Journal of Occupational Rehabilitation

, Volume 4, Issue 4, pp 185–198 | Cite as

Workplace surveillance for carpal tunnel syndrome using hand diagrams

  • Alfred Franzblau
  • Robert A. Werner
  • James W. Albers
  • Christin L. Grant
  • Denise Olinski
  • Elizabeth Johnston


Four hundred and eleven workers from 4 different companies participated in a worksite screening program designed, in part, to estimate the prevalence of carpal tunnel syndrome (CTS). Each worker completed a discomfort survey and underwent limited nerve conduction testing of the median and ulnar sensory nerves in both wrists. The discomfort survey included a hand diagram which allowed subjects to shade in area(s) affected by numbness, burning, tingling, or pain. The discomfort survey also asked each worker to indicate whether she or he had experienced neuropathic symptoms (i.e., numbness, burning, tingling, or pain) in the wrist, hand or fingers of each hand, without regard to localization (i.e., median versus ulnar versus radial distribution), and also nocturnal occurrence of symptoms. Analyses involved comparing hand diagram scores and non localized wrist/hand/finger symptoms with electrodiagnostic test results. All configurations of hand diagram scores of the dominant hands had a statistically significant association with electrophysiologically determined median nerve dysfunction, but so did non localized symptom reports. The sensitivity, specificity, and positive predicted values of hand diagrams were poorer than those reported previously. While some test performance characteristics of hand diagrams were better than those for non localized distal extremity symptoms consistent with CTS, some were worse. Overall, our data suggest that hand diagrams are no better than using a questionnaire to determine if workers have experienced symptoms consistent with CTS in their wrists, hands or fingers without regard to localization. The choice of screening tool would depend on the goal of screening, in particular, whether it is more desirable to have slightly higher sensitivity or positive predictive value.

Key words

carpal tunnel syndrome screening hand diagrams nerve conduction velocity testing median mononeuropathy cumulative trauma disorders 


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Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Alfred Franzblau
    • 1
  • Robert A. Werner
    • 1
    • 2
    • 3
  • James W. Albers
    • 1
    • 4
  • Christin L. Grant
    • 5
  • Denise Olinski
    • 1
  • Elizabeth Johnston
    • 1
  1. 1.Department of Environmental and Industrial HealthUniversity of Michigan School of Public HealthAnn Arbor
  2. 2.Physical Medicine and Rehabilitation ServiceAnn Arbor Veterans Administration HospitalAnn Arbor
  3. 3.Department of Physical Medicine and RehabilitationUniversity of Michigan School of MedicineAnn Arbor
  4. 4.Department of NeurologyUniversity of Michigan School of MedicineAnn Arbor
  5. 5.Center for ErgonomicsUniversity of Michigan School of EngineeringAnn Arbor

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