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Opting Out of EMG: Recognizing Carpal Tunnel Syndrome Patients Who Do Not Require EMG Studies - Preliminary Results
Diwakar Phuyal, MB BS
1, Riley Marlar, DO
1, Mychajlo Kosyk, MD
1, Julia Ting, BS
2, Yomna E. Dean, MD
1, Mihir Patel, BS
1, Kyle Barclay, BA
2, Sara Yacoub, BA, MPH
1, Chantal Bhan, DO
1, Bahar Bassiri Gharb, MD, PhD
1; Antonio Rampazzo, MD, PhD
1(1)Cleveland Clinic, Cleveland, OH, (2)Case Western Reserve University School of Medicine, Cleveland, OH
Introduction:Electrodiagnostic studies (EDS), including electromyography (EMG), are widely used to diagnose carpal tunnel syndrome (CTS). This study aims to identify predictors of severe EMG findings, with the goal of reducing unnecessary EMG testing in patients who are likely to demonstrate severe results based on certain risk factors.
Methods:We conducted a retrospective chart review of patients who underwent EMG testing for CTS between 2018 and 2023 at a single academic institution. All patients were seen in the clinics of two surgeons. Patients were categorized by EMG severity into lower (normal, very mild, mild) and higher (moderate, severe) groups. EMG severity was determined using criteria established by the neuromuscular team. Demographics, comorbidities, and clinical symptoms were compared using univariable and multivariable logistic regression to identify independent predictors of EMG severity.
Results:A total of 201 patients were included in the preliminary analysis (102 with lower EMG severity, 99 with higher severity). Patients in the higher EMG group were significantly older (64.4 vs. 55 years, p < 0.001) and had a higher BMI (31.8 vs. 29.4, p = 0.03). Hypertension (p < 0.001), cardiovascular disease (p < 0.001), and osteoarthritis (p = 0.009) were more common in the higher EMG group in univariable analysis. The Tinel test, 2-point discrimination, and strength were not significantly different between groups. However, the Phalen test was positive in 93.4% of the higher severity group compared to 80% in the lower severity group (p = 0.03). Notably, patient-reported symptom severity did not differ between EMG groups (p = 0.38). In multivariable logistic regression, only age (OR 1.04, p = 0.002) and BMI (OR 1.05, p = 0.03) remained independently associated with higher EMG severity with with no multicollinearity (VIF = 1.070).
Conclusion:Older age (>52 years) and higher BMI (>35 kg/m^2) were independently associated with increased EMG severity, despite symptom burden comparable to those with less severe EMG findings (probability threshold >0.5). These results suggest that EMG could be omitted in these specific patient populations. Future studies with larger cohorts are needed to validate these observations and to identify other potential predictors.
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