SynthesisPhysical therapy2023
Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.
Synthesis in Physical therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 14 citations in OpenAlex.
- "Intraoperative pillar corticosteroid injection": does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study.BMC musculoskeletal disorders · 2025Trial
- Thumb Positioning Modulates Median Nerve Mobility and Morphology During Postural Changes in Carpal Tunnel Syndrome: Implications for Nerve Gliding Exercises.Archives of rehabilitation research and clinical translation · 2026Article
- Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials.Brain sciences · 2026Review
- Correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome.Journal of rehabilitation medicine · 2026Article
- Article
- Diagnostic Dilemmas in Carpal Tunnel Syndrome and Cervical Spine Disorders: A Comprehensive Review.Diagnostics (Basel, Switzerland) · 2025Review
- Carpal tunnel syndrome.Nature reviews. Disease primers · 2024Review
- Relationship of obesity indices with clinical severity and nerve conduction studies in females presenting with median nerve compression neuropathy at the wrist.Journal of family medicine and primary care · 2024Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
Abstract
objectiveThe purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS).
methodsThe MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool.
resultsThirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies.
conclusionMeta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. IMPACT: Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.
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