Utilization of Diagnostic Testing for Carpal Tunnel Syndrome: A Survey of the American Society for Surgery of the Hand

Abstract

In 2016, the American Academy of Orthopaedic Surgeons (AAOS) changed the clinical practice guidelines (CPGs) for the diagnosis of carpal tunnel syndrome, relaxing the recommendation for electrodiagnostic studies (EDS) prior to offering surgery. However, it is unknown how the updated guidelines changed the practice patterns of hand surgeons. A web-based multiple-choice survey was sent to the members of the American Society for Surgery of the Hand. We assessed the current diagnostic practice patterns of hand surgeons. The survey was pretested using expert review with content and survey methodology experts and cognitively tested to ensure readability and understandability. The final cohort consisted of 770 hand surgeons. Approximately 26% of respondents required EDS prior to seeing a patient in consultation, and 56% of members routinely ordered EDS after evaluating a patient with carpal tunnel syndrome if testing was not performed prior to evaluation. The top reasons for obtaining EDS were to provide additional information for unclear diagnoses (97% selected), for patients with worker's compensation (82% selected), for grading the severity (73% selected), and to provide a baseline examination in the event of persistent symptoms (72% selected). However, only 38% of respondents believed that the current AAOS CPGs were appropriate, and 43% of respondents did not know what the guidelines recommended. Despite the change in AAOS CPGs, EDS continues to be ubiquitously used for the diagnosis of carpal tunnel syndrome. Nevertheless, a substantial proportion of hand surgeons are unaware of the recommendations for EDS within the AAOS CPGs. These findings highlight the importance of explicitly defining which patients and which clinical scenarios would benefit from additional diagnostic testing and identifying strategies for more widespread dissemination of guidelines.