Physical examination has a low yield in screening for carpal tunnel syndrome.
Dale-AM; Descatha-A; Coomes-J; Franzblau-A; Evanoff-B
Am J Ind Med 2011 Jan; 54(1):1-9
BACKGROUND: physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly hired workers, we evaluated the yield of such screening. METHODS: our study population included 1,108 newly hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy. RESULTS: of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing. CONCLUSION: physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.
Carpal-tunnel-syndrome; Exposure-assessment; Musculoskeletal-system-disorders; Nerves; Nervous-system; Neurological-system; Neuromuscular-system; Neurophysiological-effects; Physical-examination; Physiological-factors; Physiological-testing; Physiology; Preemployment-examinations; Questionnaires; Risk-analysis; Risk-factors; Statistical-analysis; Work-analysis; Work-environment; Work-operations; Work-performance; Work-performance; Workplace-studies;
Author Keywords: carpal tunnel syndrome; post-offer pre-placement examinations; physical examination; screening; clinical epidemiology
Ann Marie Dale PhD, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110
American Journal of Industrial Medicine
Washington University - St. Louis, Missouri