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American Association for Hand Surgery

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Correlation of CTS-6 Score and Physical Exam Maneuvers with Electrodiagnostic Test Severity in Carpal Tunnel Syndrome: A Blinded Prospective Cohort
Andrew Yang, M.D.1, Priscilla K Cavanaugh, MD2, Pedro K Beredjiklian, MD2, Jonas Matzon, MD3, Daniel Allan Seigerman, MD4 and Christopher Jones, MD5, (1)Rothman Orthopedic Instiitute, Philadelphia, PA, (2)Rothman Institute, Philadelphia, PA, (3)Rothman Institute at Thomas Jefferson University, Philadelphia, PA, (4)Hand and Upper Extremity Surgery, Rothman Institute/ Jefferson Medical College, Philadelphia, PA, (5)Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Hypothesis: While carpal tunnel syndrome (CTS) can be diagnosed clinically with the CTS-6 evaluation tool, the relationship between disease severity and CTS-6 score has not been elucidated. The purpose of our study was to determine the correlation of the CTS-6 score and several other commonly utilized physical exam maneuvers with the carpal tunnel severity grade by electrodiagnostic testing (EDT). We hypothesized that the CTS-6, Durkan, and SWMT would positively correlate with EDT severity.
Methods: We prospectively enrolled 105 consecutive patients who presented to the office with suspected carpal tunnel syndrome. Inclusion criteria included patients 18 years of age and older with clinical suspicion for CTS. Exclusion criteria included prior carpal tunnel surgery, workman's compensation claims, prior EDT from an outside facility or those with evidence of concomitant neuropathies. Four fellowship trained orthopaedic hand surgeons obtained the CTS-6 score, time to obtain a positive Durkan compression test, and Semmes Weinstein monofilament test (SWMT) of thumb index and long fingers. All patients were sent for EDT. Hand surgeons were blinded to the results of the EDT, and the electrodiagnosticians were blinded to the clinical data. We utilized the Bland criteria (0-6) for grading CTS severity on EDT. This grade was compared to the CTS-6 score, Durkan time, and SWMT results.
Results: Using Spearman correlation coefficients, we found a (p < .001). Mean CTS-6 score based on EDT grading were: 14.8 (grade 0), 16.0 (grade 1), 14.8 (grade 2), 16.7 (grade 3), 18.7 (grade 4), 18.3 (grade 5­), 22.4 (grade 6). We also found a weakly positive (r = 0.332) correlation between a higher SWMT sensory score and a higher severity grade on EDT (p = .001). The Durkan compression test (r = -0.134) did not appear to correlate with the EDT grade (p = 0.212).
Conclusion: CTS-6 and SWMT sensory score shows positive correlation with EDT severity in CTS based on the bland criteria. Time to Durkan did not show any correlation.


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