Correspondence between clinical presentation and electrophysiological testing for potential carpal tunnel syndrome

The diagnosis of carpal tunnel syndrome (CTS) is often applied in the absence of objectively verifiable pathophysiology (i.e. electrophysiologically normal carpal tunnel syndrome). The primary purpose of this study was to determine whether depressive symptoms, heightened illness concern, and pain ca...

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Bibliographic Details
Published in:The Journal of hand surgery, European volume European volume, 2013-06, Vol.38 (5), p.489-495
Main Authors: Makanji, H. S., Zhao, M., Mudgal, C. S., Jupiter, J. B., Ring, D.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carpal Tunnel Syndrome - diagnosis
Carpal Tunnel Syndrome - physiopathology
Carpal Tunnel Syndrome - psychology
Diagnosis, Differential
Electrodiagnosis - methods
Female
Humans
Male
Middle Aged
Pain Measurement
Physical Examination
Predictive Value of Tests
Prospective Studies
Surveys and Questionnaires
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Summary:The diagnosis of carpal tunnel syndrome (CTS) is often applied in the absence of objectively verifiable pathophysiology (i.e. electrophysiologically normal carpal tunnel syndrome). The primary purpose of this study was to determine whether depressive symptoms, heightened illness concern, and pain catastrophizing are associated with an absence of electrophysiological abnormalities. The secondary purpose was to examine the correspondence between the Levine scale, the CTS-6, and electrophysiological abnormalities. Ninety-eight participants completed validated questionnaires assessing psychosocial factors at the initial visit, and surgeons recorded clinical data and their confidence that the diagnosis was carpal tunnel syndrome. Symptoms and signs that are characteristic of carpal tunnel syndrome (e.g. the CTS-6 and Levine scale) significantly, but incompletely coincided with electrophysiological testing. Psychological factors did not help distinguish patients with normal and abnormal objective testing and it remains unclear if symptoms that do not coincide with abnormal tests represent very mild, immeasurable median nerve dysfunction or a different illness altogether. Future studies should address whether outcomes are superior and resource utilization is optimized when surgery is offered based on symptoms and signs (e.g. the CTS-6) or when surgery is offered on the basis of measurable pathophysiology.
ISSN:1753-1934
2043-6289
DOI:10.1177/1753193412461860