Agreement between symptom surveys, physical examination procedures and electrodiagnostic findings for the carpel tunnel syndrome

Objectives The goal of this study was to evaluate the concordance between v arious clinical screening procedures for carpal tunnel syndrome. Methods The subject population consisted of 824 workers from 6 facilities. The evaluated procedures included bilateral sensory nerve conduction testin g, physical examinations, and symptom surveys, including hand diagrams. The agreement between the outcomes of various combinations of these procedures was assessed by determining the kappa coefficient. Results There was relatively poor overlap between the reported symptoms, th e physical examination findings, and the electrodiagnostic results consiste nt with carpal tunnel syndrome. Overall, only 23 out of 449 subjects (5%) w ith at least 1 positive finding met all 3 criteria (symptoms, physical exam ination findings, and electrophysiological results consistent with carpal t unnel syndrome) for the dominant hand. The screening procedures showed poor or no agreement with kappa values ranging between 0.00 and 0.18 for all th e case definitions evaluated for carpal tunnel syndrome. Conclusions The poor overlap between the various screening procedures warns against the use of electrodiagnostic findings alone without the symptom pr esentation being considered. The results of this study also point to a need for the further development and evaluation of methods for detecting carpal tunnel syndrome.