Understanding the Clinical Significance of Durkan’s Test in Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is among the most frequently diagnosed neuropathies, affecting millions of individuals worldwide. Characterized by compression of the median nerve in the carpal tunnel of the wrist, CTS leads to a range of symptoms, including numbness, tingling, hand weakness, and in severe cases, permanent nerve damage. Although widely known clinical maneuvers such as Phalen’s test and Tinel’s sign are integral to diagnosing CTS, Durkan’s Test—also known as the carpal compression test—serves as another valuable diagnostic tool. This article offers a thorough look at the procedure, accuracy, and clinical insights of Durkan’s Test, elucidating how it can help clinicians more accurately identify Carpal Tunnel Syndrome.

The carpal tunnel is a narrow passageway in the wrist formed by carpal bones and the transverse carpal ligament. Within this confined space run nine flexor tendons and the median nerve, which supplies sensation to the thumb, index finger, middle finger, and part of the ring finger. Any swelling, inflammation of the tendons, or narrowing of the tunnel can compress the median nerve, causing:

• Numbness or tingling in the affected fingers
• Nighttime hand pain or discomfort
• Weakness in thumb opposition or pinch strength
• Potential muscle atrophy in chronic or severe cases

Early identification of CTS is critical for preventing permanent nerve damage. The chronic compression of the median nerve can lead to demyelination and, over time, axonal degeneration. Accurate, non-invasive clinical tests help clinicians decide whether more definitive studies such as nerve conduction velocity (NCV) testing or electromyography (EMG) are required and whether a patient might benefit from conservative measures (e.g., splinting, wrist braces) or advanced treatments (e.g., corticosteroid injections, surgery).

While Tinel’s sign and Phalen’s test have historically been the most recognized clinical tests for CTS, Durkan’s Test gained prominence in the mid-1990s, attributed to Dr. James Durkan, who described a direct compression technique aimed at reproducing the patient’s symptoms. The simplicity and direct approach of applying pressure over the carpal tunnel area have made it a popular choice among some healthcare providers.

The technique can also be referred to as the “carpal compression test.” Despite its relative novelty compared to Phalen’s test, Durkan’s Test has emerged as an influential diagnostic maneuver in clinical settings, especially given certain advantages in specificity and reproducibility.

• Direct Median Nerve Compression: Unlike Tinel’s sign, which involves tapping over the median nerve, Durkan’s Test creates sustained pressure in the carpal canal, often mirroring real-life provocative positions (e.g., wrists flexed with load).
• Simplicity: The procedure is straightforward and can be performed easily in a physician’s office without specialized equipment.
• High Clinical Utility: Some studies have demonstrated that this test may have better sensitivity and specificity than older or more established tests when performed correctly.

Though the exact performance metrics can vary depending on methodology, examiner experience, and the patient population, Durkan’s Test remains a valuable addition to the CTS diagnostic toolkit.

Have the patient seated comfortably with the elbow flexed at 90 degrees. The forearm should be supinated (palm facing upward) and supported on a firm surface.

The examiner uses their thumb or thenar eminence to apply direct pressure over the patient’s carpal tunnel (around the distal wrist crease, in line with the ring finger and middle finger).

Gradually press the median nerve within the carpal tunnel. The typical recommended force approximates the pressure you would need to elicit mild but firm compression—often described as around 150 mmHg if measured by specialized tools like a sphygmomanometer or dynamometer. However, in practice, clinicians estimate an even, firm pressure.

Maintain this compression for 30 seconds to 1 minute (some clinicians extend to up to 2 minutes). Observing the patient’s reaction and any reported numbness or tingling is crucial.

A positive Durkan’s Test is indicated by numbness, tingling, or pain in the median nerve distribution (thumb, index, middle, and lateral half of the ring finger). The patient may also describe an uncomfortable, crawling sensation or an intensification of baseline symptoms.

If the patient develops typical CTS symptoms during compression, the test is considered positive. If they do not experience symptom reproduction, the result is negative. However, an isolated negative result does not definitively rule out CTS, especially if the clinical suspicion remains high.

• Be consistent with the location of compression: specifically over the transverse carpal ligament.
• Ensure the wrist is in neutral or slight extension. Flexion or extension of the wrist during the exam can introduce confounding variables.
• Avoid pressing too lightly. Inadequate pressure can yield a false-negative test.

Clinical literature reports a range of sensitivity (40–90%) and specificity (70–90%) for Durkan’s Test, reflecting differences in study design, patient populations, and examiner technique. Generally, research suggests:

• High Specificity: When Durkan’s Test is positive, it strongly suggests a median nerve compression consistent with CTS.
• Moderate Sensitivity: If the test is negative, CTS cannot be entirely ruled out. Patients may still have the condition, especially if other clinical signs or symptoms point toward it.

A commonly cited study by Durkan indicated that this carpal compression technique often yielded slightly higher specificity than Tinel’s sign and Phalen’s test. Nonetheless, combined diagnostic approaches (including nerve conduction studies) typically provide the highest accuracy.

Procedure: Involves tapping the median nerve at the wrist. A positive sign elicits tingling or paresthesia in the nerve distribution.

Pros: Quick, easy, and well-known.

Cons: Can have lower specificity; may be positive in other neuropathies or nerve irritations.

Procedure: The patient flexes both wrists and presses the dorsal surfaces of the hands together for about 60 seconds. A positive result is symptom reproduction.

Pros: Simple, can be done by the patient independently.

Cons: In some patients, wrist flexion can cause discomfort unrelated to CTS. This can lead to false positives, especially in individuals with arthritis or other wrist pathologies.

Procedure: The patient extends both wrists with the palmar surfaces pressed together.

Clinical Utility: Another variation for eliciting median nerve compression.

Accuracy: Similar to Phalen’s test but used less commonly.

Key Insight: Durkan’s Test complements these existing maneuvers by directly mimicking the pressure on the median nerve. Each test has its strengths and weaknesses; combining tests enhances overall diagnostic accuracy.

Family physicians can use Durkan’s Test as a quick screening tool when patients present with nocturnal hand numbness or suspected CTS.

Orthopedic surgeons employ this test in conjunction with imaging or NCV/EMG studies to grade the severity of CTS.

Durkan’s Test can help identify employees at risk due to repetitive strain, especially those in assembly lines or jobs requiring forceful wrist flexion/extension.

Physical therapists and hand therapists may use the test to monitor treatment progress, adjusting therapy or splinting strategies as needed.

While physical exam maneuvers such as Durkan’s Test, Tinel’s sign, and Phalen’s test are common first steps, additional tests often come into play:

Measure the speed of conduction through the median nerve. Slowed conduction across the wrist segment strongly supports a CTS diagnosis.

Checks for muscle denervation in the abductor pollicis brevis muscle, which the median nerve innervates.

May show median nerve swelling in the carpal tunnel. Ultrasound can also visualize structural anomalies (e.g., ganglion cysts).

Rarely used as a routine investigation due to expense but can identify soft tissue changes or subtle anatomic variations.

Durkan’s Test is often performed before ordering these more advanced studies, helping guide clinical decision-making and justify further diagnostics.

Clinical Impression: Suggests median nerve compression. Patients with a positive test frequently report tingling, numbness, or an electric shock-like sensation in the median nerve distribution.

Next Steps:

• Confirm with nerve conduction tests or EMG.
• Begin conservative management (night splints, wrist braces, ergonomic modifications, NSAIDs).
• Assess severity for possible referral to a hand surgeon.

Clinical Impression: Reduced likelihood of CTS, though not an absolute rule-out.

Possible Explanations:

• Improper technique or insufficient force.
• Mild or early-stage CTS that is not readily reproducible.
• Alternative diagnoses (e.g., cervical radiculopathy, pronator teres syndrome).

If clinical suspicion remains high, clinicians may proceed with further tests despite a negative Durkan’s.

The force of compression can vary between clinicians, influencing the test’s outcome.

Patients with a low pain threshold or significant wrist tenderness may find Durkan’s Test uncomfortable, possibly confounding results.

Osteoarthritis, rheumatoid arthritis, or wrist tendonitis might also cause discomfort, creating false positives.

Some individuals have structural differences (e.g., thickened transverse carpal ligament, bifid median nerve) affecting the test results.

Despite these challenges, consistency in technique and a thorough patient history can mitigate many of these limitations.

Wrist Splinting: Encourages the wrist to remain in a neutral position, minimizing median nerve compression. Often used at night to combat nocturnal symptoms.

Activity Modification: Advising patients to avoid repetitive wrist flexion/extension or providing ergonomic tools and keyboards.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): May provide relief if inflammation contributes to symptoms.

Physical Therapy: Targeted exercises, tendon glides, nerve gliding techniques, and ultrasound therapy can reduce mild cases of CTS.

Corticosteroid Injections: Reduce swelling of synovial tissues in the carpal tunnel, often providing temporary relief.

Carpal Tunnel Release Surgery: Used in moderate to severe cases or when conservative treatments fail. This can be done using open or endoscopic techniques to divide the transverse carpal ligament and decompress the nerve.

Follow-Up Evaluations: Patients should be re-assessed post-surgery to ensure symptom resolution and nerve recovery.

Combine Tests for Higher Accuracy: Using Durkan’s Test alongside Tinel’s sign and Phalen’s test increases diagnostic confidence.

Observe Response Timing: Symptoms arising quickly after applying compression (within 15 seconds) often point to moderate to severe CTS.

Perform Bilateral Exams: Many CTS patients have symptoms in both hands. Compare results to see if one side is more severely impacted.

Document Objectively: Note the exact timing of symptom onset, type of symptoms (tingling vs. pain), and distribution for a clearer record.

Durkan’s Test is a practical, direct compression maneuver offering valuable insights into Carpal Tunnel Syndrome. While not a standalone diagnostic tool, it provides an additional layer of clinical information when combined with a thorough patient history, Phalen’s test, Tinel’s sign, and advanced diagnostics like nerve conduction studies. A positive Durkan’s Test strongly suggests median nerve compression, guiding clinicians toward effective treatment strategies—ranging from conservative splinting and ergonomic adjustments to possible surgical intervention.

• Procedure: Simple, involving direct pressure to the median nerve at the carpal tunnel.
• Accuracy: Often offers good specificity, particularly useful for confirming CTS in suspected cases.
• Comparisons: Complements Tinel’s sign and Phalen’s test for a well-rounded clinical picture.
• Clinical Application: Used in primary care, orthopedics, occupational health, and rehabilitation settings.
• Holistic Management: After a positive test, clinicians can recommend conservative to surgical interventions based on severity and nerve conduction results.

By understanding Durkan’s Test, healthcare practitioners can bolster their ability to diagnose CTS early, implement targeted interventions, and help patients preserve hand function and quality of life.

Also Read:

• 7 Prevention Tips for Carpal Tunnel Syndrome
• Surgery for Carpal Tunnel Syndrome and Its Recovery Time
• Massage Therapy Can Do Wonders in Treating Carpal Tunnel Syndrome (CTS)
• Disability Benefits for Carpal Tunnel Syndrome