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Evidence-Based Clinical Medicine: J. Thomas Megerian, Xuan Kong, and Shai N. Gozani Utility of Nerve Conduction Studies for Carpal Tunnel Syndrome by Family Medicine, Primary Care, and Internal Medicine Physicians J Am Board Fam Med 2007; 20: 60-64 [Abstract] [Full text] [PDF]

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CTS is a clinical syndrome

Sidha.S. Sambandan   (30 May 2007)

CTS is a clinical syndrome 30 May 2007
Sidha.S. Sambandan, FP & GPwSI Orthopaedics Hon.Senior Lecturer,UEA,Norwich,UK Send response to journal: Re: CTS is a clinical syndrome sambandan{at}aol.com Sidha.S. Sambandan	The advance of technology has enabled clinicians to enhance their diagnostic skills. Carpal tunnel syndrome (CTS) is a clinical syndrome and the diagnosis of this syndrome is based on symptoms and signs. It presents as a dynamic compression and when more chronic or severe can lead to ischaemic demyelination. A small percentage (<10%) of the population have asymptomatic CTS, when NCS is done. At the same time a small proportion of symptomatic carpal tunnel syndrome have normal NCS. A diagnosis is a psychological construct of the human mind, which has a utility value. i.e. an intervention leads to the resolution of symptoms and improves if not restores the function. This patient orientated evidence that matters is crucial for clinicians as opposed to technicians. But we should be mindful of the usefulness of NCS in certain situations such as for Insurance claims, double crush syndrome,or when the diagnosis is doubtful. Asmuch as NCS is a good objective standard and the availability of new technology which will considerably decrease the cost by removing the need to refer to a neurologist or electrophysiologist, it has little value in the management of majority of patients presenting with CTS.