Nerve Conduction Studies for Carpal Tunnel Syndrome: Gold Standard or Unnecessary Evil?

This prospective study compared the sensitivities of a scored questionnaire and electrophysiological examination in the diagnosis of carpal tunnel syndrome. Patients were assessed by a hand surgeon using a scored questionnaire, and then underwent an electrophysiological assessment by an experienced neurophysiologist (blinded to the questionnaire results). Patients diagnosed as having carpal tunnel syndrome by either the questionnaire, the electrophysiological examination or both underwent decompression. Symptom relief was taken as the “gold standard” for true carpal tunnel syndrome. The results showed a sensitivity of 85% for the scored questionnaire and 92% for nerve conduction studies with a positive predictive value of 90% for the scored questionnaire and 92% for nerve conduction studies. The authors recommend that a scored questionnaire can replace nerve conduction studies in the initial assessment of whether patients presenting with dysaesthesiae in the fingers should undergo surgery. This will give major time, personnel and cost benefits.

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Ultrasound: A Screening Tool for Carpal Tunnel Syndrome

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-26-4-102 ◽

2015 ◽

Vol 26 (4) ◽

pp. 102-108

Author(s):

Bobeena Rachel Chandy ◽

M. Betty ◽

Henry Prakash Magimairaj ◽

Binu P. Thomas ◽

George Tharion

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Gold Standard ◽

Screening Tool ◽

Nerve Conduction Studies ◽

Cross Sectional ◽

Non Invasive ◽

Tunnel Syndrome

Abstract Background Electrodiagnostic test is considered as the gold standard for diagnosis of carpal tunnel syndrome (CTS). Ultrasonography provides a simple non-invasive means of visualising peripheral nerve pathology. Objective The objective of the study was to assess the role of ultrasonography in CTS and its correlation with the present day gold standard of nerve conduction studies (NCS). Materials and Methods A prospective cohort size of 100 subjects was calculated based on a hypothesized sensitivity of 90% and a confidence interval of 85-95%. All 100 subjects, 64 controls and 36 patients underwent nerve conduction studies and USG. Transverse images of the median nerve were obtained at three levels: proximal to the carpal tunnel inlet, at the carpal tunnel inlet and at the carpal tunnel outlet. The flattening ratio was also assessed at the tunnel inlet and outlet. Statistical analysis was done to corelate the ultrasound findings at each level with nerve conduction studies and calculation of the positive and negative predictive values. The cut offs of the cross-sectional areas of the median nerve at the three anatomical levels on ultrasonography were taken at the best sensitivity and specificity according to the ROC curve. Results We found that at any one anatomical level, the sensitivity of ultrasound to detect carpal tunnel syndrome by increase in the cross-sectional area of median nerve as compared to the nerve conduction studies is 90%. Conclusions At 45% specificity, ultrasonography could be used as a non-invasive and easily available screening tool in carpal tunnel syndrome. Also, the best level to look for nerve compression is at the level of the carpal tunnel inlet.

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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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