Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome

When examining a patient with suspected carpal tunnel syndrome (CTS), clinicians should use Semmes-Weinstein monofilament testing (SWMT), using the 2.83 or 3.22 monofilament as the threshold for normal light touch sensation and static 2-point discrimination on the middle finger to aid in determining the extent of nerve damage. In those with suspected moderate to severe CTS, clinicians should assess any radial finger using the 3.22 filament as the threshold for normal. Semmes-Weinstein monofilament testing should be repeated by the same provider. BIn those with suspected CTS, clinicians should use the Katz hand diagram, Phalen test, Tinel sign, and carpal compression test to determine the likelihood of CTS and interpret examination results in the context of all clinical exam findings.Clinicians should assess and document patient age (older than 45 years), whether shaking their hands relieves their symptoms, sensory loss in the thumb, the wrist ratio index (greater than 0.67), and scores from the Boston Carpal Tunnel Questionnairesymptom severity scale (CTQ-SSS) (greater than 1.9). The presence of more than 3 of these clinical findings has shown acceptable diagnostic accuracy. D There is conflicting evidence on the diagnostic accuracy and clinical utility of the upper-limb neurodynamic tests, scratch-collapse test, and tests of vibration sense in the diagnosis of CTS, and therefore no recommendation can be made. EXAMINATION -OUTCOME MEASURES: ACTIVITY LIMITATIONS/SELF-REPORTED MEASURES BClinicians should use the CTQ-SSS to assess symptoms and the Boston Carpal Tunnel Questionnaire functional scale (CTQ-FS) or the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to assess function when examining patients with CTS. Clinicians should use the CTQ-SSS to assess change in those undergoing nonsurgical management. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL PERFORMANCE MEASURES C Clinicians may use the Purdue Pegboard (PPB) or the Dellon-modified Moberg pick-up test (DMPUT) to quantify dexterity at the onset of treatment and compare scores with established norms. Clinicians should not use the PPB test, Jebsen-Taylor Hand Function Test, or the Nine-Hole Peg Test to assess clinical change following carpal tunnel release (CTR) surgery. Clinicians may use the DMPUT to assess change following CTR surgery. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL IMPAIRMENT MEASURES Strength MeasuresA Clinicians should not use lateral pinch strength as an outcome measure for patients with nonsurgically or surgically managed CTS. B Clinicians should not use grip strength when assessing short-term (less than 3 months) change in individuals following CTR surgery.C Clinicians may assess grip strength and 3-point or tip pinch strength in individuals presenting with signs and symptoms of CTS and compare scores with established norms. D There is conflicting evidence on the use of tip and 3-point pinch strength and abductor pollicis brevis muscle strength testing in individuals following CTR surgery. Sensory and Provocative MeasuresC C...

show abstract

“…The correlation between Quick-DASH scores and electrodiagnostic findings is not statically significant (r = -0.18, P = .08). 276…”

Section: IIImentioning

confidence: 99%

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Erickson¹,

Lawrence²,

Jansen³

et al. 2019

Journal of Orthopaedic & Sports Physical Therapy

View full text Add to dashboard Cite

show abstract

“…The Boston scale has been shown to be responsive to change after treatment, but has not been validated to serve as the threshold between specific severity levels (Atroshi et al., 2006; Gerritsen et al., 2002; Leite et al., 2006). Similarly, patient symptoms, electromyography, and nerve conduction studies have not been found to correlate with patient overall well-being (Tulipan et al., 2017). In fact, recent studies are contesting the notion that surgery be reserved solely for patients with severe CTS, especially when considering cost-utility ratios (Ono et al., 2010).…”

Section: Discussionmentioning

confidence: 99%

Direct and indirect utilities of patients with mild to moderate versus severe carpal tunnel syndrome

Wang

Retrouvey

Krahn

et al. 2020

J Hand Surg Eur Vol

View full text Add to dashboard Cite

Health utility is a quantitative global measure of patients’ health status. This retrospective cohort study aimed to compare health utilities of patients with mild to moderate versus severe carpal tunnel syndrome and determine inter-instrumental agreement. Health utilities of 29 patients with varying severity of carpal tunnel syndrome were measured indirectly by Short-Form Sixth Dimension and EuroQol 5D questionnaire and directly by Chained Standard Gamble and a visual analogue scale. Health utility was 0.69 for Short-Form Sixth Dimension, 0.78 for EuroQol 5D Questionnaire, 0.98 for Chained Standard Gamble, and 0.76 for the visual analogue scale. There was a significant inter-instrumental agreement between three of the instruments, but not the Chained Standard Gamble. The difference in health utilities between patients with mild or moderate versus severe carpal tunnel syndrome was significant only for the EuroQol 5D questionnaire. We conclude based on our results that there are no clear indications on how health utilities can be integrated into decision analysis models and economic evaluation regarding carpal tunnel syndrome of various severities . Level of evidence: IV

show abstract

“…Bakhsh et al 4 found no significant correlation between DASH or BCTQ scores and electrodiagnostic results in a cohort of 48 patients with a primary diagnosis of CTS. Similarly, Tulipan et al 25 evaluated electrophysiologic severity in 50 patients with CTS who completed DASH and found no correlation between degree of median neuropathy and patient-reported symptom severity. The poor correlation between PROs and electrodiagnostic severity is in part due to variability among sensory and motor values, which complicates the achievement of a consensus.…”

Section: Discussionmentioning

confidence: 99%

The PROMIS Upper Extremity Computer Adaptive Test Correlates With Previously Validated Metrics in Patients With Carpal Tunnel Syndrome

Phillips

Freedman

Simon

et al. 2019

Hand (New York, N,Y.)

Self Cite

View full text Add to dashboard Cite

Background: The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) computer adaptive test was developed to improve precision and reduce question burden. We hypothesized that in patients with carpal tunnel syndrome (CTS): (1) PROMIS UE would correlate with established patient-reported outcome measures (PROs); (2) the time and number of questions required would be lower than current metrics; (3) there would be no floor or ceiling effects; and (4) PROMIS UE would not correlate with disease severity. Methods: Patients undergoing electrodiagnostic evaluation found to have a primary diagnosis of unilateral CTS prospectively completed PROMIS UE, Quick Disabilities of the Arm, Shoulder and Hand (qDASH), and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrophysiologic and clinical severity was recorded. The relationships among PROs were described with Spearman coefficients. A floor or ceiling effect was confirmed if >15% of patients achieved the lowest or highest possible score, respectively. Results: Fifty-one patients (average, 53.9 years) were enrolled. An excellent correlation was identified between PROMIS UE and qDASH ( R = −0.76, P < .001). There was a good correlation between PROMIS UE and BCTQ ( R = −0.58, P < 0.001). The PROMIS UE required less time and fewer questions than qDASH and BCTQ ( P = .02 and P < .001). There were no floor or ceiling effects. Neither neurophysiologic nor clinical severity correlated with PROMIS UE ( R = 0.24, P > .05 and R = −0.18, P > .05). Conclusions: The PROMIS UE has an excellent correlation with qDASH and a good correlation with BCTQ in patients with CTS. Furthermore, PROMIS UE required less time and fewer questions than established PROs. Used as a single PRO, PROMIS UE represents a practical alternative to current metrics in patients with CTS.

show abstract

Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome

Cited by 15 publications

References 27 publications

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Direct and indirect utilities of patients with mild to moderate versus severe carpal tunnel syndrome

The PROMIS Upper Extremity Computer Adaptive Test Correlates With Previously Validated Metrics in Patients With Carpal Tunnel Syndrome

Contact Info

Product

Resources

About