Diagnostic Accuracy of Clinical Provocative Tests versus Electrodiagnostic Studies in Carpal Tunnel Syndrome: A Correlation with Intraoperative Findings

Abstract

Accurate diagnosis of carpal tunnel syndrome (CTS) relies on a combination of clinical provocative tests and electrodiagnostic studies. This study aimed to evaluate the sensitivity of three standard provocative tests (Phalen's test, Tinel's sign, and Durkan's test), compare their findings with nerve conduction velocity/electromyography (NCV/EMG) results, and correlate all diagnostic findings with intraoperative severity grading in patients undergoing open carpal tunnel decompression. A prospective case series of 51 patients undergoing open carpal tunnel decompression via mini-palm incision at Misrata Medical Center in 2018 underwent preoperative provocative testing and NCV/EMG studies, with intraoperative severity graded as mild, moderate, or severe. Durkan's test demonstrated the highest sensitivity (92.16%), followed by Tinel's sign (90.20%) and Phalen's test (86.27%). All 51 patients had positive NCV/EMG findings, and NCV/EMG and operative grading were concordant in 38 cases (74.51%). Cases with mild intraoperative findings had at least two negative provocative tests. Diagnostic accuracy for CTS is maximized by combining clinical provocative tests with NCV/EMG studies. Durkan's test is the most sensitive single provocative test, and the combination of all three tests with electrodiagnostic studies correlates strongly with intraoperative findings and should guide surgical decision-making.