Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.171
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
There is still debate around what is the best approach for assessment of Carpal tunnel syndrome (CTS). Controversies do exist regarding the need for investigations such as the need for nerve conduction studies (NCS) to aid with management decisions.
We hypothesised that a scoring system combining symptoms, signs and risk factors can help with the diagnosis of carpal tunnel syndrome and whether nerve conduction studies would be required.
The aim of the study was to correlate the severity of nerve conduction study results to a scoring system which included symptoms, signs and risk factors.
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 and four clinical signs and two risk factors. We classified the NCS results to normal, mild, moderate and severe.
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.
Based on our study, we believe that patients who score less than 8 may require NCS to confirm the diagnosis of CTS. However, patients who score more than 7 have a 93% chance of having moderate to severe CTS on NCS. The use of our simple scoring methods can help determine patients with moderate and severe CTS. In this group of patients, we recommend not using NCS. Patients scoring less than 8 may have mild or moderate CTS and in this group of patients, we recommend the use of NCS.
The use of our Liverpool carpal tunnel scoring system can have the potential to be used to help determine if NCS is required. Further studies looking into the validation of the scoring system is required.