Graham B, Regehr G, Naglie G, et al. The Journal of hand surgery 2006 · PMID 16886290 · doi:10.1016/j.jhsa.2006.04.007
- Question
- Which clinical features best identify carpal tunnel syndrome without relying on nerve conduction studies?
- Design
- Expert Delphi ranking of clinical findings, then expert panels rated simulated case histories to build a weighted logistic regression model, validated against a second expert panel.
- Patients
- Simulated case histories built from the top-ranked clinical criteria, judged by panels of expert clinicians.
- Intervention
- Six clinical criteria: numbness mainly in median territory, nocturnal numbness, thenar atrophy or weakness, positive Tinel's, positive Phalen's, loss of two-point discrimination
- Comparison
- Probability of CTS estimated by an independent expert panel
- Primary outcome
- Agreement between model-predicted and expert-estimated probability of CTS
- Key result
- The weighted clinical criteria (CTS-6) correlated well with the judgement of an independent expert panel, providing a consistent clinical definition of CTS.
- Limitations
- Validated against expert opinion on hypothetical cases rather than real patients or an objective reference test.
- Impact on practice
- Provides a structured clinical diagnosis of CTS, supporting the UK approach that nerve conduction studies are not mandatory before surgery in typical cases.