Two Simple Tests May Screen For Carpal Tunnel Syndrome

March 26, 1998

COLUMBUS, Ohio -- Based on a new study, researchers are suggesting physicians use two simple tests to screen patients for carpal tunnel syndrome (CTS).

According to the study, published in a recent issue of the American Journal of Physical Medicine and Rehabilitation, the best preliminary tests physicians can use to determine the presence of CTS are the square-shaped wrist and abductor pollicis brevis (or thenar) weakness tests.

Results showed that the thenar weakness test detected the presence of CTS in 66 percent of 142 hands with CTS. The square-shaped wrist was correct in 69 percent of the cases, said Kurt Kuhlman, clinical assistant professor of medicine at Ohio State University. Kuhlman co-authored the study with William Hennessey of the Latrobe Area Hospital in Pennsylvania.

“A reason for doing these tests is that they can be done quickly,” Kuhlman said. “These tests are meant to help key a physician in to determining if a patient really has CTS.”

Researchers compared the accuracy of these tests with the tried-and-true method of detecting CTS, the nerve conduction study. The NCS is accurate in about 90 percent of CTS cases. The NCS test uses electrical signals to gauge how fast nerve impulses move through the median nerve of the hand.

The thenar test assesses any weakness of the thenar muscles, which are located in the palm of the hand. Patients place their thumb and small finger together while the physician pushes on the thumb. If the patient shows weakness, the sign is considered positive for CTS.

In the square-shaped wrist test, a physician uses a caliper to determine if a wrist is more square or rectangular. Having a square-shaped wrist is a major predisposing factor for CTS, Kuhlman said.

The researchers also examined four other possible tests for CTS, but these tests proved accurate in only 51 percent or fewer patients. The purpose of this study was to determine if the simple tests could take the place of the pricey NCS, Kuhlman said. According to Kuhlman, the cost of a routine physical that can include these basic tests is significantly cheaper than the few hundred dollars that an NCS usually costs.

While Kuhlman said these basic tests cannot take the place of the NCS, the square-shaped wrist and thenar tests can give the physician an idea if CTS is present and are recommended as part of the examination for CTS.

Carpal tunnel syndrome is often caused by repetitive motion, such as typing. Symptoms include pain, numbness or tingling in the wrist or hand; a pain that can be “shaken out;” and having a difficult time holding on to objects.

Yet scoring positive on these tests may also be signs of another tendon-related malady. “You could have tendinitis,” Kuhlman said. "You can have tendinitis and have almost all of the CTS signs and symptoms. A physician has to learn a patient’s history and perform a physical on the patient to help determine the likelihood that he or she has CTS. If a person had all of the signs and symptoms, the chance of them having CTS would be pretty significant.”

Written by Holly Wagner, (614)292-8310;

Ohio State University

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