Practice Parameter for Electrodiagnostic Studies in
Carpal Tunnel Syndrome: 

Summary Statement

Description: 

Carpal tunnel syndrome (CTS) is a common clinical problem and frequently requires surgical therapy. The results of electrodiagnostic (EDX) studies have been found to be highly sensitive and specific for the diagnosis of CTS. This document defines the standards, guidelines, and options for EDX studies of CTS based on a critical review of the literature published in 1993 ¹ and recently updated by a review of the literature through the year 2000.² The reader is referred to the updated review² for a detailed discussion of the literature and the EDX techniques for the assessment of CTS which are summarized here. Both reviews addressed the following key clinical questions:

1. In patients clinically suspected of having CTS, what are the best EDX studies to confirm the diagnosis?
2. How can future clinical research studies be improved to evaluate the usefulness of laboratory studies, including EDX studies, to confirm the diagnosis of CTS?

Key words: carpal tunnel syndrome; electromyography; literature review; nerve conduction study; reference values; sensitivity; specificity

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Literature Review for Electrodiagnostic Studies
in Carpal Tunnel Syndrome

Description: 
The first AAEM Carpal Tunnel Syndrome (CTS) Literature Review (1993) evaluated the sensitivity and specificity of nerve conduction studies (NCSs) and needle electromyography (EMG) to confirm a clinical diagnoses of (CTS) based upon a critical review of 165 articles from the literature through May 1991. This new report includes all of the information from the first review and 113 additional articles from the literature through December 2000. The authors concluded that median sensory and motor NCSs are valid and reproducible clinical laboratory studies that confirm the clinical diagnoses of CTS with a high degree of sensitivity (>85%) and specificity (>95%) and that the clinical practice recommendations published in 1993 remain valid. Needle EMG studies were not as sensitive or specific as NCSs to diagnose CTS although they are useful to document axonal nerve pathology. In future research studies to evaluate the usefulness of NCSs and needle EMGs to diagnose CTS, the authors recommend that (1) the physician performing and interpreting the NCS and needle EMGs be blinded to the diagnosis of the subjects (normal, CTS patient, or disease control) to avoid observer bias and (2) the clinical diagnosis of CTS be made according to a new set of consensus clinical diagnostic criteria presented in this report to provide a more uniform population of CTS patients.

Key words:  carpal tunnel syndrome; electromyography; literature review; nerve conduction study; reference values; sensitivity; specificity

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