In Reply

Abstract

The constructive comments on our study are highly appreciated. We agree that there are arguments about the best diagnostic criteria for carpal tunnel syndrome, and variable criteria have been suggested by different researchers.1Roll S.C. Case-Smith J. Evans K.D. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature.Ultrasound Med Biol. 2011; 37: 1539-1553Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar The continual improvement of our patients' outcome, in both survival and quality of life, is still the main goal of health care services. Although the mathematical optimal choice for the cutoff point on the receiver operating characteristic curve might still be maximizing the value of “sensitivity + specificity −1,” we usually are left with a difficult choice for making a trade-off between these 2 indicators, given the priority of our major goals and resource constraints. Thus, we agree that further research is needed to obtain universally accepted diagnostic criteria for carpal tunnel syndrome to consistently improve the outcome because the cross-sectional area of the median nerve might be different in different ethnicities.2Hobson-Webb L.D. Padua L. Median nerve ultrasonography in carpal tunnel syndrome: findings from two laboratories.Muscle Nerve. 2009; 40: 94-97Crossref PubMed Scopus (47) Google Scholar In addition, as the core value of our diagnosis and treatment is to improve the quality of life and prevent any functional disability of our clients, we do not support any aggressive management in any patient with some positive sonographic or magnetic resonance imaging signs but without any carpal tunnel syndrome-related symptoms. Ultrasound and MRI in Carpal Tunnel Syndrome: The Dilemma of Simplifying the Approach to a Complex Disease or Making Complex Assessments of a Simple ProblemJournal of Hand SurgeryVol. 37Issue 10PreviewI read with great interest the article by Horng et al1 that focuses on the accuracy of ultrasonography and magnetic resonance imaging (MRI) in diagnosing carpal tunnel syndrome (CTS) in both the rest and grasp conditions. Full-Text PDF