Are relieving maneuvers useful in diagnosis of carpal tunnel syndrome?

Objective: Our aim was to assess and compare the diagnostic accuracyof the carpal tunnel syndrome relief maneuver (CTS-RM) andthe Flick sign for the diagnosis of carpal tunnel syndrome (CTS) infemale patients.Materials and Methods: This is a diagnostic test study with blindcomparison to a reference criterion. A total of 87 consecutivefemale patients with typical symptoms for CTS referred for electrophysiologicalexamination were included in the study. Normal limitsof nerve conduction were obtained from 50 healthy female subjects.After the electrodiagnostic assessment clinical evaluation wasperformed by a physician and it included testing of all patients forthe CTS-RM and Flick sign. The diagnostic accuracy was evaluatedfor each test alone and in combination and sensitivity was correlatedwith the electrophysiological severity of CTS. Main outcome measuresincluded the estimates of sensitivity, specificity, positive andnegative likelihood ratios (PLR, NLR).Results: After electrophysiological assessment, 58 patients (pre-testprobability, 67%) have been diagnosed as CTS. The sensitivity andspecificity estimates were %81,86 for the CTS-RM and %69, 79 forthe Flick maneuver. Combining a positive CTS-RM and Flick signimproved the specificity to 93%. The PLRs of the CTS-RM and Flicksign were 3.3 and 5.9 and the NLRs were 0.39 and 0.22 respectively.Combining a positive CTS-RM and Flick sign had the PLR of 9.5 andthe NLR of 0.37. When evaluating the subjects with CTS, the CTS-RMdetected significantly more subjects compared to the Flick sign.Conclusions: Our study reveals that the accuracy of Flick sign is lowin the diagnosis of CTS. While the CTS-RM alone is helpful in confirmingthe diagnosis in patients with typical symptoms, combinationwith the Flick sign further improves its predictive accuracy. [ABSTRACT FROM AUTHOR]