Prospective Comparison of the Six-Item Carpal Tunnel Symptoms Scale and Portable Nerve Conduction Testing in Measuring the Outcomes of Treatment of Carpal Tunnel Syndrome with Steroid Injection

Abstract

Background We prospectively studied patients clinically diagnosed with carpal tunnel syndrome (CTS) and treated with the injection of corticosteroid into their carpal tunnel in order to compare changes in the six-item CTS symptoms scale and portable nerve conduction study (NCS) parameters as outcome tools. Our pilot study was the first to assess the utility of the six-item CTS symptom scale (CTS-6) with steroid injections as a patient-directed outcome measure for the treatment of CTS. Methods We enrolled patients who presented to our county hospital orthopedic surgery clinic from August 2012 through August 2013. The patients were clinically diagnosed with CTS. After completing the six-item CTS symptoms scale questionnaire, portable NCS was obtained. Each patient then received an injection of 1 ml of triamcinolone acetonide 40 mg/ml mixed with 1 ml of 1 % lidocaine into the carpal tunnel. Six weeks postinjection, each patient repeated a CTS-6 questionnaire and underwent a repeat portable NCS. The CTS-6 and NCS results were analyzed using the paired samples t test. A Pearson correlation was used to assess the correlation between the changes in the CTS-6 and the NCS measurements. Statistical significance was set at P<0.05. Results Thirty-two wrists in 20 patients were evaluated. There was a statistically significant difference between the CTS-6 scores before and after injection. There were also statistically significant changes in the five of the NCS parameters. None of the correlations between the CTS-6 and the NCS parameters were statistically significant. Conclusions The six-item CTS symptoms scale and portable NCS are both useful measures for evaluating the results of steroid injections. The CTS-6 is an effective tool because of its ease of use, low cost, correspondence with changes in NCS, and ability to monitor the outcome of steroid treatment for carpal tunnel syndrome.

Measuring symptoms severity in carpal tunnel syndrome: score agreement and responsiveness of the Atroshi-Lyrén 6-item symptoms scale and the Boston symptom severity scale

“…The A-L scale has previously demonstrated good construct validity and reliability for measuring symptoms severity in CTS, both after surgical treatment [10,14] and after steroid injection [12]. This was also the case in our present study (Cronbach alpha estimates 0.89-0.91).…”

“…The responsiveness of the 6-item scale has also been established [11]. Since its introduction, the Atroshi-Lyrén (A-L) 6-item CTS symptoms scale has been translated to various languages and used in clinical studies [12][13][14]. It is not known whether the scores of the Boston and the A-L scales are equivalent to enable direct score comparisons across studies that have used either scale.…”

Patient-Reported Outcomes and Provocative Testing in Peripheral Nerve Injury and Recovery

“…The CTS-6 is also reliable and responsive in tracking postoperative changes. 58,60 Items removed from the CTS to develop the CTS-6 were ultimately deemed redundant or nonessential to characterize median nerve status. 58…”