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Chiropractic Research Review

Reliable Diagnosis of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is an important cause of pain and functional impairment in the hand. This pain usually results from compression of the median nerve at the wrist.

This article reviews the evaluation of carpal tunnel syndrome, using the MEDLINE database (January 1966 - February 2000) to gather literature on the diagnosis of CTS in adults.

Twelve articles met the above criteria, forming the basis for the authors' evaluation of CTS. The authors discuss the following:

* important information gleaned from the patient history;

* symptoms and signs of CTS;

* orthopedic tests; and

* physical examination procedures and findings of CTS.

Additionally, the authors review the literature for the diagnostic accuracy of a number of CTS evaluative procedures, and suggest that Phalen and Tinel signs have limited utility in predicting an accurate CTS diagnosis. Several other traditional findings showed limited or no value in evaluating CTS patients, including patient age; presence of bilateral or nocturnal symptoms; thenar atrophy; other sensory abnormalities; provocation test; and tourniquet test.

Conclusion: When evaluating patients with hand dysesthesias, the authors recommend that doctors use hand symptom diagrams (which are available in the article). They also note that hypalgesia and weak thumb abduction strength testing are important findings in predicting the electrodiagnosis of CTS.

D'Arcy CA, McGee S. Does this patient have carpal tunnel syndrome? Journal of the American Medical Association, June 21, 2000:283(23), pp3110-3117.

Chiropractic Research Review

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