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Carpal tunnel syndrome - Management
Basis for recommendation

  • These recommendations are based on guidelines from the American Academy of Neurology [Quality Standards Subcommittee of the American Academy of Neurology, 1993] and expert opinion in review articles [Katz and Simmons, 2002; Barnardo, 2004; MacDermid and Wessel, 2004; Bland, 2007].
  • There is no gold standard for the diagnosis of carpal tunnel syndrome. Clinical diagnosis depends on specified symptoms and signs, and sometimes on the results of electrodiagnostic tests [Jordan et al, 2002].
  • The authors of a systematic review did not recommend electrodiagnostic testing if the symptoms of carpal tunnel syndrome are well defined [Jordan et al, 2002]. The authors cited a systematic review [Jablecki et al, 1993] which found that electrodiagnostic testing had a high specificity (95%) so few people without carpal tunnel syndrome would have an abnormal result. However the sensitivity was low (between 49% and 84%) so many people with positive clinical symptoms would have a negative result. Although electrodiagnostic testing is not recommended routinely in primary care it may be helpful where there is diagnostic doubt, before surgery [Bland, 2007], and in ruling out neuropathy and other nerve entrapments [Katz and Simmons, 2002]. The sensitivity of nerve conduction studies has improved with modern techniques and the false negative rate is now probably around 5–10% [Bland, 2007].
  • High resolution ultrasonography measures the diameter of the median nerve and has been compared with nerve conduction studies in a prospective cohort study of people (n = 120) suspected of having carpal tunnel syndrome. Figures for sensitivity and specificity are not clear as the authors optimized the ultrasound measurement cut off values to achieve specificity rates of 65% and sensitivity rates of 95% and also there were no absolute diagnostic standards for comparison [Wong et al, 2004]. Ultrasonography may also show relevant structural abnormalities such as bifid median nerves or space occupying lesions in the carpal tunnel but these are rare [Bland, 2007].

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