Natl. J. Physiol. Pharm. Pharmacol. (2025), Vol. 15(1): 76–79

Research Article

10.5455/NJPPP.2025.v15.i1.13

Provocative diagnostic test to evaluate the median nerve compression at wrist in computer operators

Pooja Thembe¹, Priyanka Rane^2* and Vriti Shah³

¹Department of Physiology, MGM Medical College, Navi Mumbai, India

²Department of Physiology, MGM Medical College, Navi Mumbai, India

³Department of Neurology, MGM Medical College, Navi Mumbai, India

*Corresponding Author: Priyanka Rane. Department of Physiology, MGM Medical College, Navi Mumbai, India. Email: chaudharypriyanka18 [at] gmail.com

Submitted: 26/11/2024 Accepted: 31/12/2024 Published: 31/01/2025

---

ABSTRACT

Background: In the era of the computer revolution, ubiquitous electronic devices comprise more than 80% of the work done using desktops and laptops. The wrist joint’s reduced movement due to longer working hours on a computer is more closely associated with neurological symptoms like entrapment neuropathy at the wrist. With varying sensitivity and specificity, certain provocative tests such as Phalen’s test are used to make diagnoses and have been employed as outcome measures in clinical investigations in the study.

Aim: To evaluate and compare the role of provocative tests in the diagnosis of nerve compression among computer operators.

Methods: This observational study was conducted in the Neurology OPD and Physiology Department. Sample size: the study included 120 participants with an average age of 18–50 (34 ± 6.4) years. Group I—60 long duration (>6 hrs/day for more than two years) and Group II—60 short duration (<2 hrs/week for more than two years) computer operators were included in the study. Phalen’s test for median nerve compression was performed on participants.

Results: The study showed Phalen’s test with positive results with 15% in long-duration computer operators and 1.7% in short-duration computer operators. There was a statistically significant association between the duration of computer use and Phalen’s test for diagnosing median nerve compression.

Conclusion: Computer use for a long time causes median nerve compression, and Phalen’s test is sensitive to tingling, numbness, and paraesthesia. Phalen’s test as a provocative diagnostic test can be used for screening and early detection of CTS in computer operators. Further confirmation by nerve conduction studies is required.

Keywords: Computer operators, Carpal tunnel syndrome, Phalen’s test, Carpal compression test, Median nerve.

---

Introduction

In contemporary culture, computers are ubiquitous electronic devices that perform more than 80% of the work done on desktops and laptops. In many industrial, corporate, and medical sectors, the use of computers and their fundamental components, such as the keyboard and mouse, has grown dramatically. In the workplace, about 2 out of every 5 people who are employed use computers (Desai et al., 2014).

With varying sensitivity and specificity, provocative tests, such as the Phalen and Tinel tests, are used to diagnose the condition. The diagnosis is mostly clinical, based on the symptoms and distribution of sensory alterations in the hand, as well as neurophysiological, which assesses the conduction velocity of the median nerve. In addition to being the primary test for this neuropathy’s diagnosis, electroneuromyography is crucial for making a differential diagnosis between other neuromuscular disorders and assessing the severity of CTS (Jesus Filho et al., 2014; Cunha et al., 2020).

The aim of this study was to evaluate and compare the role of provocative tests in the diagnosis of nerve compression among computer operators, and the objective was to study and compare Phalen’s test and carpal compression test (CCT) among long- and short-duration computer operators.

---

Materials and Methods

This was an observational and cross-sectional Study conducted with 120 participants who were from the MGM Medical College and Hospital Kamothe campus staff.

Sampling method

Computer users were assigned to two groups: Groups I and II

Fig. 1. Phalen’s maneuver.

Fig. 2. Carpal compression test.

Table 1. Phalen’s test for long- and short-duration computer operators.

Group I (Long-Duration Computer Operator): It includes 60 subjects using a computer for >6 hours/day for more than 2 years.

Group II (Short-Duration Computer Operator): It includes 60 subjects using a computer for <2 hours/week for more than 2 years.

Inclusion criteria for participants

• Group I: long-duration computer operators (>6 hrs/day for more than two years).
• Group II: short-duration computer operators (<2 hrs/week for more than two years).
• 18–50 years of age are included.

Table 2. Carpal compression test in long- and short-duration computer operators.

Exclusion criteria for participants

• Musculoskeletal disorders.
• Participants with wrist fracture.
• Participants with any metabolic diseases.
• Congenital disorders
• Those who are not willing to cooperate with the study.
• Participants on any long-term medication.
• IEC approval letter no. N-EC/2022/SC/01/03 dated 11/02/2022 was obtained.
• The study was conducted at the Department of Physiology, MGM Medical College, and Hospital, Kamothe, Mumbai.
• The study was conducted on 120 healthy subjects’ age group between 18 and 50 years.
• Group I: 60 computer workers who work >6 hours/day.
• Group II: 60 computer workers who work for <2 hours per week.
• The subjects from different departments were identified, and after assessing the inclusion and exclusion criteria, those who were eligible for the study were explained the study.
• Written consent from the subject in a known language (Marathi/Hindi/English) was taken.
• Patient information and detailed clinical history were obtained.
• Phalen’s test and the CCT were performed on the participants.

Phalen’s test

To evaluate the median nerve compression, Phalen’s test was performed.

The participant was instructed to raise their arms at the shoulder level, then bring the dorsum of the hands together in midline, compress the back of hands against each other so that the wrists flexed a full 90°, and held it for 1 minute (Fig. 1). Positive test elicits tingling in the median nerve distribution (index finger, and middle and lateral half of the ring finger) and is indicative of carpal tunnel syndrome.

Fig. 3. Phalen’s test for long- and short-duration computer operators.

Fig. 4. Carpal compression test using long- and short-duration computer operators.

Carpal compression test

To test the median nerve compression, the participant’s forearm was kept in the supine position, and then, pressure was applied by the thumb on the participant’s carpal tunnel area between the thenar and hypothenar eminence for 30–60 seconds (Fig. 2). The test was considered positive if the patient responded with numbness and tingling in the median nerve distribution within 30–60 seconds.

Statistical analysis

We used mean and standard deviation to analyze quantitative data. Frequency and percentages for qualitative data. We used the chi-square test to examine Phalen’s test and the CCT.

---

Results

Phalen’s test for long- and short-duration computer operator

In the long-duration group, 15% of participants had a positive Phalen’s test, whereas 1.7% in the short-duration group.

Similarly, duration showed a statistically significant association with Phalen’s test (p-value=<0.05) (Table 1; Fig. 3).

CCT using long- and short-duration computer operators

In the long-duration group, 36.7% of participants had a positive CCT, whereas 6.7% in the short-duration group.

Similarly, duration was statistically significantly associated with the CCT (p-value=<0.05) (Table 2; Fig. 4).

---

Discussion

The study included 120 participants: 60 were long-duration and 60 were short-duration computer operators from MGM Medical College and Hospital, Navi Mumbai.

In the present study, the 15% long-duration group showed positive test results compared with the 1.7% short-duration group. Thus, there is a statistical association of duration with Phalen’s test.

Cunha et al. (2020) showed Phalen’s test with similar results to electroneuromyography studies. Almasi-Doghaee et al. (2016) showed that Phalen’s test can be used for screening suspected CTS patients, but the carpal compression test has more sensitivity and specificity. El Miedany et al. (2008). The sensitivity of Phalen’s test for CTS was 47%, and the specificity was 17%.

---

Conclusion

Long-duration work on computers has given rise to computer-related health problems, such as decreased nerve sensitivity of peripheral nerves, mainly in the median nerve, followed by the ulnar nerve. This may have been due to poor workstation design, improper posture, and working on a computer for a longer duration.

The study showed a statistically significant increase in Phalen’s test and CCT in long-duration computer operators and sensitivity for median nerve compression.

The recently developed CCT performed better than Phalen’s test (PT) in some studies in terms of sensitivity and specificity (Almasi-Doghaee et al., 2016).

The carpal compression test and Phalen’s test are used to diagnose the condition and have been employed as an outcome measure in clinical investigations in this study.

We conclude that Phalen’s test and the carpal compression test can be used for screening compression in the median nerve for early detection of symptoms of CTS, but nerve conduction studies are required for confirmation of the diagnosis and severity of CTS.

---

References

Almasi-Doghaee, M., Boostani, R., Saeedi, M., Ebrahimzadeh, S., Moghadam-Ahmadi, A. and Saeedi-Borujeni, M.J. 2016. Carpal compression, Phalen’s, and Tinel’s tests test which one is more suitable for carpal tunnel syndrome? Iran. J. Neurol. 15(3), 173.

Cunha, T.A., Oliveira Filho, O.M. and Ribeiro, M.B. 2020. Phalen test positivation time and its correlation with electroneuromyography. Acta Ortopédica Brasileira. 28(3), 114–6.

Desai D., Shah C., Soni H., Patel H. and Soni K. A comparative study to assess the changes in the conduction of median nerve at wrist joint in apparently asymptomatic computer users with that in general population [internet]. Oxford, UK: Elsevier Health Sciences; 2014

El Miedany Y., Ashour S., Youssef S., Mehanna A. and Meky F.A. 2008. Clinical diagnosis of carpal tunnel syndrome: old tests–new concepts. Joint Bone Spine. Jul 175(4), 451–7.

Jesus Filho A.G., Nascimento B.F., Amorim M.D., Naus R.A., Loures E.D. and Moratelli L. 2014. Comparative study between physical examination, elctroneuromyography, and ultrasonography in diagnosing carpal tunnel syndrome. Rev. Bras Ortop. 49, 446–51.