Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2022; 13(2): 171-177
Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.171
Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study
Yuen Chan, Veenesh Selvaratnam, Tharjan Manickavasagar, Vishwanath Shetty, Vishal Sahni
Yuen Chan, Department of Trauma and Orthopaedics, Mersey Deanery, Prescot L35 5DR, Merseyside, United Kingdom
Veenesh Selvaratnam, Department of Trauma and Orthopaedics, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, United Kingdom
Tharjan Manickavasagar, Vishwanath Shetty, Vishal Sahni, Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport L39 2AZ, United Kingdom
Author contributions: Chan Y and Selvaratnam V wrote and edited the manuscript and were involved in the analysis of the study; Selvaratnam V, Manickavasagar T, Shetty V, and Sahni V were involved in the collection of data and editing of the manuscript.
Institutional review board statement: This study was approved by Southport and Ormskirk NHS Hospital.
Clinical trial registration statement: A clinical trial registration was not required.
Informed consent statement: The informed consent statement is not applicable for this study.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuen Chan, FRCS, MBChB, MSc, Surgeon, Department of Trauma and Orthopaedics, Mersey Deanery, Warrington Rd, Rainfall, Prescot L35 5DR, Merseyside, United Kingdom. y.chan1@nhs.net
Received: March 25, 2021
Peer-review started: March 25, 2021
First decision: June 16, 2021
Revised: June 30, 2021
Accepted: January 18, 2022
Article in press: January 18, 2022
Published online: February 18, 2022
Processing time: 329 Days and 8 Hours
Abstract
BACKGROUND

Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions.

AIM

To correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.

METHODS

This was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe.

RESULTS

There were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.

CONCLUSION

We feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.

Keywords: Carpal tunnel syndrome; Nerve; Compression neuropathy; Median nerve; Scoring

Core Tip: The use of our simple scoring method can help determine if patients with carpal tunnel syndrome need nerve conduction studies. Patients scoring less than 8 may have mild or moderate carpal tunnel syndrome and in these patients we recommend the use of nerve conduction studies. In patients scoring 8 or more, we do not recommend the use of nerve conduction studies for the diagnosis of carpal tunnel syndrome.