The purpose of this study was to evaluate a new diagnostic technique, the opponens roll test, to determine if it predicts the results of electrodiagnostic evaluation of carpal tunnel syndrome in symptomatic patients such that diagnosis in a primary care setting can be accomplished without referral for electrodiagnostic evaluation. The study also examined three other physical exam tests for carpal tunnel syndrome: the Phalen's test, the Tinel' s test, and the wrist compression test.
Fourteen patients referred by primary care clinicians for electrodiagnostic evaluation of suspected carpal tunnel syndrome to the Tuality Healthplace clinic during the four-month study period were included in the study group. The average age of the study group was 37, 79% were female, 86% were right hand dominant, and 48% were electrophysiologically diagnosed with carpal tunnel syndrome. All subjects received the four physical exam tests and electrodiagnostic evaluation, which was used as the reference standard.
The results of the clinical examinations were 67% sensitivity; 45% specificity; positive likelihood ratio of 1.2, and negative likelihood ratio of 0.73 for the opponens roll test. The Phalen's test had 70% sensitivity, 64% specificity, 1.9 positive likelihood ratio and 0.47 negative likelihood ratio. The Tinel's test had 20% sensitivity, 82% specificity, .1.1 positive likelihood ratio and 0.98 negative likelihood ratio. The wrist compression
Assuming a 20% pretest probability of carpal tunnel syndrome in the study group, a positive opponens roll test increased the probability to 23% and a negative opponens roll test decreased the probability to 15%. The post-test probability for a positive Phalen's test was 32%, Tinel's test was 22%, and wrist compression test was 15%. The post-test probability for a negative Phalen's test was 11 %, Tinel's test was 20%, and wrist compression test was 31 %.
Of the four physical exam tests evaluated, when comparing post-test probabilities, the Phalen's test was the best followed by the opponens roll test, the Tinel's test, and lastly the wrist compression test, which gave results contradictory to expected findings. The results were weak, and the diagnostic impact of each of the tests was indeterminate. None of the tests were sufficient predictors of electrodiagnostic evaluation to substitute for it.
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