Overview
Our clinical
experience indicated that unsatisfactory results after treatment
for carpal tunnel syndrome could frequently be linked to an
inaccurate initial diagnosis. A review of the literature
indicated that the diagnosis of carpal tunnel syndrome is often
made according to highly variable criteria. A large number of
internal medicine, surgical and primary care specialties treat
the condition and it seemed possible that some of the variation
might be specialty-specific. In other words, the way in
which a rheumatologist, an occupational health physician and a
neurosurgeon diagnose carpal tunnel syndrome might vary
substantially. In addition, the use of electrodiagnostic
tests in the overall evaluation of carpal tunnel also appeared
to be highly variable. While some clinical groups reported
little or no role for electrodiagnostic tests, others considered
this investigation to be the gold standard for the diagnosis of
carpal tunnel syndrome.
We reasoned that the role of electrodiagnostic testing should be
in adjusting the probability of carpal tunnel syndrome
established clinically. In a bayesian context, the
clinical evaluation of carpal tunnel syndrome should allow the
pre-test probability of carpal tunnel syndrome to be
established. Where this is intermediate, that is, neither
very high or very low, an electrodiagnostic evaluation is
indicated and should be used to modify the probability of carpal
tunnel syndrome either up or down depending on the outcome of
testing. We tested this hypothesis on data published in
the literature. The results are shown in Figure.
In the absence of widely
accepted, standardized diagnostic criteria it is impossible to
establish a valid estimate of the pre-test probability of carpal
tunnel syndrome
The main objective of our work
over the past five years has been to develop standardized
criteria for the diagnosis of carpal tunnel syndrome. These
criteria have been identified and comprise a diagnostic
instrument that we are naming the CTS-6. Initial
validation of this instrument has been completed.
Reliability studies are currently under design.
For a more detailed communication
of our findings read the synopsis:
Standardized
criteria for the diagnosis of carpal tunnel syndrome: A synopsis
of the development of the CTS-6
Supported by Physicians’
Service Foundation Grant 97-52 |
