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Evaluation of a symptom diagram for identifying carpal tunnel syndrome.

Bonauto DK; Silverstein BA; Fan ZJ; Smith CK; Wilcox DN
Occup Med 2008 Dec; 58(8):561-566
Background: Hand symptom diagrams (HSDs) for rating the distribution of paraesthesias are proposed for use in epidemiological studies of carpal tunnel syndrome (CTS). Aim: To assess the validity of HSDs in a working population of manufacturing and service workers participating in a prospective study of musculoskeletal disorders. Methods: Assessment of each subject involved completing a HSD, a heath assessment and electrodiagnostic studies (EDSs). HSDs were rated for CTS blinded to the health assessment and EDS results. The validity assessments of HSD used EDS as the sole confirmatory standard for CTS. Results: A total of 733 subjects (65% of those eligible) participated in the study and 720 underwent EDSs. Dominant hand prevalence of a positive HSD and delayed nerve conduction studies in this working population was 9.2 per 100 workers. The sensitivity of a positive HSD for all workers was 0.28. By restricting the population to those workers with any current hand symptoms or to any worker with neuropathic hand symptoms, the sensitivities of HSD improved to 0.61 and 0.79, respectively. The positive predictive value of a HSD, with our study prevalence, was 0.48. Conclusions: The HSD classification schema has poor validity when applied to a general working population but improves when applied to workers with current neuropathic symptoms. The high number of false-negative HSDs in the general study population is most likely to be due to the inadequacies of using EDS as the confirmatory test. With a low prevalence of CTS, the positive predictive value for HSDs is poor.
Biological-function; Biological-monitoring; Biomechanical-modeling; Biomechanics; Electrochemical-analysis; Epidemiology; Ergonomics; Motion-studies; Musculoskeletal-system; Musculoskeletal-system-disorders; Nerve-function; Neurological-reactions Posture; Standards; Statistical-analysis; Testing-equipment; Work-analysis; Work-performance; Work-practices; Author Keywords: Carpal tunnel syndrome; epidemiological studies; musculoskeletal; screening
David K. Bonauto, SHARP Program, Washington State Department of Labor and Industries, PO Box 44330, Olympia, WA 98504-4330
Publication Date
Document Type
Journal Article
Email Address
Funding Amount
Funding Type
Cooperative Agreement
Fiscal Year
Identifying No.
Issue of Publication
Priority Area
Disease and Injury: Musculoskeletal Disorders of the Upper Extremities
Source Name
Occupational Medicine
Performing Organization
Washington State Department of Labor and Industries
Page last reviewed: October 16, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division