Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis Academic Article uri icon

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  • Abstract Objective The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). Methods The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity and specificity of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. Results Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled sensitivity of 0.57 (95% CI = 0.44–0.68; range = 0.12–0.92) and a pooled specificity of 0.67 (95% CI = 0.52–0.79; range = 0.30–0.95). For the Tinel sign (7 studies, 748 patients), the pooled sensitivity was 0.45 (95% CI = 0.34–0.57; range = 0.17–0.97), the pooled specificity was 0.78 (95% CI = 0.60–0.89; range = 0.40–0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. Conclusions Meta-analyses are imprecise but suggest that the Phalen test has moderate sensitivity and specificity, whereas the Tinel test has low sensitivity and high specificity. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. Impact Evidence of unclear and high ROB supports not using any single provocative maneuver for diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.


  • Dabbagh, Armaghan
  • MacDermid, Joy C
  • Yong, Joshua
  • Packham, Tara
  • Grewal, Ruby
  • Boutsikari, Eleni C