Carpal tunnel, de Quervain’s and scapholunate tests: how to perform them and what the research says.
For clinician education; special tests support but do not replace a full examination. This page is a reference for physical therapists, occupational therapists, athletic trainers, students and other clinicians. Patients with joint or spine pain should be examined by a licensed clinician.
Carpal tunnel tests are the most studied in the hand. Single tests are moderate at best; a cluster of history and exam findings performed better in one derivation study.
| Test | Target condition | Sn | Sp | +LR | −LR | Source |
|---|---|---|---|---|---|---|
| Phalen’s test | Carpal tunnel syndrome (weighted estimate across studies) | 68% | 73% | — | — | [1] |
| Tinel’s sign at the wrist | Carpal tunnel syndrome (weighted estimate across studies) | 50% | 77% | — | — | [1] |
| Carpal compression test | Carpal tunnel syndrome (weighted estimate across studies) | 64% | 83% | — | — | [1] |
| Finkelstein’s test | Accuracy data not verified | — | ||||
| Watson scaphoid shift test | Accuracy data not verified | — | ||||
Sn = sensitivity, Sp = specificity, LR = likelihood ratio. A dash means the source we checked did not report that value.
Each test is described in our own words. Compare with the uninvolved side and stop if the test provokes severe pain.
Also called: Wrist flexion test
| Target condition (source) | Sensitivity | Specificity | +LR | −LR |
|---|---|---|---|---|
| Carpal tunnel syndrome (weighted estimate across studies)[1] | 68% | 73% | — | — |
| Target condition (source) | Sensitivity | Specificity | +LR | −LR |
|---|---|---|---|---|
| Carpal tunnel syndrome (weighted estimate across studies)[1] | 50% | 77% | — | — |
Also called: Durkan test
| Target condition (source) | Sensitivity | Specificity | +LR | −LR |
|---|---|---|---|---|
| Carpal tunnel syndrome (weighted estimate across studies)[1] | 64% | 83% | — | — |
Also called: Eichhoff test (variant)
Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.
Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.
Combinations of findings usually shift probability more than any single test.
Items: Five findings: shaking the hand relieves symptoms; wrist-ratio index greater than 0.67; Symptom Severity Scale score greater than 1.9; reduced median sensory field of digit 1; age over 45.
Accuracy: All 5 positive: +LR 18.3. Derivation study; not yet validated.[2]
Two-point discrimination and thenar weakness (specific but insensitive, per MacDermid 2004) are not described as separate tests. No accuracy study for Finkelstein’s or Watson’s test was verified. We only show accuracy numbers we could check against the original study or review.
How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective or case-control study, or a clinical prediction rule that has only been derived (not yet validated). D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 13, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”
Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 13, 2026.
We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.
Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.
This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.
For clinician education; special tests support but do not replace a full examination. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.
In a 2004 systematic review, carpal compression had the best balance (64% sensitivity, 83% specificity), followed by Phalen’s (68%, 73%) and Tinel’s (50%, 77%). None is good enough alone; nerve conduction testing is the usual confirmation.
A five-item cluster from a 2005 derivation study: symptom relief from shaking the hand, wrist-ratio index over 0.67, Symptom Severity Scale over 1.9, reduced sensation in the thumb, and age over 45. All five positive gave a positive likelihood ratio of 18.3.
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