Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome

Abstract

This study examined the severity of symptoms in carpal tunnel syndrome (CTS) in relation to nerve conduction measures of the median nerve. Clinical symptom severity and nerve conduction studies were evaluated for 64 hands with CTS in 45 patients. We found the following: (1) significant relationships identified among the clinical scales resulted in a dichotomous symptom classification scheme into primary and secondary symptoms, with the former being more specific for those symptoms usually seen in association with nerve injury; (2) there were significant relationships between symptom severity and nerve conduction abnormality; (3) the primary symptom scale correlated more strongly with the electrodiagnostic measures of nerve injury than did the secondary symptom scale. Based on these findings, we believe that these clinical scales have biological significance and reflect median nerve injury. This would support their potential utility for evaluating the outcome of CTS treatment and developing a model for exposure–severity relationship. © 1999 John Wiley & Sons, Inc. Muscle Nerve 22: 497–501, 1999.

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

“…According to the American Academy of Neurology practice parameters criteria, CTS is defined [12,13] as follows:…”

Carpal Tunnel Syndrome in Patients with and without Diabetes Mellitus in Upper Egypt: The Impact of Electrophysiological and Ultrasonographical Studies

“…All patients were subjected to full history taking, thorough clinical examination and neurological examination including (1) parathesia, pain provoked or worsened by sleep, sustained hand or arm position or repetitive action of the hand or wrist that is mitigated by a change in posture or by shaking of the hand (2) sensory deficit in median nerve distribution, (3) motor deficit of median innervated thenar muscles and (4) positive provocative tests for CTS (Tinel sign, Phalen test and Reverse Phalen test). The clinical diagnosis of CTSwas made when criterion 1 and one or more of criterion 2-4 were fulfilled [10,11]. Electrophysiological assessment of wrists and gray scale ultrasonography were done for all patients.…”

Do Electrodiagnostic Variables Correlate with Functional Outcomes in Carpal Tunnel Syndrome?

“…EDX findings have been positively correlated with patient symptom severity and negatively correlated with functional status [11,12]. One study, however, reported a negative correlation between EDX data and development of symptoms and diagnosis of CTS in industrial workers followed prospectively [13].…”

“…There is no universally accepted standard in classification of severity assessment of CTS. However, several electro diagnosticians use the AANEM minimonograph as their guideline [12,17]. In a previous study, clinical and EDX changes after surgery were evaluated in patients with "severe" CTS, and severity was defined based on EDX data [18].…”

“…Although there was improvement in EDX and PRO measures post-surgically, there was no significant relationship established between the EDX findings and PRO measures themselves in both the pre-and post-treatment period [21]. Additionally, it is unclear how clinically relevant a summative assessment of severity of CTS based on EDX is in reflecting prognosis or predicting outcome after treatment [12,14,16]. Studies addressing these unanswered questions will provide further clarification and guidance regarding optimal conservative and surgical management of CTS [22].…”