The forearm elevation-compression test: a novel test for carpal tunnel syndrome

Abstract

Background: As the time available to spend with patients decreases, a rapid test for bedside diagnosis of carpal tunnel syndrome (CTS) could be useful.

Design and methods: We describe the forearm elevation-compression test (FECT) in this context. The FECT was assessed in 40 patients with clinically suspected CTS and compared to Tinel's and Phalen's signs. Routine electromyography and nerve conduction tests (EMG/NCT) were performed in all cases. In addition, 85 healthy controls were examined by FECT and compared to the patient group.

Results: All three provocative tests, particularly FECT, were frequently positive in suspected CTS. Neurophysiological tests were normal in 5 of 40 cases of clinically suspected CTS, and the FECT was positive in all of these suggesting a positive predictive value of 87.5% if one accepts EMG/NCT as the reference. Amongst the healthy controls, 18 of 85 (21.2%) were positive on the FECT suggestive of a high false-positive rate or subclinical disease.

Conclusion: It is proposed that the FECT is a useful addition to the clinical examination of suspected CTS. Although the positive rate may be falsely elevated, this is offset by restricting the latency for tingling onset to 10 s or less (FECT2).