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WED 222 Hawkes sign: a novel test for carpal tunnel syndrome
  1. Hawkes Christopher
  1. Barts and The London Hospital


Background In carpal tunnel syndrome (CTS) patients often report symptoms when elevating the arms, as in driving or phoning.

In Hawkes test both forearms are squeezed firmly about 50 mm (2 inches) proximal to the patient’s wrist while simultaneously elevating the subject’s hands just above shoulder height. When positive there is tingling in a median nerve distribution within a few seconds.

Methods Fifteen patients with suspected CTS were evaluated by a) Tinel’s, Phalen’s and Hawkes’ manoeuvres b) routine nerve conduction tests (NCT) then graded positive or negative and compared with NCT.

Results Positive signs were present for Tinel in 14/15; Phalen in 8/10 and Hawkes in 15/15. NCT supported CTS in 9/15. Where NCT were abnormal Tinel and Hawkes signs were always positive but Phalen was negative in 2/7. Where NCT was normal (6/15) the negative/positive rates were: Tinel 1/5; Phalen 3/3; Hawkes 0/6.

Conclusion All three procedures, particularly Tinel and Hawkes had a high positive rate for CTS, but confirmed by NCT in only 6/15. However, NCT may be falsely negative especially in mild cases. The proposed arm elevation/compression test permits useful initial assessment of CTS although the false positive rate is probably high.

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