Carpal tunnel syndrome and provocative clinical tests

Abstract

This is a letter to the editor commenting on “Carpal tunnel syndrome: evaluation of its provocative clinical tests.”

Introduction

This is letter to editor commenting on “Carpal tunnel syndrome: evaluation of its provocative clinical tests.”

Main text

Dear Editor, we read the publication on “Carpal tunnel syndrome: evaluation of its provocative clinical tests” with great interest [1]. Arab et al. evaluated provocative clinical test for carpal tunnel syndrome and concluded that “Arm raising test (ART) is a simple, reliable, and easily performed test for evaluating carpal tunnel syndrome; it is superior to other tests and could be used also to assess improvement after surgery [1].” We agree that the ART should be a good test and appropriate for any setting with limited resource. However, the diagnostic property might vary and depends on the clinical skill of the practitioner. Also, different provocative tests have different diagnostic properties. Tetro et al. mentioned that wrist flexion and median-nerve compression test was superior to other provocative tests including Tinel’s percussion test, Phalen’s wrist flexion test, and the carpal compression test in terms of diagnostic properties [2]. The observed specificity of wrist flexion and median-nerve compression test is 99% [2] comparing to 97.1% of ART [1].

Conclusions

This is a letter to the editor commenting on “Carpal tunnel syndrome: evaluation of its provocative clinical tests.”