Masahiro Sonoo, Daniel L. Menkes, Jeremy D.P. Bland, David Burke

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Presentation transcript:

Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Masahiro Sonoo, Daniel L. Menkes, Jeremy D.P. Bland, David Burke Clinical Neurophysiology Practice Volume 3, Pages 78-88 (January 2018) DOI: 10.1016/j.cnp.2018.02.005 Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 1 Calculated pre-test and post-test probability using two studies (Jackson et al., 1989; Stevens, 1987) adopted by Graham (2008) as stringent and lax criteria. Using the lax criterion, a patient with the pre-test probability of 0.85 will keep the post-test probability of 0.93 if NCS is abnormal, but the post-test probability will decline to 0.42 if NCS is normal. The results exactly agree with Fig. 1 in Graham (2008) using the stringent criterion. Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 2 The probability of CTS estimated from symptoms vs neurophysiological severity of CTS in 2,695 subjects with hand symptoms. The probability of CTS (vertical axis) is derived from the algorithms used on www.carpal-tunnel.net. The higher the score, the more typical of CTS is the patient’s presentation. (As the degree of NCS abnormality increases it becomes more likely that a clinician will recognize the problem as CTS.) The neurophysiological severity was assessed as in Bland (2000a). Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 3 Relationship between neurophysiological severity of CTS, assessed as in Bland (2000a), and subjective severity of symptoms in 29,594 tests in patients referred with possible CTS (some patients tested on more than one occasion). SSS = Boston/Levine symptom severity score for right hand at the time of test. Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 4 Relationship between pre-operative neurophysiological grade, assessed as in Bland (2000a), and surgical outcome. Overall subjective opinion of the effect on symptoms of surgery for 7,410 routine NHS carpal tunnel decompressions. Patient opinions were collected 3 months to 2 years after surgery. Number of cases in each group is indicated in the bars. Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 5 Popular grading schemes for CTS. For details of the grading criteria based on NCS, see (Padua et al., 1997, Stevens, 1997, Bland, 2000a). Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 6 Change in neurophysiological grade from before to after surgery in 559 operations vs outcome of surgery. The neurophysiological severity was assessed as in Bland (2000a). Green bars show the percentage of patients with a given improvement in NCS results reporting that symptoms are completely cured or much improved. Red bars show the percentage of patients with a given change in NCS who report themselves worse after surgery. Clinical Neurophysiology Practice 2018 3, 78-88DOI: (10.1016/j.cnp.2018.02.005) Copyright © 2018 International Federation of Clinical Neurophysiology Terms and Conditions