Carpal tunnel syndrome is one of the most common conditions I treat, and it is also one of the most commonly self-diagnosed — usually incorrectly. The hand going numb at night gets labeled carpal tunnel. The wrist aching after typing gets labeled carpal tunnel. The fingers feeling stiff in the morning gets labeled carpal tunnel. Some of those are accurate. Many are not. The symptoms of carpal tunnel syndrome — median nerve distribution numbness and tingling — overlap with cervical radiculopathy, pronator syndrome, thoracic outlet syndrome, and several other conditions that require completely different treatment.
What I want to give you today is a single clinical test that is more sensitive than Phalen's test for carpal tunnel — one that you can perform at home before you ever come see me, and one that will tell you whether your symptoms deserve a formal evaluation.
"Phalen's test — the classic prayer-hands wrist flexion maneuver — has a false negative rate of roughly 25–30%. Durkan's compression test is the one I rely on in the clinic."
— Dr. Ben Levine, MDDurkan's test: the technique
The test is called Durkan's compression test, and it was first described by JA Durkan in a landmark 1991 Journal of Bone and Joint Surgery paper. The technique is straightforward. Direct pressure is applied to the carpal tunnel — the soft hollow in the center of your wrist crease — compressing the median nerve directly. This is mechanically more provocative than Phalen's test, which relies on wrist flexion to indirectly compress the tunnel.
How the tests compare: the numbers
In Durkan's original 1991 paper, he compared his compression test to both Tinel's sign and Phalen's test against electrodiagnostically confirmed carpal tunnel syndrome. The compression test showed 87% sensitivity and 90% specificity — outperforming both established tests. Subsequent research has shown some variability in those numbers, but the consistent finding across studies is that Durkan's test is more sensitive than Tinel's sign and at least comparable to Phalen's test, often outperforming it.
| Test | Sensitivity | Specificity | Clinical Utility |
|---|---|---|---|
| Durkan's Compression Test | 71–87% | 90%+ | First-line test in clinic |
| Phalen's Test (wrist flexion) | 50–70% | 84% | Commonly used, moderate miss rate |
| Tinel's Sign (tapping) | 47–60% | 80% | High false negative rate |
The nerve distribution: why location of symptoms matters
Median Nerve (Carpal Tunnel)
Thumb, index finger, middle finger, and the thumb-side half of the ring finger. Symptoms typically in the palm — not the back of the hand. Classic nighttime numbness, waking to shake the hand out.
Ulnar Nerve (Cubital Tunnel)
Ring finger and little finger. Often associated with elbow positioning — worse when elbow is flexed, as when sleeping or holding a phone. We covered this pattern in Issue 1.
What a positive test means — and what it doesn't
A positive Durkan's test is not a diagnosis. It is a strong clinical signal that warrants formal evaluation, which typically means nerve conduction studies and EMG to confirm the diagnosis and assess severity before any treatment decisions are made. What the test gives you is something valuable: an informed reason to seek that evaluation rather than continuing to wonder whether your nighttime hand numbness is something or nothing.
In my experience, patients who understand their own symptoms come to appointments better prepared, ask better questions, and make better decisions about treatment. The Levine CTS-6 Clinical Screen — a validated six-item questionnaire for carpal tunnel diagnosis — uses symptom pattern, hand diagram, and clinical findings to build a probability score before electrodiagnostic testing. Durkan's test is one of the clinical components. You now have one of the tools in that screen.
This came from The Form & Function Brief.
Every Tuesday — one clinical question answered, one condition explained, one piece of gear worth knowing about. Five minutes. Evidence over ego.
Subscribe Free →- Durkan JA. A new diagnostic test for carpal tunnel syndrome. Journal of Bone and Joint Surgery. 1991;73(4):535–538. PMID: 1796937.
- Zhang D, Chruscielski CM, Blazar P, Earp BE. Accuracy of provocative tests for carpal tunnel syndrome. Journal of Hand Surgery Global Online. 2020;2(3):121–125. doi:10.1016/j.jhsg.2020.03.002
- Fowler JR, Cipolli W, Hanson T. A comparison of three diagnostic tests for carpal tunnel syndrome using latent class analysis. Journal of Bone and Joint Surgery. 2015;97(23):1958–1961. doi:10.2106/JBJS.O.00476