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Changes in Treatment Plan for Carpal Tunnel Syndrome Based on Electrodiagnostic Test Results
Stéphanie J.E. Becker, MD; Heeren S. Makanji; David C. Ring, MD, PhD; Massachusetts General Hospital
Massachusetts General Hospital, Boston, MA, USA

Introduction: The role of electrodiagnostic testing in the management of carpal tunnel syndrome (CTS) is debated. We wanted to evaluate how often electrodiagnostic testing changed the treatment plan for CTS. Secondly, we wanted to determine if there were any predictors of change in treatment plan for CTS.

Materials & Methods: One hundred-and-twenty-six English-speaking adult patients underwent electrodiagnostic testing in a prospective cohort study. Prior to testing, patients completed a survey regarding demographics and validated questionnaires assessing symptom severity and functional status, catastrophic thinking, depressive symptoms, and heightened illness concern. Surgeons completed a survey regarding clinical information, likelihood of CTS, suspected severity of CTS, and treatment plan. Treatment plan after electrodiagnostic testing was collected from the medical records. The proportional difference in operative treatment plan pre- and post-testing was evaluated using the Chi-Square Goodness-of-Fit Test. Bivariate and multivariable analysis were used to determine predictors of change in treatment plan.

Results: Treatment plan changed in 19% of the cases based on electrodiagnostic test results: 1) less severe CTS than suspected (45.8%), 2) no CTS (37.5%), and 3) more severe CTS than suspected (16.7%). The plan for operative treatment before electrodiagnostic testing (85%) decreased significantly after testing (72%) (p < 0.001). The only variable that related significantly to change in treatment plan was median distal sensory latency (normal, prolonged recordable or non-recordable) (p < 0.001). Phalen’s test was nearly significantly related to change in treatment plan (p = 0.050). The best logistic regression model included prolonged, recordable and non-recordable median distal sensory latency, and both significantly decreased the probability of a change in treatment plan (OR = 0.20, p = 0.0016; and OR = 0.04, p = 0.0025, respectively).

Conclusions: Electrodiagnostic testing had a significant and clinically relevant impact on treatment plans.

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