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Median Nerve Compression (Durkan's Test)

Exams and Signs

Historical Overview

  • Paget first published descriptions of compression of the median nerve in 1853. In 1947, when W. Russell Brain described compression of the median nerve in the carpal tunnel, he concluded that occupation is one of the causal factors.1

Description

  • The median nerve compression test is also called Durkan’s test.
  • Mostly commonly, compression of the median nerve results in carpal tunnel syndrome.

Pathophysiology

  • Compression neuropathy arises when there is more than normal pressure on a nerve from an adjacent anatomic structure.2
  • Chronic neuropathy may be related to conditions such as diabetes or hypothyroidism.2

Instructions

  1. Apply sufficient pressure over the carpal tunnel to cause skin blanching (≥30 sec)
  2. Observe the patient for symptoms of pain or paresthesias, which will be similar to the symptoms s/he experiences at night

Variations

  • In some cases, Durkan’s test is performed using a calibrated piston over the transverse carpal ligament.3

Related Signs and Tests

  • Pinch strength
  • Tinel’s test
  • Phalen’s test

Diagnostic Performance Characteristics

  • To diagnose carpal tunnel syndrome with high sensitivity and specificity, a positive median nerve compression test needs to be accompanied by a patient completed hand-diagram, the presence of night pain and abnormal sensibility by monofilament testing. A diagnosis of carpal tunnel syndrome will be correct 86% of the time, if all four are abnormal.3
Presentation Photos and Related Diagrams
  • Median Nerve Compression Test
    Median Nerve Compression Test
Classic Durkan Test
  • Dr. John Durkan demonstrating the application of pressure on the interthenar portion of the median nerve during the Durkan test. Image provided by Dr. Durkan.
    Dr. John Durkan demonstrating the application of pressure on the interthenar portion of the median nerve during the Durkan test. Image provided by Dr. Durkan.
Definition of Positive Result
  • A positive result occurs when the patient experiences paresthesias within 30 seconds of applied pressure over the carpal tunnel.
Definition of Negative Result
  • A negative result occurs when the patient does not experience paresthesias within 30 seconds of applied pressure to the carpal tunnel.
Comments and Pearls
  • Nerves can be compressed at multiple levels. In the double crush phenomenon, cervical radiculopathy is superimposed on a peripheral compression neuropathy.4
Diagnoses Associated with Exams and Signs
Videos
Median Nerve Compression Exam
Median nerve compression test is part of the 35 second carpal tunnel syndrome complete exam
YouTube Videos
Carpal Tunnel Syndrome
References
  1. Boskovski MT, Thomson JG. Carpal Tunnel Syndrome, Syndrome of Partial Thenar Atrophy, and W. Russell Brain: A Historical Perspective. J Hand Surg Am 2014;39(9):1822-29. PMID: 25063392
  2. Doyle JR. Hand and Wrist. Philadelphia: Lippincott Williams & Wilkins, 2006.
  3. Szabo R, Slater R, Farver T, et al. The Value of Diagnostic Testing in Carpal Tunnel Syndrome. J Hand Surg Am 1999;24:704-14. PMID: 10447161
  4. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
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