Clinical tests for carpal tunnel syndrome, compared
Compression of the median nerve in the tunnel at the front of the wrist. Causes tingling and numbness in the thumb, index and middle fingers, often at night.
The 4 tests in the library for carpal tunnel syndrome, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.
| Test | Sensitivity | Specificity | LR+ | LR− | Verdict |
|---|---|---|---|---|---|
| Carpal compression test (Durkan's test) | 64% | 83% | 3.76 | 0.43 | A weak test on its own |
| Phalen's test | 57% | 67% | 1.71 | 0.65 | A weak test on its own |
| Reverse Phalen's test | 41% | 55% | 0.91 | 1.07 | A weak test on its own |
| Tinel's sign (at the wrist) | 45% | 78% | 2.05 | 0.71 | A weak test on its own |
Reading the table
A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.
A five-item clinical prediction rule combining history and examination has been derived, but Rule It In, Rule It Out does not reproduce its figures because they could not be re-checked against the source; no single physical test confirms or excludes carpal tunnel syndrome, and when the answer matters, nerve conduction studies are the reference standard.
Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together.
To turn a figure into a probability for your patient, use the probability calculator.
Get the book for how to do and read each wrist and hand test with published figures, and which carpal tunnel test to trust
This page gives the published figures. Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.
Coming in late 2026 as a PDF and a paperback. Join the list to hear when it's out
One study, one test, once a month
Rule It In is a free evidence letter for musculoskeletal clinicians: one recent study explained, one examination test with its real numbers. From Trokos, publisher of Rule It In, Rule It Out.
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