Background: Carpal tunnel syndrome (CTS) has no internationally accepted diagnostic criteria nor gold standard test. Nerve conduction studies (NCS) are expensive, and have their limitations. The CTS-6 is a diagnostic scale which predicts the probability of carpal tunnel syndrome based on six clinical findings in history or examination. A score of 12 or greater indicates at least 80% probability of CTS.
Aim: Evaluate the value of CTS-6 in our population. Assess whether the NCS result changed the decision to operate on our patients.
Method: Retrospective review of all patients who underwent CTS release over 3 years at Hutt Hospital.
Results: 223 patients analysed. Mean age was 57.5 years, 33.6% were male. 52.0% had bilateral CTS. NCS was ordered in 42.6%. NCS was ordered by general practitioners (GPs) (44.2%), hand surgeons (orthopaedic [27.4%] and plastics [17.9%]), and physicians (10.5%). Of patients who had NCS, 58.9% had no atypical symptoms documented. Of these, only 19.6% were ordered by hand surgeons.
Overall, 96.4% patients had symptom relief after release. There was no difference in outcomes in patients who did and did not undergo NCS (95.7% vs 96.9%, p=0.723)
Mean CTS-6 score was 15.0 and 81.8% had CTS-6 score of 12 or greater. Of the patients who underwent NCS but did not have atypical symptoms, 85.7% had CTS-6 scores of 12 or greater, and 97.2% of these patients had successful relief of symptoms after CTS release. Four patients had negative NCS results, but all had CTS-6 score greater than 12. These four had symptom relief after CTS release.
Conclusion: Our study demonstrates excellent outcomes in CTS surgery at our hospital, regardless of whether the patient underwent NCS or not. There is a significant number of expensive NCS, ordered by non-hand surgeon colleagues, which do not aid diagnosis but do delay treatment.