Quality measures in electrodiagnosis: Carpal tunnel syndrome—An AANEM Quality Measure Set

Abstract

Carpal tunnel syndrome (CTS) is a common neuromuscular condition and a major cause of work‐related disability. As healthcare in the United States transitions toward a value‐based system from fee‐for‐service, quality measures assume importance in the evaluation of care provided. This report from the American Association of Neuromuscular & Electrodiagnostic Medicine Quality Improvement Committee provides an introduction to quality measures and outlines a quality measurement set for the electrodiagnosis of CTS. The measures attempt to standardize technical requirements for electrodiagnostic (EDX) studies of CTS, the criteria for diagnosing median neuropathy at the wrist and assessing its severity, and the role of operative EDX testing. The assumption is that implementation of these measures will improve the accuracy of CTS diagnosis when EDX is performed, help exclude mimics, and, therefore, improve care of patients with CTS with the ultimate goal of improving outcomes. Postimplementation assessment of outcomes will refine these measures.

A new diagnostic morphological parameter for the Carpal tunnel syndrome: The palmaris longus tendon cross-sectional area

“…Women are 3 times more likely to have CTS than men, and the prevalence and severity have been documented to increase with aging process. [ 16 , 17 ] The most common symptoms of CTS are pain, numbness, and paresthesia in the index, middle, thumb and radial half of the fourth finger that is worst at night. Wrist extension and flexion increase pressure in the CT, and wrist flexion during sleep may worsen symptoms such that CTS patients awake with numbness and burning to the hand.…”

“…confirmation by a nerve conduction examination according to the American Academy of Neurology standards. [ 16 ]…”

“…2) W-MR image taken within 1 year; 3) confirmation by a nerve conduction examination according to the American Academy of Neurology standards. [16] The exclusion criteria 1) double crush syndrome; 2) wrist fracture;…”

Carpal tunnel syndrome: state-of-the-art review

“…In cases with longstanding and severe compression, there is evidence of denervation on EMG needle sampling of the abductor pollicis brevis muscle. The minimum requirements for the EDX evaluation of CTS outlined in the AANEM Practice Parameters and in Clinical Quality Measures published by the Carpal Tunnel Quality Group are testing of median sensory latency, testing of median distal motor latency, another sensory and motor nerve study in the same extremity, and, if these results are normal, followed by comparison short segment studies [33,64,83]. EDX study can augment the clinical diagnosis of CTS, assess its severity, determine its pathophysiology (demyelination vs axon loss) and rule in/out coexistent conditions such as: cervical radiculopathy (especially C6-C7), coincidental ulnar nerve disease or polyneuropathy.…”

Uji Validitas dan Reliabilitas Kuesioner Sindrom Terowongan Karpal Boston Versi Bahasa Indonesia

“…Penilaian derajat keparahan STK berdasarkan: (1) anamnesis, mengenai gejala berupa rasa tidak nyaman pada tangan seperti baal, kesemutan, kelemahan otot, rasa nyeri; (2) pemeriksaan neurologis; (3) pemeriksaan penunjang seperti pemeriksaan elektrodiagnostik untuk menilai konduksi hantar saraf (KHS) saraf medianus yang melewati terowongan karpal. 2,[6][7][8] Tidak semua fasilitas rumah sakit memiliki alat elektrodiagnostik dan pemeriksaan ini membutuhkan biaya yang tidak sedikit. Sebagian pasien menolak menjalani pemeriksaan elektrodiagnostik karena rasa tidak nyaman yang dapat muncul selama pemeriksaan.9 Dengan adanya keterbatasan tersebut maka dikembangkan kuesioner-kuesioner yang dapat membantu klinisi untuk menilai dan menentukan derajat keparahan gejala serta status fungsional STK.…”