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Accuracy of the most common provocation tests for diagnosing carpal tunnel syndrome: a systematic review with meta-analysis

Nunez de Arenas-Arroyo S, Cavero-Redondo I, Torres-Costoso A, Reina-Gutierrez S, Guzman-Pavon MJ, Martinez-Vizcaino V

The Journal of Orthopaedic and Sports Physical Therapy 2022 Aug;52(8):522-531

systematic review

OBJECTIVE: To estimate the screening performances of the most important provocation tests for diagnosing carpal tunnel syndrome (CTS). DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: We systematically searched the Medline, Scopus, Web of Science, and Cochrane databases from inception to November 2020. STUDY SELECTION CRITERIA: Observational studies comparing the accuracies of the Durkan Test (DT), the Hand Elevation Test (HET), the Phalen Test (PT), the Tinel Test (TT), and the Upper-Limb Neurodynamic Test Specific to the Median Nerve (ULNT1) with electrodiagnosis for screening for CTS. DATA SYNTHESIS: Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of these tests. Hierarchical summary receiver operating characteristic curve analyses were used to summarize the overall test performance. RESULTS: Thirty-seven studies were included in the meta-analysis, with a total sample of 2,662 wrists for DT, 864 wrists for HET, 6,361 wrists for PT, 6,094 wrists for TT, and 571 wrists for ULNT1. The pooled dORs for screening for CTS were 15.84 (95% CI 3.78 to 66.38) for DT, 128.63 (95% CI 40.64 to 407.12) for HET, 7.23 (95% CI 4.06 to 12.86) for PT, 5.31 (95% CI 3.49 to 8.09) for TT, and 1.78 (95% CI 0.61 to 5.19) for ULNT1. CONCLUSION: HET has the best clinical performance for detecting CTS and should be considered the first screening test of choice during the physical examination. The most common tests (DT, PT, and TT) have good accuracies for screening for CTS.

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