1. Andary, M.T., So, Y.T., Wilkins, D.E., Williams, F.H., “Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome.” Muscle & Nerve, 1993; 16: 1392-1414.
Exhaustive outline of literature on use of NCS.
2. Durkan, J.A., “The carpal-compression test: An instrumental device for diagnosing carpal tunnel syndrome.” Orthopaedic Review, 1994; 522-525.
The author added an objective measure of pressure applied to the median nerve at the carpal tunnel in a clinical test originally presented by Paley and McMurtry in 1985. This study is seriously flawed, however, in that yesteryear electrodiagnostic studies had been utilized in the patients who had been screened, eliminating the accuracy of sensitivity and specificity determinations. This is further attested to by the fact that 83% of the 48 hands were utilized for the study had abnormal median distal motor latency, when in fact; patients with early carpal tunnel syndrome usually do not have an abnormal DML. Thus at best, the study shows that the median nerve compression test may be sensitive in patients with long standing CTS, wherein nerve conduction study would also not be considered normal. Unfortunately, most of us don’t see patients at this late stage any more on a regular basis, i.e. patients complain earlier at a time well before the majority of them have an abnormal DML.
3. Jackson, D.A., Clifford, J.C., “Electrodiagnosis of mild carpal tunnel syndrome.” Arch Phys Med & Rehabil, 1989; 70:199-204.
4. Koris, M., Gelberman, R.H., Duncan, K., Boublick, M., and Smith, B. “Carpal tunnel syndrome: Evaluation of a quantitative, provocational diagnostic test." CORR, 1990; 251:157-161.
Studied effect on NCS by increasing the carpal tunnel pressure before performing the NCS. A small number of otherwise negative tests became positive.
5. Marin, E.L., Vernick, S., and Friedmann, L.W. “Carpal tunnel syndrome: Median nerve stress test.” Arch Phys Med Rehab, 1983; 64:206-208.
Little value. Limited increased sensitivity of NCS by subjecting the median nerve to extra pressure preceding an NCS. Useful in very early CTS when demyelination is just beginning and NCS is otherwise WNL.
6. Massy-Westropp, N. “Sensitivity and specificity of clinical diagnostic tests and review scores.” JHS, 2000; 25:4:779.
General overview of office tests developed to assist in diagnosis of CTS.
7. Paly, D., McMurtry, R.Y., “Median nerve compression test in carpal tunnel syndrome diagnosis.” Orthopaedic Review, 1985; XIV; 7:411-441.
This simple, data substantiated, clinical report introduced the concept of reproduction of symptoms of carpal tunnel syndrome by direct application of pressure over the median nerve at the carpal tunnel, particularly for patients who had stiff or painful wrists who were intolerant of one of the other classical, but not very sensitive tests (e.g. Phalen’s wrist flexion test). The potential value of the test was supported by earlier research from UC, San Diego, relating to the elevated pressure in the carpal tunnel in patients with carpal tunnel syndrome and experimentally elevated carpal tunnel pressure necessary to precipitate paresthesias associated with carpal tunnel syndrome. Thus this report is a merely a pilot upon which future studies could be based.
8. Robinson, L.R., “Role of neurophysiologic evaluation in diagnosis.” J of the Am Academy of Orthopaedic Surgeons, 2000; 8:190-199.
Very nice synopsis of use and interpretation of nerve conduction studies.
9. Rojviroj, S., Sirichativeapee, W., Kowsuwon, W., Wongwiattananon, J., Tamnathong, N., Jeeravipoolvarn, P., “Pressures in the carpal tunnel: A comparison between patients with carpal tunnel syndrome and normal subjects.” JBJS, British, 1990; 70: 516-8.
Corroborates the work of Gelberman (reference #13 in Underlying cause section). Perhaps methodology accounts for the actual pressure difference recorded here compared to others.
10. Rosenbaum, R.B., Ochoa, J.L., Carpal tunnel syndrome and other disorders of the median nerve, Butterworth-Heinemann, MA, 1993.
Good read. This timely text is the most comprehensive source on carpal tunnel syndrome in print today. There is a lot left to be updated in terms of the actual genetic relationship to the development of carpal tunnel syndrome and the clinical management of the problem. Its greatest strong point is the explanation of the pathophysiology of nerve compression and the utilization of electrodiagnostic testing for it. Dr. Ochoa has been studying abnormalities of peripheral nerves for many years and his findings are the basis for a good deal of our understanding.
11. Shamir, D. and Pease, W.S. “Developments in the electrodiagnostic assessment of carpal tunnel syndrome.” Phys Med and Rehab Clinics of North Am, 1994; 5:3.
Nice, easy to read summary of general concepts involved in nerve conduction studies. Similar to Robinson article above.
12. Szabo, R.N., Gelberman, R.H., and Dimick, M.P. “Sensibility testing in patients with carpal tunnel syndrome.” JBJS, 1983; 34.
Limited value. This verbose article really added almost nothing to our understanding of carpal tunnel syndrome except that sensory testing results may follow subjective improvement after CTR. It appears to have been an attempt to confirm the sensory testing performed preoperatively in patients with entrapment neuropathy could be expected to improve within just a few weeks of decompression of the nerve in accordance with the subjective improvement in the patient. Six weeks after carpal tunnel release, 23 hands of 20 patients demonstrated improvement on threshold testing (Semmes-Weinstein monofilament) with 65% exhibiting normal values. This study would have been of more value if they had had further follow up before rushing to publication, as they could have determined ultimately the percentage of patients who had regained normalcy of sensibility to the limited tests available. A much greater size of study population would have also been beneficial, as would a control population with electrodiagnostically proven absence of neuropathy.
13. Tetro, A.M., Evanoff, B.A., Hollstien, S.B., “A new provocative test for carpal tunnel syndrome.” JBJS, 1998; 80-B: 3: 493-498.
Worthless. This poor study submitted by Washington University, St. Louis, Department of Orthopaedics, suggested that there was 82% sensitivity at 20 msec with 99% specificity for provocative tests for carpal tunnel syndrome. Unfortunately, the control patients had not undergone NCS, thus invalidating their conclusion. Were this study to be re-conducted with larger numbers of subjects including properly tested controls, then it might be of value. In it’s present form it is merely a historical interest.
14. Werner, R.A., Albers, J.W., Franzblau, A., Armstrong, T.J., “The relationship between body mass index and the diagnosis of carpal tunnel syndrome.” Muscle & Nerve, 1994; 17: 632-636.
Suggests a very high incidence of obesity in patients seen with CTS. Does not, however, help to make connections for the inadequacy/fallacy of the method used to determine “obesity” in the first place. Fails to account for the small CT volume and genetics and sex noted in prior, more enlightened research.
15. Williams, T.M., Mackinnon, S.E., Novak, C.B., McCabe, S., and Kelly, L. “Verification of the pressure provocative test in carpal tunnel syndrome.” Ann Plast Surg, 1992; 29:8-11.
The limited value of this contribution is showing that tests can assist clinicians in the office where electrodiagnostic studies are not readily available. It is a precursor to having electrodiagnostic studies performed. This is yet another small study comparing 30 carpal tunnel syndrome patients with 30 control subjects to assess the value of using median nerve compression tests originally advised by Paly and McMurtry. This study is severely flawed in its failure to define the specific electrodiagnostic technique and criteria utilized in confirming the diagnosis of CTS in the symptomatic subjects and excluding neuropathy in the asymptomatic “control” group. This would attest to uncharacteristically high sensitivity for a clinical test (100%) and sensitivity of 88% that they reported, which is also directly the exact opposite that was concluded by Durkan in his article in Orthopaedic Review (see reference).