False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome

Background: Previous studies do not agree with each other on the association between electrodiagnostic findings and clinical symptoms of Carpal tunnel syndrome (CTS). In most of these studies, many variables such as age, sex, obesity and hypothyroidism have not been taken into account. Material & methods: About 62 patients with hypothyroidism and 62 patients without hypothyroidism with sign and symptoms of CTS were included in this study. Electrodiagnostic tests were done for all patients. And relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters was examined statistically in each group. Results: This study showed that distal motor latency in control group (without hypothyroidism) is significantly more prolonged than hypothyroid patients. Also there was significant correlation between clinical symptoms and electrodiagnostic findings in control group, but there was not such correlation in hypothyroid patients. In 62% of hypothyroid patients with clinical signs and symptoms of CTS, electrodiagnostic findings were normal and only in 38% of cases, electrodiagnostic findings were suggestive of CTS. Conclusion: Relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters is very weak in hypothyroid patients. Many hypothyroid patients with clinical signs and symptoms of CTS have normal electrodiagnostic findings; so we need more studies for revising the para-clinic criteria of labeling patients having CTS in hypothyroid patients.

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Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist?

Journal of Clinical Medicine ◽

10.3390/jcm10184208 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4208

Author(s):

Fatma Kilinc ◽

Bedjan Behmanesh ◽

Volker Seifert ◽

Gerhard Marquardt

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Surgical Intervention ◽

Clinical Signs ◽

Signs And Symptoms ◽

Long Term Results ◽

Transverse Ligament ◽

Tunnel Syndrome ◽

Clinical Signs And Symptoms

The aim of this study was to evaluate whether recurrent carpal tunnel syndrome (CTS) after complete and sufficient division of the transverse ligament really exists. Another goal was to analyze the underlying reasons for recurrent CTS operated on in our department. Over an observation period of eleven years, 156 patients underwent surgical intervention due to CTS. The records of each patient were analyzed with respect to baseline data (age, gender, affected hand), as were clinical signs and symptoms pre- and postoperatively. To assess long-term results, standardized telephone interviews were performed using a structured questionnaire in which the patients were questioned about persisting symptoms, if any. Of the 156 patients, 128 underwent first surgical intervention due to CTS in our department. In long-term follow-up, two-thirds of these patients had no symptoms at all; one-third of the patients described mild persisting numbness. None of the patients experienced a recurrence of CTS. The 28 patients who received their first operation outside of our department were operated on for recurrent CTS. The cause of recurrence was incomplete division of the distal part of the transverse carpal ligament in all cases. The results suggest that recurrent CTS after complete and sufficient division of the transverse ligament is very unlikely.

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A new method to define cutoff values in nerve conduction studies for carpal tunnel syndrome considering the presence of false-positive cases

Neurological Sciences ◽

10.1007/s10072-019-04145-2 ◽

2019 ◽

Vol 41 (3) ◽

pp. 669-677

Author(s):

Yosuke Miyaji ◽

Masahito Kobayashi ◽

Chizuko Oishi ◽

Yoshikazu Mizoi ◽

Fumiaki Tanaka ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

False Positive ◽

Nerve Conduction Studies ◽

New Method ◽

Cutoff Values ◽

Tunnel Syndrome

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Correlation of Clinical Signs with Nerve Conduction Tests in the Diagnosis of Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90244-5 ◽

1994 ◽

Vol 19 (6) ◽

pp. 720-724 ◽

Cited By ~ 88

Author(s):

N. BUCH-JAEGER ◽

G. FOUCHER

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Clinical Signs ◽

Nerve Conduction Studies ◽

Clinical Criteria ◽

Operative Evaluation ◽

Tunnel Syndrome ◽

Phalen's Test ◽

A Prospective Study

In order to establish the need for nerve conduction studies, a prospective study has been performed on 112 patients with symptoms of carpal tunnel syndrome (172 symptomatic hands), seeking correlation with 11 clinical criteria taken either singly or in combination. Even when the patient presents with a typical clinical presentation of carpal tunnel syndrome the diagnosis is only confirmed electrophysiologically in 61% of cases. Analysis of the sensitivity and specificity of various clinical tests and diagnostic manoeuvres has shown their mediocre reliability in establishing the diagnosis with a sensitivity of 58% and a specificity of 54% for Phalen’s test. We consider nerve conduction studies to be an indispensable part of the pre-operative evaluation.

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LP48: Segmental nerve conduction studies for distinguishing carpal tunnel syndrome from diabetic neuropathy in diabetics presenting with hand paresthesia

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50887-5 ◽

2014 ◽

Vol 125 ◽

pp. S271

Author(s):

M.S.H. El Morsi ◽

D.M.F. Mohasseb ◽

G.A. Youniss ◽

M.M. Hassan

Keyword(s):

Carpal Tunnel Syndrome ◽

Diabetic Neuropathy ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Nerve Conduction Studies ◽

Segmental Nerve ◽

Tunnel Syndrome

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Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100017 ◽

2009 ◽

Vol 67 (1) ◽

pp. 69-73 ◽

Cited By ~ 8

Author(s):

Dante Guilherme Velasco Hardoim ◽

Guilherme Bueno de Oliveira ◽

João Aris Kouyoumdjian

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Sensory Nerve ◽

Nerve Conduction Studies ◽

Sensory Nerve Action ◽

Tunnel Syndrome ◽

The Mean ◽

Compound Action

OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) <46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) >4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

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Automatic Electrodiagnosis of Carpal Tunnel Syndrome Using Machine Learning

Bioengineering ◽

10.3390/bioengineering8110181 ◽

2021 ◽

Vol 8 (11) ◽

pp. 181

Author(s):

Konstantinos I. Tsamis ◽

Prokopis Kontogiannis ◽

Ioannis Gourgiotis ◽

Stefanos Ntabos ◽

Ioannis Sarmas ◽

...

Keyword(s):

Machine Learning ◽

Decision Making ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Automatic Detection ◽

Nerve Conduction Studies ◽

Machine Learning Techniques ◽

Tunnel Syndrome

Recent literature has revealed a long discussion about the importance and necessity of nerve conduction studies in carpal tunnel syndrome management. The purpose of this study was to investigate the possibility of automatic detection, based on electrodiagnostic features, for the median nerve mononeuropathy and decision making about carpal tunnel syndrome. The study included 38 volunteers, examined prospectively. The purpose was to investigate the possibility of automatically detecting the median nerve mononeuropathy based on common electrodiagnostic criteria, used in everyday clinical practice, as well as new features selected based on physiology and mathematics. Machine learning techniques were used to combine the examined characteristics for a stable and accurate diagnosis. Automatic electrodiagnosis reached an accuracy of 95% compared to the standard neurophysiological diagnosis of the physicians with nerve conduction studies and 89% compared to the clinical diagnosis. The results show that the automatic detection of carpal tunnel syndrome is possible and can be employed in decision making, excluding human error. It is also shown that the novel features investigated can be used for the detection of the syndrome, complementary to the commonly used ones, increasing the accuracy of the method.

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KINESIOLOGY TAPING AND NEURAL GLIDING EXERCISE IN CARPAL TUNNEL SYNDROME

International journal of Research science and Management - September-2020 ◽

10.29121/ijrsm.v7.i7.2020.2 ◽

2020 ◽

Vol 7 (7) ◽

pp. 13-16

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Nerve Conduction Studies ◽

Factory Workers ◽

Wrist Movement ◽

Tingling Sensation ◽

Repetitive Injury ◽

Tunnel Syndrome ◽

Carpal Tunnel Questionnaire

Introduction: Carpal Tunnel Syndrome (CTS) is a condition of neuropathy caused by median nerve entrapment, which is related to repetitive injury mostly due to workload. Some people have occupation that require a lot of repetitive wrist movement such as cigarette factory workers. Kinesiology taping and neural gliding exercises are conservative interventions, which can be performed on people with CTS. Case: This case report showed that there was improvement symptom of carpal tunnel syndrome treated with kinesiology taping and neural gliding exercise. The patient was female, 43 years old, a cigarette factory worker. She had complains of tingling sensation on her palms, moreover on finger 1, 2 and 3 since 2 weeks before. The physical examination revealed positive test of carpal tunnel syndrome such as Phalen, Pressure Provocation and Tinel test. Boston Carpal Tunnel Questionnaire (BCTQ) was also performed. The diagnose was confirmed with nerve conduction studies result. Kinesiology taping was applied on this patient and reapplied weekly until 4 weeks. Patient was also taught about neural gliding exercise and was asked to do it every day for 4 weeks. BCTQ was evaluated weekly and improved every week. While nerve conduction studies was evaluated in 4 weeks and there was also improvement in the result. Conclusion: The improved outcome occurring in this case shows that kinesiology taping and neural gliding exercise can be considered as management of carpal tunnel syndrome, but of course further research is needed to prove its significance.

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