A Practical Electrophysiological Guide for Non-Surgical and Surgical Treatment of Carpal Tunnel Syndrome

Abstract

In the present study, we illustrate the use of an electrophysiological classification as a guide to the treatment of carpal tunnel syndrome (CTS). A total of 113 CTS patients were assessed with symptom severity scores, hand functional scores and electrophysiological studies. By setting criteria of electrophysiological tests, 179 hands in 113 patients were classified into mild, moderate and severe degrees of CTS. Of these, the 41 hands with severe CTS were referred for surgery. The 58 hands with moderate CTS and 80 hands with mild CTS received conservative treatment. The improvement ratios in the severe group were greater than that in the moderate and mild groups, both at 6 months and at 1 year. Eighteen hands with moderate or mild CTS returned to normal electrophysiology with the conservative treatments. No patient recovered to normal electrophysiology in the severe group. This electrophysiological classification is objective and it may serve as a useful guide for non-surgical and surgical treatment of CTS.

EMG vs. Thermography in Severe Carpal Tunnel Syndrome

“…Usually, mildly expressed CTS symptomatics in clinical terms is initially treated conservatively. With regard to the decision when and which type of operative relaxation of MN is the most appropriate, there are no uniform scientifically-supported evidences (Chang et al, 2008;Finsen & Russwurm, 2001;Iida et al, 2008;Mondelli et al, 2001). In patients, who refuse surgical procedures, neurophysiological investigation with a very clear clinical picture makes no sense, because it doesn't change their treatment in any way.…”

Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography

“…Moreover, NCS provide information only about the nerve function and pathology rather than the etiology or anatomy. 10 The grading of CTS is a very important factor in deciding on the treatment type 11 ; however, to our knowledge, there have not been many studies proposing a reliable grading system for CTS based on HRUS. [6][7][8][9] Several studies have noted that increases in the crosssectional area (CSA) of the median nerve (MN) in the wrist are the most reliable finding in the diagnosis of CTS.…”

One portal simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia. Do the results justify the effort?

“…Patients had symptoms for a mean period of 43.3 months (range, three to 120 months) in both hands and electrophysiological confirmation of the nature of compression neuropathy. According to nerve conduction and electromyography findings the syndrome was classified as mild, moderate or severe [8].…”