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To the Editor: To establish sensitivity, specificity, and likelihood ratios for a diagnostic test, the investigation must include both patients with and without the disease. However, in their review of carpal tunnel syndrome (CTS), Drs D'Arcy and McGee¹ define likelihood ratios as the "odds that a given finding would occur in a patient with CTS as opposed to one without CTS," but they excluded articles with asymptomatic control groups. The use of asymptomatic control subjects ensures that patients are included who do not have any evidence of nerve compression. Thus, the 14 studies that D'Arcy and McGee excluded on this basis should have been included in the assessment of the CTS diagnostic criteria.

We also question their anatomic criteria. The hand diagram for classic CTS as shown in Figure 3 in their article describes symptoms involving the fourth and fifth digits. By contrast, classic anatomists describe the median and ulnar . . . [Full Text of this Article]

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