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Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome

Sadegh Izadi, Bahareh Kardeh, Seied Saeed Hosini Hooshiar, Mojtaba Neydavoodi and Afshin Borhani-Haghighi


Background and aims

Carpal tunnel syndrome (CTS) is a common debilitating condition. As the reliability of CTS-specific physical tests and its clinical grading remain a matter of debate, we determined the correlations between these assessments with nerve conduction study (NCS).


In this cross-sectional study, patients with uni or bilateral CTS, which was confirmed in electrodiagnosis, were enrolled. Clinical grading was based on the modified criteria of the Italian CTS Study Group. Numeric Pain Rating Scale (NPRS) and Boston Questionnaire (BQ) were used. Physical tests [Phalen’s, reverse Phalen’s, Tinel’s and manual carpal compression test (mCCT)] were performed by a single blinded neurologist. A p-value<0.05 was considered statistically significant.


A total of 100 patients (age=47.48±11.44 years; 85% female) with 181 involved hands were studied. The majority of hands (59.7%) were classified as grade 2 of clinical grading. On NCS, hands with mild (64%), moderate (27%) and severe (9%) CTS were identified. Sensory (velocity, latency and amplitude) and motor parameters (latency and amplitude) were significantly correlated with clinical grades (p-value<0.001). The correlation of NPRS (p-value=0.009) and BQ (p-value<0.001) scores with NCS was significant. None of the physical tests were significantly correlated with NCS in terms of result or duration (p-value>0.05).


We found that physical tests are not a reliable screening method for evaluation of CTS severity. However, the BQ and clinical grading can be more valuable due to their significant correlation with NCS.


Physicians might benefit from employing clinical grading and BQ in practice for better assessment of CTS severity.


This article was extracted from the thesis conducted by Seied Saeed Hosini Hooshiarand with the support of the dean of medical school and research vice-chancellor of Shiraz University of Medical Sciences. The authors appreciate the assistance of Dr. Laleh Khojasteh for proofreading this manuscript.

  1. Authors’ statements

  2. Research funding: Funded by a grant from the Shiraz University of Medical sciences (grant no. 10972).

  3. Conflict of interest: Authors declare no conflict of interest.

  4. Informed consent: Informed written declaration of consent was obtained from each patient and data confidentiality was guaranteed.

  5. Ethical approval: Our study was designed according to the Helsinki Declaration and approved by the Ethics Committee of Shiraz University of Medical Sciences.


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Received: 2017-11-13
Revised: 2018-03-09
Accepted: 2018-03-14
Published Online: 2018-05-22
Published in Print: 2018-07-26

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved