Carpal tunnel syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Dheeraj Makkar, M.D.[2]

• Physical examination includes inspection for thenar atrophy, though strength may be preserved in cases with anomalous innervation. Provocative tests are central: Durkan’s compression test is most sensitive, Phalen’s maneuver and Tinel’s sign are supportive. Sensory testing with Semmes–Weinstein monofilaments detects early deficits, while two-point discrimination assesses functional integrity and recovery.

Thenar atrophy  

Carpal tunnel compression test (Durkan’s test) 

• is the most sensitive test to diagnose carpal tunnels syndrome
• performed by pressing thumbs over the carpal tunnel and holding pressure for 30 seconds and pain or paresthesia in the median nerve distribution considered as positive result.

Phalen test 

• wrist volar flexion for 60 sec produces symptoms

Tinel’s test

• provocative tests performed by tapping the median nerve over the volar carpal tunnel

Semmes-Weinstein testing

• most sensitive sensory test for detecting early carpal tunnel syndrome 
• measures a single nerve fiber innervating a receptor or group of receptors

innervation density test

• static and moving two-point discrimination