A study to further develop and refine carpal tunnel syndrome (CTS) nerve conduction grading tool

Abstract

BackgroundThe severity of carpal tunnel syndrome (CTS) may be categorised in a number of ways utilising one of a range of presently available grading tools. The grading systems proposed by Bland and Padua are the most commonly used, however, both have limitations, which are discussed in detail in this paper.The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current CTS nerve conduction grading tool, and to compare with existing grading tools used in UK Neurophysiology clinics. The revised scale is designed from a clinical physiologist perspective and based on the numerical values of nerve conduction findings.The proposed revised grading system is based on more nuanced, descriptive categories, ranging from Normal to Early, Mild Sensory, Mild Sensory Motor, Moderate Sensory, Moderate Sensory Motor, Severe Sensory Motor, Extremely Severe Sensory Motor, and Complete absence.MethodA total of 1123 patients (2246 hands) were included in this study, with the aim of evaluating the revised grading system. Data was collected based on the extensive and detailed grading systems previously described by Bland and Padua. All data was recorded numerically to ensure methodological reliability.ResultOf the 2246 patients’ hands tested, the nerve conduction was graded as normal in 968 hands; nerve conduction showed early changes in 271 hands; mild sensory changes in 215 hands, mild changes in both motor and sensory response in 51 hands; moderate sensory changes in 134 hands; moderate sensory and motor changes in 356 hands; severe changes in motor and sensory responses in 204 hands; extremely severe sensory and motor changes in 33 hands and complete absence of response in 14 hands.ConclusionThe revised grading tool could offer a more numerical grading to the Clinical Physiologist and could help the surgeon to ascertain the level of severity in order to decide on either a conservative or surgical approach to treatment if they decide to use the proposed grading which could support them to defend their decision in cases of litigation.

Clinical Relevance of Ultrasonographic and Electrophysiological Findings of the Median Nerve in Unilateral Carpal Tunnel Syndrome Patients

“…First, it has been pointed out that, Japanese may be less likely to complain about physical symptoms than the patients in other country even when neurological abnormalities are present [ 33 ]. The average latency of CMAP in asymptomatic hands in this study was 4.4 ± 0.9 ms, suggesting that the condition progresses to some extent insidiously according to previous grading [ 34 ]. Generally, sensory nerves are damaged first, and the onset of CTS is confirmed by a decrease in the sensory conduction velocity.…”

Shear‐wave elastography evaluation of thenar muscle in carpal tunnel syndrome

“…In addition, both the CSA ( r = 0.57, p < 0.001) and SWV in the median nerve ( r = 0.35, p < 0.001) of CTS hands were proportionally correlated with the modified Hirani CTS grading score, which is considered to be an electrophysiological parameter of CTS (Tables 3 and 4). The modified Hirani CTS grading score was also significantly associated with the Padua CTS scale, which is a clinical CTS parameter 31 . Several electrophysiological parameters, including modified‐Hirani CTS grading score, have been reported to functionally reflect the pathological condition of the median nerve due to demyelination or axonal damage and to be well correlated with the clinical parameters of CTS 7,31 .…”

Machine learning-based approach for disease severity classification of carpal tunnel syndrome

“…CTS has a wide spectrum of symptoms and signs 16 . Because therapeutic options may vary according to its severity, it is important to determine appropriate severity grading of CTS 17,18 . Electrodiagnosis remains the main evaluation tool for CTS severity grading.…”