Background: The diagnosis of diagnosing Carpal Tunnel Syndrome through provocative testing is controversial. The Purpose of this study is to establish a relationship between electrodiagnostic severity and provocative tests. Methods: A prospective study was conducted in 277 hands, which underwent surgery for carpal tunnel release. CTS severity was determined according to the modified Stevens Criteria(mild, moderate and severe). The relationship between electrodiagnostic severity and the sensitivity of three provocative tests(Phalen's, Tinel's and Hand Elevation Test) was investigated. A correlation between each individual test was established for each level of electrodiagnostic severity. The results were then statistically analyzed. Results: All three provacative tests showed highest sensitivity for the 'moderate level of electrodiagnostic severity. The Hand Elevation Test and Phalen's Test had the highest correlation for all levels of electrodiagnostic severity(range: 0.41~0.66). Interpretations: The sensitivities of all the provocative tests are different according to the levels of electrodiagnostic severity. Provocative tests have little merit as diagnostic tools in 'severe' and 'mild' cases of CTS. The provocative tests are much more reliable in 'moderate' cases.
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