Purpose: Identify patients who likely have carpal tunnel syndrome based on specific patient characteristics.

Stage of CPR Development: Derivation.


1. Shaking hands for symptom relief
2. Wrist-ratio index greater than .67
3. Symptom Severity Scale score greater than 1.9
4. Reduced median sensory field of digit 1
5. Age greater than 45 years


Variables Sensitivity Specificity +LR Post-Test Prob
3 0.98 0.54 2.10 52%
4 0.77 0.83 4.60 70%
5 0.18 0.99 18.30 90%


1. Wainner RS, et al. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005; 86(4): 609-18.

Continued Learning…

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Continued Reading…


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  1. I have a question about CTS as a diagnosis. I have found in 3 different texts and some other articles as well that the actual sensory distribution of the median nerve does not pass through the carpal tunnel. If symptoms are found in the hand, the compression is actually taking place somewhere proximal to the carpal tunnel. Do you have any clarification on this and how does it affect the CPR? Thanks and great resource!


    1. Hi Chris, I know this is about 2.5 years later but I’m going to respond as best as I can. THe palmar cutaneous branch of the median nerve does not pass through the carpal tunnel and actually passes superior to the carpal tunnel. Therefore, a good differential is if symptoms are only in the digits, then the symptoms are more closely related to true carpal tunnel vs if symptoms are both in the palm and the digits. True carpal tunnel is digits only.


      1. There is also some interesting reasearch that was presented at IFOMPT in 2016 (I think 2016) on neuroinflammation secondary to CTS creating an inflammatory response at the nerve root… symptoms were proximal to the wrist and on the back of the hand. I suspect this response happens when the problem becomes chronic and the digital distribution is more acute.


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