A systematic review of the clinical diagnostic tests for carpal tunnel syndrome.

The purpose of this report was to critically review studies of the clinical diagnostic tests for carpal tunnel syndrome. The reports were located through Medline, Current Contents, related readings, and the reference lists of the articles. They all explored the use of clinical diagnostic tests for carpal tunnel syndrome compared with the results of NCS. Criteria for systematically reviewing the studies were developed, tested for reliability, and applied to the studies. Many studies did not have sufficient detail to allow repetition of the protocol by other researchers. The sensitivities and specificities reported for each can be compared with the quality criteria ratings they each received. The literature supports the use of the wrist flexion and carpal compression test and suggests that 2-point discrimination has low sensitivity for diagnosing carpal tunnel syndrome. Many reports do not include methodology, which makes the results difficult to reproduce and to apply to other populations. (J Hand Surg 2000; 25A:120-127.