The value of clinical examination in the diagnosis of carpal tunnel syndrome.

Carpal tunnel syndrome is the most common neuropathy of the peripheral nerves. In diagnosing carpal tunnel syndrome, the case history and physical examination are of primary importance. The goal of our research was to examine the dependencies between particular clinical parameters in the diagnosis of carpal tunnel syndrome. For this purpose 80 cases of carpal tunnel syndrome were analyzed, involving 51 patients ranging in age to 81 (average 50). When the patient history was taken, the major complaints were noted: numbness, swelling, stiffness of the fingers, pain in the region of the wrist and fingers. As part of the clinical testing Lovett's method was used to evaluate muscle strength in the short abductor muscles of the thumb and the antagonist muscle of the thumb in both hands; surface and bifocal sensation were tested on the tips of the first, second, and third fingers; and the Tinel and Phalen Tests performed. In the clinical interviews most often complained of nocturnal pain in the wrist region (98,75%). On the Lovett scale the muscle strength of the short abductor muscle of the thumb was 5 in 85% of the cases, and 4 in the other 15%. Similarly, when the antagonist muscle of the thumb was tested, the result was 5 in 77,5% of the cases, 4 in 17,5% and 3 in 5%. Reduced surface sensation within the innervation zone of the medial nerve was found in 70% of the examined cases. Weakened bifocal sensation occurred in the first finger of the affected hand in 21,25% of the cases, in the second finger in 20% and in the third finger in 22,5% of the cases. On physical examination 54% of the cases showed a positive Tinel symptom, and 87,5% a Phalen symptom. The Tinel test results showed positive correlation with weakened bifocal sensation in the first and second fingers, which was confirmed statistically. The lack of statistical correlation between the results of case history and physical examination render it impossible to diagnosis carpal tunnel syndrome exclusively on the basis of either case history or physical examination.