ChiroACCESS Clinical Review

Carpal Tunnel Syndrome: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

March 4, 2009

Text Size:     
The diagnosis of carpal tunnel syndrome (CTS) is not nearly as straight forward as one might think.  Although long considered the “gold standard” for evaluating CTS, electrodiagnostic studies (EDS) seem to have as many critics as adherents.  Based on the available studies, a high quality history and examination appears to be the most cost efficient and accurate path to a proper diagnosis, particularly when conservative treatment remains the first treatment option.  Electrodiagnostic studies are of value in a properly selected subgroup of patients where surgical intervention is being considered or diagnosis is uncertain.

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D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 2000; 283(23):3110-3117.

 [ Medline ID 10865306 ]


Dale AM, Strickland J, Symanzik J, Franzblau A, Evanoff B. Reliability of Hand Diagrams for the Epidemiologic Case Definition of Carpal Tunnel Syndrome. J Occup Rehabil 2008 Jun 3.

 [ Medline ID 18521726 ]


Ferry S, Silman AJ, Pritchard T, Keenan J, Croft P. The association between different patterns of hand symptoms and objective evidence of median nerve compression: a community-based survey. Arthritis Rheum 1998 Apr;41(4):720-4.

 [ Medline ID 9550482 ]


Walker-Bone KE, Palmer KT, Reading I, Cooper C. Criteria for assessing pain and nonarticular soft-tissue rheumatic disorders of the neck and upper limb. Semin Arthritis Rheum 2003 Dec;33(3):168-84.

 [ Medline ID 14671727 ]


Gerr F, Letz R, Harris-Abbott D, Hopkins LC. Sensitivity and specificity of vibrometry for detection of carpal tunnel syndrome. J Occup Environ Med 1995 Sep;37(9):1108-15.

 [ MANTIS ID 171393 ]  [ Medline ID 8528719 ]


Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil 1997 Nov;76(6):451-7.

 [ MANTIS ID 39555 ]  [ Medline ID 9431262 ]


Agabegi SS, Freiberg RA, Plunkett JM, Stern PJ. Thumb abduction strength measurement in carpal tunnel syndrome. J Hand Surg [Am] 2007 Jul;32(6):859-66.

 [ MANTIS ID 311484 ]  [ Medline ID 17606067 ]


Li ZM, Harkness DA, Goitz RJ. Thumb strength affected by carpal tunnel syndrome. Clin Orthop Relat Res 2005 Dec;441:320-6.

 [ MANTIS ID 231364 ]  [ Medline ID 16331021 ]


Golding DN, Rose DM, Selvarajah K. Clinical tests for carpal tunnel syndrome: an evaluation. Br J Rheumatol 1986 Nov;25(4):388-90.

 [ Medline ID 3779325 ]


Finsen V, Russwurm H. Neurophysiology not required before surgery for typical carpal tunnel syndrome. J Hand Surg [Br ] 2001 Feb;26(1):61-4.

 [ MANTIS ID 47961 ]  [ Medline ID 11162020 ]


Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4:9.

 [ MANTIS ID 130043 ]  [ Medline ID 12734018 ]


Jordan R, Carter T, Cummins C. A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. Br J Gen Pract 2002; 52(481):670-673.

 [ Medline ID 12171229 ]


Bagatur AE, Zorer G, Oral B. [The role of magnetic resonance imaging in carpal tunnel syndrome. Correlation of clinical, electrodiagnostic, and intraoperative findings and staging]. Acta Orthop Traumatol Turc 2002; 36(1):22-30.

 [ Medline ID 12510107 ]


Deryani E, Aki S, Muslumanoglu L, Rozanes I. MR imaging and electrophysiological evaluation in carpal tunnel syndrome. Yonsei Med J 2003; 44(1):27-32.

 [ Medline ID 12619172 ]


El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology (Oxford) 2004; 43(7):887-895.

 [ Medline ID 15100417 ]


Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 2002; 26(6):798-803.

 [ Medline ID 12451604 ]


LaJoie AS, McCabe SJ, Thomas B, Edgell SE. Determining the sensitivity and specificity of common diagnostic tests for carpal tunnel syndrome using latent class analysis. Plast Reconstr Surg 2005 Aug;116(2):502-7.

 [ Medline ID 16079681 ]


Hansen PA, Micklesen P, Robinson LR. Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome. Am J Phys Med Rehabil 2004; 83(5):363-367.

 [ MANTIS ID 107288 ]  [ Medline ID 15100625 ]


Mondelli M, Passero S, Giannini F. Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001; 103(3):178-183.

 [ Medline ID 11532560 ]


Rayegani SM ADKM. Sensitivity and specificity of two provocative tests (Phalen's test and Hoffmann-Tinel's sign) in the diagnosis of carpal tunnel syndrome. Journal of Orthopedic Medicine 2004;26(2).

 [ MANTIS ID 113760 ]  [ Medline ID 113760 ]


Weber RA, Schuchmann JA, Albers JH, Ortiz J. A prospective blinded evaluation of nerve conduction velocity versus Pressure-Specified Sensory Testing in carpal tunnel syndrome. Ann Plast Surg 2000 Sep;45(3):252-7.

 [ Medline ID 10987525 ]


Slutsky DJ. Use of nerve conduction studies and the pressure-specified sensory device in the diagnosis of carpal tunnel syndrome. J Hand Surg Eur Vol 2009 Jan 7.

 [ Medline ID 19129354 ]