April 3, 2016

Manual testing for Carpal Tunnel Syndrome

There are various manual tests that you can perform to confirm or test for median nerve compression on carpal tunnel syndrome (CTS). Whitley Lowe in an article published in Journal of Bodywork and Movement Therapies suggested tests that increased its sensitivity for identifying median nerve compression. Here is a summary of some of the tests (after Lowe, 2008).

(1) Phalen’s Test or Phalen Maneuver is the most common orthopedic test for evaluating CTS. It was discovered by an American orthopedist George S. Phalen. The patient holds their wrist in complete and forced flexion for 30–60 seconds. This maneuver moderately increases the pressure in the carpal tunnel and has the effect of pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, the presence of neurological symptoms (such as tingling or numb sensation over the thumb, index, middle and ring fingers) within about a minute, conveys a positive test result for median nerve compression in carpal tunnel syndrome.

(2) Modified Phalen Test

Greater sensitivity can be enhanced for Phalen’s test if the upper extremity was held in a position that increases neural tension on the remainder of the median nerve. This test is performed unilaterally, this involves and shoulder abduction, elbow extension, wrist flexion, lateral flexion of the neck to the opposite side.

(3) Carpal compression test. Also called Durkan test, this involves applying a moderate amount of direct pressure on the median nerve at the carpal tunnel with both thumbs is called the carpal compression. If neurological symptoms arise within about 20–30 seconds the test is considered positive for median nerve compression.

(4) Pressure proactive test. The test involves elbow extension, forearm supination and about 60 degrees of wrist flexion along with pressure over the carpal tunnel. The pressure provocative test could be enhanced with increased tension on the median nerve by stretching the median nerve at the upper extremity. The position includes lateral neck flexion to the opposite side, shoulder abduction, elbow extension, forearm supination, and partial wrist flexion. Pressure is then be applied to the carpal tunnel with the arm is in this position.

(5) Hand elevation test. This involves holding the hand overhead as high as comfortably possible. If neurological symptoms in the median nerve distribution of the hand are present within a minute, the test is considered positive.

(6) Modified hand elevation test. A neural tension in the median nerve can be added to the hand elevation test. Holding the arm overhead, the neck is laterally flexed to the opposite side. Additional tension on the median nerve is added by putting the wrist in extension.