Moderate evidence supports not using the following 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:
• Carpal Compression test
• Reverse Phalen Test
• Thenar Weakness or Thumb Abduction Weakness or Abductor Pollicis Brevis Manual Muscle Testing
• 2-point discrimination
• Semmes-Weinstein Monofilament Test
• CTS-Relief Maneuver (CTS-RM)
• Pin Prick Sensory Deficit; thumb or index or middle finger
• ULNT Criterion C
• Tethered median nerve stress test
• Vibration perception – tuning fork
• Scratch collapse test
• Luthy sign
• Pinwheel

Several moderate and high quality studies provided a moderate level of evidence to suggest that the various tests listed above were not found to have been used as individual tests to rule in or rule out the diagnosis of CTS.  CTS-RM had a moderate association to the reference standard when ruling-in CTS according to one high quality study (Gok, 2008) however the generalizability of these results is unclear because the study sample only contained female subjects. Meta-analysis could not be performed on any of these studies due to inconsistent reporting or lack of sufficient evidence. The reference standard for comparison was the use of either electrodiagnostic studies (EDS) following AANEM criteria or other general EDS methods.  There is conflicting evidence of whether or not combining tests helps to rule in or rule out the diagnosis of CTS, as the test combinations were not validated or weighted to ensure reliability, accuracy, and/or clinical relevance; any valid scales are evaluated in the diagnostic scales recommendation.


The Future of OrthoGuidelines


The OrthoGuidelines Process