Modified Phalen's test

This article^[1] examined a modification of the Phalen's test vs. the traditional Phalen's test for carpal tunnel syndrome using NCS as the gold standard. NCS has been shown to give sensitivities of 50-85% and specificities in the high 90s.^[2] In this study of 37 patients (66 hands) both the traditional and the modified Phalen's had specificities of 100% but the modified Phalen's was much more sensitive at 85% compared to 50% for the traditional Phalen's.

The modified Phalen's is almost as easy to perform, needing only a monofilament in addition to the standard wrist flexion maneuver.

Clinically, I'm not sure I'm going to use this in my clinic. I don't have monofilaments, but I bet I could get some from my primary care colleagues. The problem is, if I'm only gaining a bit of sensitivity, if the symptoms are concerning, I'll just treat them. If they don't respond to conservative treatment, I'm probably going to get an NCS anyway. I don't see that adding the monofilament is going to change my practice.

Still. I could be wrong. Certainly is something to think about.

[1]: Bilkis S, Loveman DM, Eldridge JA, Ali SA, Kadir A, McConathy W. Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome. Arthritis Care Res. 2012;64(2):287–289.

[2]: Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. 2002;58(11):1589–1592.