Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome

Schulze, Daniel Gregor; Nilsen, Kristian Bernhard; Killingmo, Rikke Munk; Zwart, John Anker; Grotle, Margreth

doi:10.3389/fneur.2021.683807

Cited by 7 publications

(7 citation statements)

References 50 publications

(73 reference statements)

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“…Literature does support that the CTS-6 can predict severity changes in patients with CTS. [8][9][10] The second analysis compared the diagnostic outcomes between patients with "bilateral" and "unilateral" CTS. The objective (NCS and median nerve CSA) and subjective (BCTSQ and CTS-6 scores) measures between the hands of bilateral CTS patients were chosen at random and compared with the unilateral CTS cohort.…”

Section: Methodsmentioning

confidence: 99%

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity

Vernick

Beckwitt

Fowler

2023

Plastic &Amp; Reconstructive Surgery

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Background: It remains unclear whether physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index on CTS severity is not well characterized. Methods: Unilateral and bilateral CTS patients were seen from October of 2014 to February of 2021. Obese and nonobese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), and six-item Carpal Tunnel Symptom Score (CTS-6) measures were obtained. Nerve conduction studies recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used Wilcoxon signed rank testing for paired continuous variables, Mann-Whitney U testing for nonpaired continuous variables, and chi-square testing for continuous variables, with a significance level of P < 0.05. Results: A total of 109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score (P < 0.0001), CTS-6 score (P < 0.0001), DML (P < 0.0001), and DSL (P < 0.01). Bilateral patients also had higher symptom severity scale (P < 0.01) and DSL (P < 0.001) outcomes compared with unilateral patients. Obese patients had higher median nerve CSA (P < 0.01), prolonged DML, and prolonged DSL (P < 0.0001) values despite similar CTS severity (BCTSQ and CTS-6). Conclusions: Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS and BCTSQ). Obesity increases median nerve CSA and prolongs nerve conduction studies without influencing CTS severity. This information can be used when considering which diagnostic test to order for CTS.

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Section: Methodsmentioning

confidence: 99%

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity

Vernick

Beckwitt

Fowler

2023

Plastic &Amp; Reconstructive Surgery

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“…We calculated the carpal syndrome risk using the Boston scale. A Boston score higher than 2.47 is a high-risk factor for developing carpal tunnel syndrome and is widely used for early diagnosis (with a sensibility of 95% and a specificity of 95%) [13,14]. Further, we divided the questions of the Boston scale into 3 groups based on the symptoms assessed: pain (question 1,2,3,4,5), sensory function impairment (question 6,8,9,10), and motor function impairment (question 7,11).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of occupational and non-occupational risk factors associated with carpal tunnel syndrome-related symptoms in office workers

Mocanu,

Axente

2023

Romanian Journal of Occupational Medicine

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Background : While the main occupational and non-occupational risk factors associated with carpal tunnel syndrome are known, we still need to understand which of these factors has a stronger correlation with carpal tunnel-related symptoms in office workers and to improve future work-space recommendations accordingly. Objective : This study aimed to investigate the relationship between occupational and non-occupational risk factors and carpal tunnel syndrome-related symptoms among office workers who use a computer in their dayto-day activities. Methods : The data used in this study were collected from May to September 2022 through an online questionnaire from one respondent to another through different forms of social media, using the snowball method. The recorded data were further analysed using an SPSS program. In this way, we analysed quantitative variables by calculating the means, the medians, the standard deviation and the normal distribution and qualitative variables by reporting them as absolute values and percentages of the total. We compared different subgroups of samples using the chi-square test and the binary regression method. A p-value of less than 0.05 was the threshold of statistical significance. Results : This study evaluated 130 office workers and identified and analysed the complex relationships between occupational and non-occupational risk factors of CTS and CTS symptoms grouped as pain, sensory function impairment and motor function impairment. Through data analysis and further logistic regression analysis, we concluded that while sensory function impairment is mostly associated with occupational factors such as computer typing with one hand, pain and motor function impairment are associated with both non-occupational, well-known risk factors (female sex, high BMI) and number of hours on the computer outside of work, and occupational risk factors like using both a mouse and an external keyboard, having a chair with adequate arm support and typing with one hand. Conclusion : Both occupational and non-occupational risk factors contribute to the development of CTS-related symptoms. Our dataset highlights the complex relationship between CTS occupational and non-occupational risk factors in office workers, thus providing insights for future workplace recommendations and preventive strategies.

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“…15,16 Compared with the Boston Carpal Tunnel Questionnaire, the CTS-6 is shorter but has similarly high clinical validity and reliability, and is broadly used in diagnosing CTS. 17,18 In patients with a positive CTS-6 result, ultrasonographic examination is reportedly more effective than EDX testing for the definitive diagnosis of CTS. 19 Furthermore, as ultrasonographic examination and the CTS-6 are sufficient in diagnosing CTS, EDX testing is not necessary in most cases.…”

Section: Proposed Diagnostic Criteria For Cts Include the Boston Carp...mentioning

confidence: 99%

“…The Boston Carpal Tunnel Questionnaire diagnoses CTS based on the results of a patient questionnaire, while the CTS‐6 score diagnoses CTS based on the medical history, clinical symptoms, and physical findings 15,16 . Compared with the Boston Carpal Tunnel Questionnaire, the CTS‐6 is shorter but has similarly high clinical validity and reliability, and is broadly used in diagnosing CTS 17,18 . In patients with a positive CTS‐6 result, ultrasonographic examination is reportedly more effective than EDX testing for the definitive diagnosis of CTS 19 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic utility of anteroposterior measurements of the median nerve on sagittal ultrasonographic images and their correlation with clinical findings in carpal tunnel syndrome

Okura,

Tajima,

Fukuda

et al. 2023

J of Clinical Ultrasound

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PurposeTo investigate the efficacy of sagittal ultrasonography of the median nerve in diagnosing carpal tunnel syndrome (CTS).MethodsSeventy‐six hands with idiopathic CTS and 80 hands of asymptomatic subjects were included. All patients with CTS underwent ultrasonographic examination, electrodiagnostic testing, and CTS‐6 assessment. In the sagittal ultrasonographic examination, the maximum and minimum median nerve diameters (MNDs) were measured at the proximal and distal ends of the carpal tunnel, respectively. The median nerve stenosis rate (MNSR) was computed as (1 – minimum MND/maximum MND) × 100 (%). The cross‐sectional area (CSA) of the median nerve at the level of the pisiform was measured.ResultsIn the sagittal ultrasonographic examination, the mean maximum MNDs were 0.252 cm and 0.202 cm, mean minimum MNDs were 0.145 cm and 0.165 cm, and mean MNSRs were 41.83% and 17.35% in the CTS and control groups, respectively; the mean maximum MND and MNSR were considerably larger in the CTS group. The maximum MND and MNSR were correlated with the electrodiagnostic testing results and CTS‐6 score. The MNSR with a cut‐off value of 34.0% had a higher sensitivity and specificity than the CSA in diagnosing CTS.ConclusionsSagittal ultrasonographic examination is useful in diagnosing CTS.

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Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome

Cited by 7 publications

References 50 publications

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity

Evaluation of occupational and non-occupational risk factors associated with carpal tunnel syndrome-related symptoms in office workers

Diagnostic utility of anteroposterior measurements of the median nerve on sagittal ultrasonographic images and their correlation with clinical findings in carpal tunnel syndrome

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