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Do Electrodiagnostic Variables Correlate with Functional Outcomes in Carpal Tunnel Syndrome?

Donald Kasitinon, Thiru M. Annaswamy, Alexandru Anastase, Tong Zhu, Hai-Yan Li and Samuel M. Bierner

Background: The most common entrapment neuropathy seen in electrodiagnostic (EDX) laboratories is carpal tunnel syndrome (CTS). The diagnostic value of EDX with regard to CTS is well-established, but EDX’s predictive value is unclear. To date, only one study has attempted to establish a relationship between EDX findings and a patient’s clinical status pre- and post-treatment, and there was no significant relationship found.

Objective: To establish a relationship between EDX variables and clinical severity assessment with Disabilities of the Arm, Shoulder, and Hand (DASH) scores at a single point in time and over a period of time.

Methods: The study was a prospective single group cohort. 41 patients referred to an EDX clinic with suspected diagnoses of CTS were enrolled. Patients underwent EDX studies and completed DASH questionnaires at initial and follow-up visits at 8-month to 12-month intervals. Data collected included median sensory, mixed, and motor latencies, amplitudes, conduction velocities, and needle electromyography (EMG). Correlation coefficients were determined between EDX data variables and severity assessment (independent variables) and patients’ DASH questionnaire measures (dependent variables) at initial and follow-up assessments.

Results: Change in DASH score over time positively correlated with left distal median motor latency (DMML) decrement and right transcarpal median sensory conduction block and negatively correlated with left median sensory nerve action potential (SNAP) amplitude decrement percentage, right needle EMG motor unit morphology abnormality, and right median forearm motor conduction velocity increment. The correlations observed are of unclear significance since the DASH scores themselves did not change significantly over time.

Conclusions: Objective EDX data coupled with patient-reported outcome (PRO) measures such as the DASH score may be more meaningful in directing clinical care than either of them alone.