175057 Physical Exam Measures have a Low Yield in Employment Screening for Carpal Tunnel Syndrome

Tuesday, October 28, 2008: 5:15 PM

Justin D. Coomes, BS , Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
Ann Marie Dale, OTR/L, PhD , Division of General Medical Sciences/ School of Public Health, Washington University School of Medicine in St. Louis/ Saint Louis University, St. Louis, MO
Alfred Franzblau, MD , Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
Alexis Descatha, MD , Occupational Health Department, Poincaré University Hospital, AP-HP, Garches, France
Jaime Strickland, MA , Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO
Bradley A. Evanoff, MD, MPH , Washington University School of Medicine, St. Louis, MO
Objectives: Employment screening for CTS using the physical exam is a common practice with unknown yield. Our goal was to evaluate physical exam measures used to screen for carpal tunnel syndrome (CTS) in a cohort of newly-hired workers.

Methods: The study population was a cohort of 1108 newly-hired workers who were participating in a prospective study of incident CTS (The PrediCTS study). Baseline testing included a symptom questionnaire and physical exam as well as nerve conduction testing of the median and ulnar nerves bilaterally. Exam measures included Semmes-Weinstein sensory testing, hand grip strength, and wrist anthropometrics; palpation at the elbow and provocation of the wrist extensors, wrist flexors, and radial tunnel using the long finger test; and Tinel's test, Phalen's test, and Finkelstein's test. We also analyzed the association between each physical exam and three outcomes: median mononeuropathy, CTS hand symptoms, and a case definition of CTS.

Results: Lateral epicondyle palpation, Phalen's test, and Semmes-Weinstein testing showed weak associations with each outcome. Only Semmes-Weinstein testing had a sensitivity value above 30% for any outcome (76.9% for our CTS case definition). Due to the low prevalence of CTS in this newly-hired population (1.2% prevalence of CTS), positive predictive values were low (<19%) and negative predictive values were high (>90%).

Conclusion: The physical exam has a low yield when screening a population of newly-hired workers for CTS. Post-offer pre-placement screening for CTS using the physical exam should be reevaluated in light of these and other data.

Learning Objectives:
Learning Objectives: As a result of this talk, the audience will: 1.Develop an increased knowledge of physical exam procedures used for carpal tunnel syndrome workplace screenings. 2.Gain an understanding of the role physical exam procedures have in CTS workplace screenings.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary author on this abstract and I am currently pursuing a doctorate of medicine degree.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.