Current practice in the use of nerve conduction studies in Carpal Tunnel Syndrome by surgeons in the Netherlands

Authors of this study sent a questionnaire to surgeons performing Carpal Tunnel release in the Netherlands. Questions regarding their opinions and method of diagnosing Carpal Tunnel Syndrome (CTS) were specifically addressed.

Guidelines regarding the treatment of CTS were published in 2006, by the Dutch Institute for Healthcare Improvement (CBO guideline 2006). The guidelines advised an open release of the carpal tunnel was only to be performed once electrodiagnostic tests have confirmed the clinical diagnosis.
If electrodiagnostic studies were normal, conservative treatment was recommended rather than surgery.

This Dutch study looked to evaluate the opinions of operating surgeons; their method of diagnosis and to what extent electrodiagnositc confirmation was needed before operating.
In the Netherlands, carpal tunnel release is most frequently performed by neurosurgeons, followed by plastic and orthopaedic surgeons.

686 surgeons in the Netherlands, who were performing carpal tunnel release at the time of this study, were each sent a questionnaire.
The questionnaire looked at the number of patients tested electrodiagnostically, and the number of patients on whom surgery for CTS was carried out by the surgeons.

324 questionnaires were anonymously completed and returned.
Results showed that 64% of surgeons reported 96-100% of patients with complaints suggestive of CTS underwent electrodiagnostic studies.
Neurosurgeons and orthopaedic surgeons were found to comply with the Dutch consensus guidelines, by rarely operating without electrodiagnostic confirmation.
Plastic surgeons were found to operate more often on patients with clinically diagnosis, even with normal electrodiagnostic studies.
Knowledge of these differences in the diagnosis of treatment across different specialities may influence the behaviour of others.

Mike Hayton takes an accurate history and clinical examination of his patients. If these give a classical picture of carpal tunnel syndrome Mr Hayton discusses with his patients the pros and cons of adding a further investigation such as nerve conduction studies. If the patient is happy to proceed to surgery without these tests, they are listed directly. However, if the clinical scenario is not classical for CTS, then Mr Hayton will add nerve conductions studies to help clarify the situation.

 

F. Claes. F., Verhagen W. J. M., and Meulstee. J.
Journal of Hand Surgery (European Volume, 2007) 32E: 6: 663-667