Physical Signs
Strong evidence supports not using the Phalen Test, Tinel Sign, Flick Sign, or Upper limb neurodynamic/nerve tension test (ULNT) criterion A/B as independent physical examination maneuvers to diagnose carpal tunnel syndrome, because alone, each has a poor or weak association with ruling-in or ruling-out carpal tunnel syndrome.
STRONG RECOMMENDATION Rationale
Evidence from five high quality studies (Gok, 2008; Naranjo, 2007; Vanti, 2011; Vanti, 2012; Wainner, 2005) and one moderate quality study (Tan, 2012) supports not using the Phalen Test, Tinel Sign, Flick Sign, or ULNT criterion A/B as independent physical examination maneuvers to rule in or rule out the diagnosis of carpal tunnel syndrome. Each of these studies showed poor agreement with electrodiagnostic tests as the reference standard. The EDS criteria in some instances used the AANEM criteria and in others general EDS methods. A meta-analysis of the performance of the Tinel sign and Phalen test also demonstrated poor agreement to this reference standard.
- Gok,H.; Ay,S.; Kutlay,S. Are relieving maneuvers useful in diagnosis of carpal tunnel syndrome?. Romatizma; 2008: 4
- Naranjo,A.; Ojeda,S.; Mendoza,D.; Francisco,F.; Quevedo,J.C.; Erausquin,C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?. Clin Exp.Rheumatol.; 2007/11: 6
- Tan,S.V.; Sandford,F.; Stevenson,M.; Probert,S.; Sanders,S.; Mills,K.R.; Koutroumanidis,M. Hand-held nerve conduction device in carpal tunnel syndrome: a prospective study. Muscle Nerve; 2012/5: 5
- Vanti,C.; Bonfiglioli,R.; Calabrese,M.; Marinelli,F.; Guccione,A.; Violante,F.S.; Pillastrini,P. Upper Limb Neurodynamic Test 1 and symptoms reproduction in carpal tunnel syndrome. A validity study. Man.Ther; 2011/6: 3
- Vanti,C.; Bonfiglioli,R.; Calabrese,M.; Marinelli,F.; Violante,F.S.; Pillastrini,P. Relationship between interpretation and accuracy of the upper limb neurodynamic test 1 in carpal tunnel syndrome. J Manipulative Physiol Ther; 2012/1: 1
- Wainner,R.S.; Fritz,J.M.; Irrgang,J.J.; Delitto,A.; Allison,S.; Boninger,M.L. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil.; 2005/4: 4