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What is the best provocative test for the diagnosis of carpal tunnel syndrome?
A 2022 study included 37 observational studies to assess the diagnostic accuracy of these provocative maneuvers.
Meta-analysis totaling 2662 wrists of patients with carpal tunnel syndrome.
Surprisingly, the winner was a test that is less familiar to some of us who were taught the traditional tests such as the Phalen test, Tinel test or the carpal tunnel compression test.
Hand elevation has been known to reproduce the symptoms of carpal tunnel syndrome.
The hand elevation test demonstrated the best clinical performance for the diagnosis of carpal tunnel syndrome.
- This test is the most sensitive for diagnosis.
The beauty of the test is that it is as simple to perform as the name suggests.
Have the patient raise their hands above their head for one minute.
Hands are raised actively and without strain, keeping the elbows and shoulders relatively loose. That’s it!
A positive test reproduces the symptoms of carpal tunnel syndrome
The hand elevation test has a high sensitivity (75%-86%) and specificity (89%-98.5%)
Take home: Consider adding this bedside provocative test as the first screening test for patients with suspected carpal tunnel syndrome
References
Núñez de Arenas-Arroyo S, et al. Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2022 Aug;52(8):522-531.