Natural history of median nerve sensory conduction in industry: Relationship to symptoms and carpal tunnel syndrome in 558 hands over 11 years

Nathan, Peter A.; Keniston, Richard C.; Myers, Lee D.; Meadows, Kenneth D.; Lockwood, Richard S.

doi:10.1002/(sici)1097-4598(199806)21:6<711::aid-mus2>3.0.co;2-a

Cited by 104 publications

(30 citation statements)

References 16 publications

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“…Results showed that newly hired workers with abnormal baseline NCS were significantly more likely to report a CTS diagnosis during the study period, which is consistent with previous studies 18, 27, 28 . Despite this finding, the predictive validity of such POPP NCS screening is at best low or modest.…”

Section: Discussionsupporting

confidence: 90%

“…A potential limitation of existing studies is the possibility of a survivor bias resulting from selection of subjects who were working for years in a hand-intensive industry 18, 27 ; these studies may have evaluated those workers who remained asymptomatic despite heavy work demands and abnormalities of nerve conduction 29 . Jobs in hand-intensive industries often have high turnover rates creating a natural selection bias against workers at greater risk of developing CTS.…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed that the percentage of future CTS cases that were correctly predicted was highly dependent upon the definition used to define an abnormal screening result. The sensitivity and specificity and positive and negative predictive values of POPP NCS have varied, in part because different criteria were used to define normal and abnormal NCS measures 18, 28 . The increased risk of CTS diagnosis in our study varied widely depending upon the measure chosen to define an abnormal result from a hazard ratio of 2.95 (95% CI: 1.45–6.01, p<0.01) for median DML (>4.5ms) to 11.25 (5.22–24.21, p<0.0001) for abnormal MUDS (>0.5 ms).…”

Section: Discussionmentioning

confidence: 99%

“…Studies of active industrial workers have found a high prevalence of asymptomatic nerve conduction abnormalities, up to 15–20% 18–26 . Available studies indicate that asymptomatic workers with abnormal nerve conduction studies are at a higher risk of developing CTS than asymptomatic workers whose nerve conduction studies are normal 18, 27, 28 .…”

Section: Introductionmentioning

confidence: 99%

“…Available studies indicate that asymptomatic workers with abnormal nerve conduction studies are at a higher risk of developing CTS than asymptomatic workers whose nerve conduction studies are normal 18, 27, 28 . However, the magnitude of the increased risk conferred by nerve conduction abnormalities, the cost benefit of doing such screening, and the effectiveness of different work placement strategies in preventing carpal tunnel syndrome all remain to be defined.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

Gardner

Zeringue

Werner

et al. 2014

Journal of Occupational &Amp; Environmental Medicine

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Objective We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness. Methods 1027 newly hired workers underwent baseline NCS, and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs. Results Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. However, PPV was poor, 6.4–18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds. Conclusions Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost effective to employers in most scenarios tested.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

Gardner

Zeringue

Werner

et al. 2014

Journal of Occupational &Amp; Environmental Medicine

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Clinical Update: Use and Abuse of Electrophysiologic Studies

Katz¹

2000

AMA Guides® Newsletter

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Electrodiagnosis of the Peripheral Nervous System: An Introduction

Katz¹

2014

AMA Guides® Newsletter

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This article is an introduction to electrodiagnosis of the peripheral nervous system, including electromyography, electroneurography (nerve conduction studies), and somatosensory evoked potentials. Electromyography involves the introduction of a special recording needle into a muscle body in search of spontaneous activity (electrical potentials that occur while the muscle is at rest). Three types of spontaneous activity are of greatest relevance: positive sharp waves, fibrillation potentials, and fasciculations. Electromyography can help assess the status of nerve fibers indirectly, but the integrity of large myelinated sensory and motor neurons can be evaluated directly by nerve conduction studies (NCS), also known as electroneurography. NCS involves the introduction of an electrical stimulus, either by surface electrode or needle, and recording an evoked response. NCS can assess motor neurons, sensory neurons, or mixed nerve trunks, depending on the strategy employed. Somatosensory evoked potentials (SSEP) sometimes are useful as an adjunct to EMG and NCS in the diagnosis of peripheral nervous system pathology and are obtained by stimulating a peripheral mixed nerve at a frequency of approximately 2-5 Hz. Several manufacturers have created automated, hand-held units for performing nerve conduction studies, and neuromuscular ultrasound is noninvasive and painless, and ultrasound of nerve entrapment has identified nerve enlargement just proximal to the site of entrapment. Physicians should know or learn the qualifications of the physician to whom they refer their patients for electrodiagnostic assessment.

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Natural history of median nerve sensory conduction in industry: Relationship to symptoms and carpal tunnel syndrome in 558 hands over 11 years

Cited by 104 publications

References 16 publications

The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

Clinical Update: Use and Abuse of Electrophysiologic Studies

Electrodiagnosis of the Peripheral Nervous System: An Introduction

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