Carpal tunnel syndrome: When is referral OK?

There is a high prevalence of carpal tunnel syndrome (CTS), and several other conditions that mimic symptoms of CTS. Do you know when it is appropriate to refer a patient to a specialist for diagnosis?

Researchers set out to develop an easy screening questionnaire to help determine when it is appropriate to refer a patient for nerve conduction studies and needle electromyography (EMG), which are the electrodiagnostic tests most commonly used to diagnose CTS.

A seven-item screening questionnaire screened patients with possible CTS before clinician referral for electrodiagnostic testing. The questionnaire was completed by 100 patients. Three key questions predicted the diagnosis of CTS:

• tingling in at least two of the first four digits;

• symptoms worsening during the night/on awakening;

• the condition improving upon shaking the hand.

With at least two "yes" responses to the questions, the sensitivity of the questionnaire to predict abnormal electrodiagnostic test was 97% (p < 0.001). Simon Podnar, MD, of the University Medical Centre Ljubljana in Slovenia, said, "It seems that only patients with the most advanced CTS may be missed by the questionnaire; therefore looking for muscle atrophy and abnormal skin sensation in the hand is not to be skipped on physical examination by the doctor."

Used by clinicians in combination with physical examination, the questionnaire can result in more timely referrals for electrodiagnostic testing, diagnosis, and treatment for patients with CTS, the researchers concluded.

This study was presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) recent annual meeting.