A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome

Wang, William L.; Buterbaugh, Kristin; Kadow, Tiffany R.; Goitz, Robert J.; Fowler, John R.

doi:10.1016/j.jhsa.2018.05.022

Cited by 28 publications

(24 citation statements)

References 16 publications

(10 reference statements)

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“…14 Studies are consistent in finding that EDS is not the reference standard test to diagnose CTS and that physical examination findings alone are sufficient to diagnose CTS in patients with classic symptoms. 15–20 Furthermore, previous studies demonstrated that for patients with a high probability of CTS based on examination criteria alone, EDS does little to change the probability of diagnosis. 18,21 Wang et al 20 recently demonstrated the relatively poor specificity of nerve conduction studies in the prospective diagnosis of CTS, which means that the routine use of EDS as a confirmatory test to diagnose CTS before a surgical consultation could be considered wasteful.…”

Section: Discussionmentioning

confidence: 99%

“…15–20 Furthermore, previous studies demonstrated that for patients with a high probability of CTS based on examination criteria alone, EDS does little to change the probability of diagnosis. 18,21 Wang et al 20 recently demonstrated the relatively poor specificity of nerve conduction studies in the prospective diagnosis of CTS, which means that the routine use of EDS as a confirmatory test to diagnose CTS before a surgical consultation could be considered wasteful. Although EDS may be helpful in scenarios in which the diagnosis is unclear, using EDS routinely as a confirmatory test has little value in directing treatment recommendations for patients with classic symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System

Sears

Meerwijk

Schmidt

et al. 2019

The Journal of Hand Surgery

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Purpose To evaluate facility-level variation in the use of services for patients with carpal tunnel syndrome (CTS) receiving care in the Veterans Health Administration (VHA). Methods A national cohort of VHA patients diagnosed with CTS during fiscal year 2013 was divided into nonsurgical and operative treatment groups for comparison. We assessed the use of 5 types of CTS-related services (electrodiagnostic studies [EDS], imaging, steroid injection, oral steroids, and therapeutic modalities) in the prediagnosis and postdiagnosis periods before any operative intervention at the patient and facility levels. Results Among 72,599 patients newly diagnosed with CTS, 5,666 (7.8%) received carpal tunnel release within 12 months. The remaining 66,933 (92.2%) were in the nonsurgical group. Therapeutic modalities and EDS were the most commonly employed services after the index diagnosis and had large facility-level variation in use. At the facility level, the use of therapeutic modalities ranged from 0% to 93% in the operative group (mean, 32%) compared with 1% to 67% (mean, 30%) in the nonsurgical group. The use of EDS in the postdiagnosis period ranged from 0% to 100% (mean, 59%) in the operative treatment group and 0% to 55% (mean, 26%) in the nonsurgical group at the facility level. Conclusions There is wide facility variation in the use of services for CTS among patients receiving operative and nonsurgical treatment. Care delivered by facilities with the highest and lowest rates of service use may suggest overuse and underuse, respectively, of nonsurgical CTS services and a lack of consideration of individual patient factors in making health care decisions regarding use. Clinical relevance Surgeons must understand the degree of treatment variability for CTS, comprehend the ramifications of large variation in reimbursement and waste in the health care system, and become involved in devising strategies to optimize hand care across all phases of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System

Sears

Meerwijk

Schmidt

et al. 2019

The Journal of Hand Surgery

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“…Clinically, CTS is characterized by multiple alterations, both motor and sensory [ 21 ]: nocturnal paraesthesia, numbness, tingling, decreased sensitivity and pain in the territory innervated by the median nerve, decreased grip strength, and atrophy of the thenar eminence [ 22 ]. Recent evidence defines CTS as a complex pain syndrome characterized by the presence of clinical, physical, neurophysiological, and psychological factors involving peripheral and central sensitization processes [ 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods

Scalise

Brindisino

Pellicciari

et al. 2021

IJERPH

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The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents (n = 225/508; 44.3%) are under 29 years old, female (n = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years (n = 213/508; 41.9%). Most of respondents correctly knows about the cause (n = 455/508, 89.6%), main signs and symptoms of CTS (n = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises (n = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient’s outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master’s degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.

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“…Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper limbs due to compression of the median nerve at the level of the carpal tunnel. 1 The diagnosis is usually made through clinical history and physical examination, 2 while electroneuromyography (ENMG) assists in the diagnostic confirmation of doubtful cases and in establishing the severity. 3,4 In 1990, Katz et al 5 popularized hand diagrams, which are schematic drawings in which the patient marks the exact location of the numbness symptoms in the hands.…”

Section: Introductionmentioning

confidence: 99%

Existe associação entre o diagrama da parestesia da mão e a eletroneuromiografia no diagnóstico da Síndrome do Túnel do Carpo?

Filho

Costa

Paiva

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Verificar se existe associação entre o diagrama da parestesia da mão (DPM) e os resultados da eletroneuromiografia (ENMG) no diagnóstico da síndrome do túnel do carpo. Métodos Um total de 92 pessoas preencheram um desenho esquemático da mão com o local exato da parestesia (167 mãos). O autor principal classificou os diagramas de acordo com os critérios de Katz et al. Os resultados do DPM foram cruzados com os resultados positivos da ENMG para o diagnóstico da síndrome do túnel do carpo. Resultados O padrão possível do DPM foi prevalente tanto isoladamente quanto após o cruzamento com os graus da ENMG. Conclusão Não houve associação entre o DPM e a ENMG no diagnóstico da síndrome do túnel do carpo.

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A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome

Abstract: Consideration should be given to using alternative diagnostic tests/tools based on the results of this study.

Cited by 28 publications

References 16 publications

Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System

Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System

Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods

Existe associação entre o diagrama da parestesia da mão e a eletroneuromiografia no diagnóstico da Síndrome do Túnel do Carpo?

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