Trends in Carpal Tunnel Surgery: An Online Survey of Members of the American Society for Surgery of the Hand

Munns, Justin; Awan, Hisham M.

doi:10.1016/j.jhsa.2014.12.046

Cited by 85 publications

(73 citation statements)

References 13 publications

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“…There is a Grade-B recommendation to obtain electrodiagnostic tests if physical examination and provocative maneuvers are positive and surgical intervention is being considered (3.1c). This is the strongest recommendation in the guideline 13 ; 90% of hand surgeons reported using electrodiagnostic testing 22 , although the utility of routine testing remains debatable 23 . Patients with less severe electrodiagnostic abnormalities note faster symptom improvement 24 , which can be useful in preoperative counseling.…”

Section: Electrodiagnosticsmentioning

confidence: 99%

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

2016

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Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Treatment options include wrist-neutral bracing, corticosteroid injections, operative release of the transverse carpal ligament, and symptom-relief options. Endoscopic carpal tunnel release may give patients a faster recovery compared with traditional open release, but there are no ultimate differences in outcome among the various surgical options.

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Section: Electrodiagnosticsmentioning

confidence: 99%

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

2016

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“…1, 14, 15 Munns et al 1 found that 72% of hand surgeons routinely obtained preoperative EDS in a 2015 survey of 716 ASSH members. A 2014 survey of 705 ASSH members also found that 55% of respondents believed EDS was usually necessary to provide sufficient justification to indicate a surgery in addition to a supporting history and physician exam.…”

Section: Discussionmentioning

confidence: 99%

“…1 However, there is no reference standard diagnostic test for CTS. Current evidence consistently reports that information gathered from the history and physical exam has similar if not better sensitivity and specificity for CTS diagnosis compared to modalities such as EDS, MRI, and ultrasound, often with EDS having the highest false positive and false negative rates of the commonly used testing modalities.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome

Sears

Wood

et al. 2017

The Journal of Hand Surgery

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Purpose We sought to evaluate how often physicians who perform carpal tunnel release (CTR) in the State of Michigan routinely request electrodiagnostic studies (EDS) or other diagnostic tests prior to an initial consultation, and whether provider or practice characteristics had an influence on requirements for pre-consultation diagnostic tests. Methods Through online data sources, we identified 356 providers in 261 practices throughout the State of Michigan with profiles confirming hand surgery practice or surgical treatment of carpal tunnel syndrome (CTS). We recorded American Society for Surgery of the Hand (ASSH) membership, teaching facility status, practice size, and primary specialty for each provider. Using a standardized telephone script, 219 providers were contacted by telephone to determine whether any diagnostic tests were needed before an appointment. Using multivariable logistic regression, we evaluated the relationship between the requirement for pre-consultation testing and surgeon and practice characteristics. Results Among the 134 providers who were confirmed to perform CTR, 57% (n=76) required and 9% (n=12) recommended a diagnostic test prior to the initial consultation. Of the 88 physicians who required/recommended testing, 85% (n=75) requested EDS, 22% (n=19) requested an MRI, 13% (n=11) requested a CT scan, and 9% (n=8) requested an X-ray. Patients were asked to have multiple studies by 19 (22%) of the 88 surgeons who requested/recommended testing. In the multivariable analysis, ASSH membership, size of practice and teaching facility status did not have a significant relationship with the requirement for pre-consultation testing. Conclusions Most surgeons who treat CTS in the State of Michigan routinely request EDS before evaluation, rather than reserving the test for cases where the diagnosis is unclear.

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“…5 A recent survey by the American Society for Surgery of the Hand compared the current practice of its members in CTS. 6 Ninety percent of surgeons used electrodiagnostic testing (EDT) to confirm CTS preoperatively. Decompression of the carpal tunnel was typically through a mini-open incision (50%) under a local anaesthetic with intravenous sedation (43%).…”

Section: Introductionmentioning

confidence: 99%