Assessment Of Carpal Tunnel Syndrome Research Articles

Added Value of Morphological and Functional Magnetic Resonance Neurography in Assessment of Carpal Tunnel Syndrome in Correlation with Nerve Conduction Studies

Added Value of Morphological and Functional Magnetic Resonance Neurography in Assessment of Carpal Tunnel Syndrome in Correlation with Nerve Conduction Studies

Is the left/right judgment task performance altered in unilateral carpal tunnel syndrome: And associated with symptom severity?

BackgroundLeft/right judgment task performance (LRJT) is impaired in severe neuropathic pain conditions. However, comparison of LRJT performance in patients with carpal tunnel syndrome (CTS) with a control group with similar cognitive functions has not been investigated. ObjectiveThe aim of the study was to compare the LRJT performance of CTS patients with healthy controls and the unaffected side. MethodsSeventy-five CTS patients with dominant, right-hand involvement and 75 control subjects were included in the study. The Recognize® tablet application was used for LRJT performance. Tactile acuity (Two-point discrimination) and handgrip strength; pain severity (Visual Analog Scale) and neuropathic component of pain (Pain Detect Questionnaire); symptom severity and functional impact of CTS (Boston CTS Assessment Test) were evaluated. Mixed-design ANOVAs and correlation analyses were used for data analysis. DesignCross-sectional study. ResultsAnalysis of variance showed that there was no significant effect of side (affected versus unaffected) or group (CTS versus control group) on recognition accuracy or time. Significant group*site interactions were found for the two-point discrimination F (1,148) = 6.388, p = 0.013; and for handgrip strength F (1,148) = 17.552, p < 0.01. A statistically significant negative correlation was found between recognition accuracy and symptom duration and a significant positive correlation was found between recognition accuracy and handgrip strength in CTS patients (r = −0.267, p = 0.020; r = 0.290, p = 0.012). ConclusionCTS patients recognize the affected side as accurately and quickly as the unaffected side and control group. Further research is needed to clarify the relationship between LRJT performance in the severely affected CTS group. ClinicalTrials.gov registration numberNCT04967144 ClinicalTrials.gov registration date19 July 2021

Clinical-electrodiagnostic correlates in three cases of Riche-Cannieu anomaly (all-ulnar hand).

Abstract.

Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study.

BACKGROUNDCarpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions. AIMTo correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.METHODSThis was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe. RESULTSThere were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSIONWe feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.

Development of a convolutional neural network for the identification and the measurement of the median nerve on ultrasound images acquired at carpal tunnel level

BackgroundDeep learning applied to ultrasound (US) can provide a feedback to the sonographer about the correct identification of scanned tissues and allows for faster and standardized measurements. The most frequently adopted parameter for US diagnosis of carpal tunnel syndrome is the increasing of the cross-sectional area (CSA) of the median nerve. Our aim was to develop a deep learning algorithm, relying on convolutional neural networks (CNNs), for the localization and segmentation of the median nerve and the automatic measurement of its CSA on US images acquired at the proximal inlet of the carpal tunnel.MethodsConsecutive patients with rheumatic and musculoskeletal disorders were recruited. Transverse US images were acquired at the carpal tunnel inlet, and the CSA was manually measured. Anatomical variants were registered. The dataset consisted of 246 images (157 for training, 40 for validation, and 49 for testing) from 103 patients each associated with manual annotations of the nerve boundary. A Mask R-CNN, state-of-the-art CNN for image semantic segmentation, was trained on this dataset to accurately localize and segment the median nerve section. To evaluate the performances on the testing set, precision (Prec), recall (Rec), mean average precision (mAP), and Dice similarity coefficient (DSC) were computed. A sub-analysis excluding anatomical variants was performed. The CSA was automatically measured by the algorithm.ResultsThe algorithm correctly identified the median nerve in 41/49 images (83.7%) and in 41/43 images (95.3%) excluding anatomical variants. The following metrics were obtained (with and without anatomical variants, respectively): Prec 0.86 ± 0.33 and 0.96 ± 0.18, Rec 0.88 ± 0.33 and 0.98 ± 0.15, mAP 0.88 ± 0.33 and 0.98 ± 0.15, and DSC 0.86 ± 0.19 and 0.88 ± 0.19. The agreement between the algorithm and the sonographer CSA measurements was excellent [ICC 0.97 (0.94–0.98)].ConclusionsThe developed algorithm has shown excellent performances, especially if excluding anatomical variants. Future research should aim at expanding the US image dataset including a wider spectrum of normal anatomy and pathology. This deep learning approach has shown very high potentiality for a fully automatic support for US assessment of carpal tunnel syndrome.

Combined Median Score Increasing Sensitivity of Carpal Tunnel Syndrome Diagnosis

Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Electrodiagnostic (EXD) of CTS has advanced to include Combined Sensory Indexes (CSI) improving the specificity and sensitivity of EXD by employing intra-hand comparative data. Ultrasound (US) is a popular tool for the assessment of CTS. Cross Sectional Area (CSA) is the most consistent US parameter, but as a single test, it has a similar false negative profile to EXD. This study describes a dual method of CTS interrogation by EXD and US with the results applied to a single numerical score; the Combined Median Score (CMS). This is the product of CSA of median nerve at Carpal Tunnel inlet and CSI. In a series of 100 suspected cases, standard EDX identified 89 positive cases, CSI identified 92 positives, CMS identified 95 positives. This new method further reduced the false negative rate in CTS.

Learning-Based Median Nerve Segmentation From Ultrasound Images For Carpal Tunnel Syndrome Evaluation.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Ultrasound imaging (US) may help to diagnose and assess CTS, through the evaluation of median nerve morphology. To support sonographers, this paper proposes a fully-automatic deep-learning approach to median nerve segmentation from US images. The approach relies on Mask R-CNN, a convolutional neural network that is trained end-to-end. The segmentation head of Mask R-CNN is here evaluated with three different configurations, with the goal of studying the effect of the segmentation-head output resolution on the overall Mask R-CNN segmentation performance. For this study, we collected and annotated a dataset of 151 images acquired in the actual clinical practice from 53 subjects with CTS. To our knowledge, this is the largest dataset in the field in terms of subjects. We achieved a median Dice similarity coefficient equal to 0.931 (IQR = 0.027), demonstrating the potentiality of the proposed approach. These results are a promising step towards providing an effective tool for CTS assessment in the actual clinical practice.

Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome

BackgroundNerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.MethodOf the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.ResultsThe average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = − 0.33; 0–12 months, r = − 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.ConclusionNCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

The Accuracy of a Screening System for Carpal Tunnel Syndrome Using Hand Drawing.

When carpal tunnel syndrome (CTS), an entrapment neuropathy, becomes severe, thumb motion is reduced, which affects manual dexterity, such as causing difficulties in writing; therefore, early detection of CTS by screening is desirable. To develop a screening method for CTS, we developed a tablet app to measure the stylus trajectory and pressure of the stylus tip when drawing a spiral on a tablet screen using a stylus and, subsequently, used these data as training data to predict the classification of participants as non-CTS or CTS patients using a support vector machine. We recruited 33 patients with CTS and 31 healthy volunteers for this study. From our results, non-CTS and CTS were classified by our screening method with 82% sensitivity and 71% specificity. Our CTS screening method can facilitate the screening for potential patients with CTS and provide a quantitative assessment of CTS.

Assessment of carpal tunnel syndrome via ultrasonography among hospital workers: a screening study

BackgroundCarpal tunnel syndrome is a reasonably common disorder among working individuals. It may also be a cause of functional impairment. The aim of the study was to screen for the presence of carpal tunnel syndrome among hospital workers by non-invasive ultrasound.ResultsThe prevalence of carpal tunnel syndrome diagnosed by ultrasound among hospital workers was 21.5%. Age and Boston carpal tunnel questionnaire scale were positively correlated to median nerve cross sectional area.ConclusionsUltrasound can be used as a non-invasive and convenient method for screening for carpal tunnel syndrome.

A non–invasive technique for evaluating carpal tunnel pressure with ultrasound vibro–elastography for patients with carpal tunnel syndrome: A pilot clinical study

Carpal tunnel syndrome (CTS) is a disorder that affects the median nerve at the wrist sufficient to cause impairment of nerve function. Elevated carpal tunnel pressure (CTP) leads to median nerve pathology, sensory, and motor changes in CTS patient. The techniques to quantify CTP used in clinic are invasive. This study aimed to investigate the feasibility of a noninvasive ultrasound vibro–elastography (UVE) to predict CTP in CTS patients and healthy individuals. The magnitudes of shear wave speed ratio (rSWS) of the 10 CTS patients (10 hands) and 6 healthy individuals (12 hands), and 10 cadaveric hands were compared using UVE. The ratios of intra to extra-carpal tunnel SWS in CTS patients was significantly higher than those in the healthy individuals (p = 0.0008) and cadaveric hands (p = 0.0015) with 500-g tendon tension. We estimated the CTP in the carpal tunnel using the mean rSWS of each group obtained from the present study and the linear approximation obtain from cadaveric hands data with 500-g tendon tension (y = 0.0036x + 1.1413). These results indicated that the elevated pressure applied to the 3rd flexor digitorum superficialis tendon in the carpal tunnel of CTS patients resulted in faster shear wave propagation. These results show that UVE was useful to indirectly estimate the CTP by measuring the rSWS; thus, they are potentially useful for the early diagnosis and assessment of CTS.

Ultrasound Assessment of Carpal Tunnel Syndrome in Comparison with Nerve Conduction Study: A Case-control Study

Introduction: Carpal Tunnel Syndrome (CTS) is the entrapment neuropathy which is diagnosed based on the clinical history, examinations and the electrophysiological findings. The Cross- sectional Area (CSA) measurement of the median nerve has emerged as an alternative to Nerve Conduction Studies (NCS) for diagnosis of CTS. This study was done to correlate NCS and Ultrasonography (USG) in clinically diagnosed CTS patients. Aim: To evaluate the diagnostic value of Cross-sectional Area (CSA) of median nerve at carpal tunnel inlet in patients with clinically and NCS confirmed Carpal Tunnel Syndrome (CTS) and to assess severity of the syndrome by NCS and its correlation with USG results. Materials and Methods: This was a hospital based, case-control study done on a total of 109 patients of CTS and analysed during the period from June 2017 to June 2019. Total 203 hands of the patients with abnormal NCS formed case group while 101 hands from healthy volunteers constituted the control group. All the patients underwent neurological evaluation by Boston Carpal Tunnel Questionnaire (BCTQ) and were divided into mild, moderate and severe according to the score. An electromyography machine was used to perform electrophysiological studies of both the limbs in all subjects. CTS was diagnosed electro-diagnostically based on the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and were classified as mild (Grades 1 and 2), moderate (Grades 3 and 4), and severe (Grades 5 and 6) grades using Bland’s electrophysiological grading scale. USG was performed for all the subjects and all the data of various investigations was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 software. Chi-square test and Mann Whitney U-test were used as test of significance for qualitative data. Results: The mean age of subjects was 44.38±9.561 years. Strongly significant association was observed in BCTQ symptom, functional and total scores with NCS severity grading (p-value &lt;0.001). Moderately significant association was found between BCTQ symptom and total scores with USG severity grading (p-value&lt;0.02). Tunnel grade and NCS grade were found significantly correlated (p-value &lt;0.001). The mean CSA cut-off value of 8.5 mm² at the inlet of carpal tunnel had a good sensitivity 86.21%, specificity 83.17%, Positive Predictive Value (PPV) 91.1% and Negative Predictive Value (NPV) 75%. Conclusion: The diagnostic accuracy of USG assessment and NCS was found to be correlated comparably and complement each other in all grades of CTS. USG, can be considered a preferable screening tool by the patients of CTS due to its painless nature and easy accessibility. It requires minimal time and many a times detects those structural abnormalities which have great therapeutic implications. In mild CTS cases, USG should always be combined with NCS for proper diagnosis as USG might give negative result.

Ultrasound examination predicts 6-month progression in carpal tunnel syndrome patients.

Carpal tunnel syndrome (CTS) is a peripheral neuropathy resulting from chronic median nerve compression. Chronic compression leads to neurological changes that are quantified through nerve conduction studies (NCS). Although NCS represents the gold standard in CTS assessment, they provide limited prognostic value. Several studies have identified ultrasound as a tool in diagnosing and potentially predicting the progression of CTS in patients. The purpose of this study was to evaluate the predictive value of ultrasound examination in CTS patients. Twenty patients recruited at their first visit with the neurologist completed two NCS and ultrasound examinations approximately 6 months apart. Ultrasound examination consisted of B-mode, pulse-wave Doppler and colour Doppler ultrasound videos and images to quantify median nerve cross-sectional area, intraneural blood flow velocity in three wrist postures (15° flexion, neutral, and 30° extension), and displacement of the flexor digitorum superficialis (FDS) tendon and the adjacent subsynovial connective tissue (SSCT) of the middle finger during repetitive finger flexion-extension cycles. A questionnaire was administered to assess the work-relatedness of CTS. Linear regression analyses revealed that intraneural blood flow velocity (R2  = 0.36, p = .03), assessed in wrist flexion, and relative FDS-SSCT displacement (R2  = 0.27, p = .04) and shear strain index (R2  = 0.28, p = .04) were significant predictors of nerve sensory and motor changes at 6 months. Results suggest the possibility of using a battery of ultrasound measures as viable markers to predict median nerve functional changes within 6 months.

Additional value of ultrasound in the assessment of carpal tunnel syndrome in rheumatological daily practice. A case of persistent median artery thrombosis

Additional value of ultrasound in the assessment of carpal tunnel syndrome in rheumatological daily practice. A case of persistent median artery thrombosis

Diagnosis of carpal tunnel syndrome: A comparative study of shear wave elastography, morphometry and artificial intelligence techniques

Ultrasonography is an acceptable modality to evaluate median nerve (MN) in patients with carpal tunnel syndrome (CTS). Additional investigations are needed to evaluate sonographic parameters and compare their performances with artificial intelligence (AI) methods. The aim of this study is to compare the performance of shear wave elastography, morphometry, and AI techniques to predict MN entrapment accurately. 200 wrists including 100 CTS and 100 control wrists were included. Twelve morphological and five elasticity parameters were measured from each MN. Two AI techniques namely, support vector machine (SVM), and convolutional neural network (CNN) were used to diagnose CTS. MN area with area under receiver-operating characteristic curve (AUC) of 0.949 and mean elasticity with AUC of 0.942 showed the highest performance to differentiate CTS from control wrists among morphological and elasticity parameters, respectively. The CNN achieved the best performance with AUC of 0.980, while SVM obtained AUC of 0.943 in testing dataset to diagnose CTC. MN is larger, stiffer, more irregular and extended in CTS patients. Deep learning technique yielded the highest performance in diagnosing CTS automatically. AI methods have vast potential to be implemented in clinical practice as an auxiliary tool for the assessment of CTS with high accuracy.

Adaptation to Arabic Language, Validity and Reliability Test of Boston Carpal Tunnel Questionnaire in Carpal Tunnel Syndrome Patients

AbstractBackground: Carpal tunnel syndrome is a frequent cause of compression neuropathy. So, it is necessary to measure function and symptoms which are highly important to patients with carpal tunnel syndrome and have the most impact on quality of life.Aim of Study: To translate and test face validity, content validity, feasibility, internal consistency reliability and test retest reliability of Arabic-language version of Boston carpal tunnel questionnaire in carpal tunnel syndrome patients.Material and Methods: Fifty patients with carpal tunnel syndrome was recruited, 95 sheets (test and retest sheets) were filled out, two expert panels (each consists of ten experts) participated in this study. Forward translation, development of preliminary initially translated version, backward translation, and development of the pre-final version and testing of pre-final version by experts then testing of the final version on patients was done. Index of clarity, expert proportion of clearance, index of content validity, expert proportion of relevance, descriptive statistics, missed item index, Cronbach's alpha and Spearman's rank correlation coefficient were used for statistical analysis.Results: The study showed that scale index of clarity equals 87.14%, the mean proportion of clearance equals 87.14%, scale index of content validity equals 96.67%, the mean proportion of relevance equals 96.67%. The questionnaire items were filled by 95% in all sheets. The questionnaire needed less than 7 minutes to be filled. Cronbach's alpha equals 0.915 (0.877, 0.915) and all Spearman's correlations between test and retest results were statistically significant.Conclusion: Arabic-language version of Boston carpal tunnel questionnaire has face and content validity, feasibility and Internal consistency and test retest reliability enough in assessment of carpal tunnel syndrome.

A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

PurposeThe purpose of this study was to determine whether there is a difference in the change in cross-sectional area (CSA) of the median nerve in patients undergoing carpal tunnel release (CTR) based on surgical technique and whether this change is associated with changes in patient-reported outcomes evaluated using the Carpal Tunnel Syndrome Assessment Questionnaire.MethodsIndividuals with carpal tunnel syndrome were evaluated with ultrasound and the CTSAQ before and 6 weeks after surgery. Patients were eligible for inclusion if they underwent either a mini-open CTR (MOCTR) or endoscopic CTR (ECTR). A single surgeon performed all surgeries. Changes in median nerve CSA, Carpal Tunnel Syndrome Assessment Questionnaire scores, and their associated surgical technique (MOCTR vs ECTR) were analyzed.ResultsA total of 77 patients were enrolled, 13 of whom were lost to follow-up, which left 64 for analysis. Of those, 42 patients underwent ECTR and 22 MOCTR. Mean age was 55 years; there were 52 women and 12 men. Mean changes in CSA for endoscopic and mini-open techniques from before to 6 weeks after surgery were –1.9 mm2 (95% confidence interval [CI], –1.1 to –2.7) and +0.6 mm2 (95% CI, –1.6 to 0.4), respectively. Mean Symptom Severity Scores improved after endoscopic and mini-open release by 1.7 (95% CI, 1.4–2.1) and 1.5 (95% CI, 1.2–1.9), respectively. Mean Functional Status Scores improved after endoscopic and mini-open release by 1.2 (95% CI, 0.9–1.9) and 0.7 (95% CI, 0.03–1.3), respectively.ConclusionsPatients undergoing ECTR demonstrated decreased median nerve CSA, whereas those undergoing MOCTR demonstrated increased median nerve CSA at 6 weeks. All patients undergoing surgical intervention demonstrated improvement in both Symptom Severity Scores and Functional Status Scores after surgery. Whereas both techniques successfully improve patient outcome scores, an increase in CSA after MOCTR may be seen in the initial postoperative period, potentially contributing to a slower short-term improvement in outcome in functional scores compared with ECTR.Type of study/level of evidenceTherapeutic IV.

Screening for Carpal Tunnel Syndrome in Patients on Chronic Hemodialysis.

To determine the prevalence of carpal tunnel syndrome risk in patients on chronic hemodialysis (HD) using Levine questionnaire for assessment of carpal tunnel syndrome - related symptoms severity and patients' functional status and to examine the relation of the determined risk with the participants' demographic, anthropometric and laboratory data. This crosssectional study included 78 chronic HD patients at Department for Nephrology in University Hospital Osijek. All participants filled out the Levine questionnaire to examine the severity of carpal tunnel syndrome - related symptoms and their functional state. The participants' demographic, anthropometric and laboratory data were taken from the medical records and statistically analyzed by SPSS for Windows (version 16.0, SPSS Inc., Chicago, IL, SAD). Risk for carpal tunnel syndrome was found in 38.5% of the participants. No significant differences between patients with and without the risk were found in sex distribution, underlying kidney disease or vascular access. Patients at risk were older (P=0.044) and had higher body mass index (BMI), (t-test, P=0.019). Participants' age, BMI and predialytic serum urea concentration were independent predictors for carpal tunnel syndrome risk (P=0.033). The prevalence of risk for carpal tunnel syndrome among patients on chronic HD was found in more than one third of patients. Older age, higher BMI and higher predialytic serum urea concentration bear a higher risk. Electromyoneurography is thus often indicated in this population to confirm the diagnosis for consecutive surgical treatment.

A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential.

Conventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.

Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients.

The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.