A revised approach for electrodiagnosis-based severity classification in carpal tunnel syndrome

J Back Musculoskelet Rehabil. 2024 Feb 29. doi: 10.3233/BMR-230275. Online ahead of print.

Abstract

Background: An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity.

Objective: This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS.

Methods: This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens' classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities.

Results: Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group.

Conclusion: The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups.

Keywords: Nerve compression syndromes; classification; neurophysiology; ultrasonography.