range of sensitivities and specificities was from .26 to .62, and from .42 to .88 respecitvely. When compared with NCS, the most sensitive tests were the Hand Diagram and the Phalen’s test alone. The combination of the Hand Diagram/Phalen’s/Tinel’s and the combination of the Hand Diagram with Tinel’s test were found to have the highest agreement. No individual clinical test or combination of clinical tests provided specificity and sensitivity equivalent to NCS confirmed CTS. Conclusions: No single clinical examination or combination of clinical examinations is found to be both as specific and as sensitive as electrodiagnostically confirmed CTS. The combination of Tinel’s, Phalen’s and a Hand Diagram was found to be highly specific, but not as sensitive in diagnosing CTS. Both sensitivity and specificity results diminish as individual’s age and provide minimal value for patients over 69 years old. Therefore, electrodiagnostic testing is the recommended procedure for the diagnosis and management of suspected CTS.
