The Association Between Electrodiagnostic Severity and Treatment Recommendations for Carpal Tunnel Syndrome

Abstract

Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR). We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR. Among all patients with an eventual diagnosis of CTS who received EDS (n= 210), nearly half had normal or mild severity (23%, n= 48; and 28%, n= 58, respectively) and the other half had moderate or severe EDS findings (26%, n= 55; and 23%, n= 49, respectively). Patients with severe findings had the highest rate of receiving surgery (53%) compared with patients with mild and moderate findings (33% vs 46%, respectively). Among the patients who received CTR (n= 73), patients with severe EDS findings had the shortest time to CTR (59.5 days; interquartile range [IQR], 30-81), compared with mild severity (170 days; IQR, 87-415) and moderate severity (77 day; IQR, 42-292). Moderate and severe EDS findings were associated with significantly higher odds of receiving CTR in adjusted analyses (odds ratio, 2.48, 95% confidence interval, 1.04-5.93 and odds ratio 3.79, 95% confidence interval, 1.51-9.50, respectively) compared with patients with mild EDS findings. However, the odds of receiving steroid injection and hand therapy/orthosis were not significantly different based on severity. Electrodiagnostic study severity had a direct relationship to the probability of receiving surgery but did not correlate with use of nonsurgical treatment. The study findings signal a need to evaluate the value of nonsurgical treatments in patients with severe EDS findings. Prognostic II.