How does neurophysiological assessment influence the management and outcome of patients with carpal tunnel syndrome?

The objective of this study was to determine how neurophysiological assessment influenced the management and outcome of 100 consecutive patients referred to a department of clinical neurophysiology in a district general hospital with a provisional clinical diagnosis of carpal tunnel syndrome. Nerve conduction studies excluded the diagnosis in 36 patients who may have otherwise received inappropriate treatment. The decision whether to perform a carpal tunnel decompression was greatly influenced by a positive study. Symptoms subsequently resolved in 72-86% of patients treated on this basis, depending on the mode of treatment and the nerve conduction study findings, with similar outcomes for surgical and conservative measures. The clinical and estimated resource implications of this diagnostic service were found to be substantial.