False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome

Abstract

The purpose of the study was to determine the rate of false positives for nerve conduction studies (NCSs) and ultrasound (US) in a population without signs and symptoms of carpal tunnel syndrome (CTS) using a CTS-6 score of 0 as the reference standard. Patients were included in this study if they were referred for NCSs for a reason other than CTS (cubital tunnel syndrome and/or cervical radiculopathy) and they had a CTS-6 score of 0. An US measurement of the cross-sectional area (CSA) of the median nerve at the level of the carpal tunnel inlet was performed by a certified ultrasound technician. An a priori CSA cutoff of 10 mm2 or greater measured using US at the carpal tunnel inlet qualified as a positive diagnosis. The NCSs were performed and interpreted according to national standards by a certified electrodiagnostician. All patients in this study were considered to not have a diagnosis of CTS based on the CTS-6 of0. Forty hands with a CTS-6 of 0 were included in this study. The US was positive in 9 of 40(23%) and NCS was positive in 17 of 40 (43%). There were only 2 patients with a false-positive US that did not also have a positive NCS. However, there were 11 patients who had a false-positive NCS that did not have a positive US. This prospective cohort series has demonstrated that US has a lower false-positive rate than NCSs in asymptomatic patients as measured by the CTS-6 diagnostic tool. Studies with a low false-positive rate are preferred when ordering a confirmatory diagnostic test. Therefore, if a confirmatory diagnostic test is desired, we recommend that US be used ratherthan NCSs. Diagnostic II.