Which of the following is NOT one of the carpal tunnel CPR points?

• A. Shaking hands to relieve symptoms
• B. Wrist ratio > 0.67
• C. Symptom severity scale > 1.9
• D. Phalen's test

Answer: (D)

These carpal tunnel CPR points are a concise set of bedside clues that together help predict carpal tunnel syndrome without nerve testing. Shaking the hands to relieve symptoms is included because patients often report symptom relief with rest or movement, reflecting the intermittent nature of median nerve compression. A wrist ratio greater than 0.67 is included as an anatomical risk indicator—the ratio captures how the wrist’s dimensions can predispose to tunnel crowding. A symptom severity scale above 1.9 provides a quantitative measure of how burdensome the symptoms are, which strengthens the prediction.

Phalen’s test, while a classic provocative maneuver for CTS, isn’t part of this particular CPR. It’s a diagnostic maneuver that can be positive in CTS but doesn’t add independent predictive value within the multivariate rule used to derive the CPR, so it isn’t included as one of the CPR points.