Overview
Carpal tunnel syndrome (CTS) CTS is the most frequent neuropathy of upper extremities and also it is known as the common work-related musculoskeletal disorder. CTS found in approximately 3% to 6% of adults in the United States.According to the clinical practice guideline (CPG) from the American Academy of Orthopedic Surgeons (AAOS), Carpal tunnel syndrome (CTS) is “a symptomatic neuropathy compression of the median nerve within wrist, characterized by increased pressure within the carpal tunnel in additon to the decreased function of the nerve.” It is the most common compressive neuropathy affecting the upper extremity, present in approximately 3% to 6% of adults in the United States. Clinical diagnosis of CTS has been based on patients symptoms and meanwhile electrodiagnostic evaluation used for confirmation in this regard. The electrodiagnostic is known as the gold standard for CTS final diagnosis.
Classification
Disease Classification in Carpal Tunnel Syndrome
| CLASSIFICATION
|
DURATION
|
TWO-POINT DISCRIMINATION TEST
|
WEAKNESS
|
ATROPHY
|
ELECTROMYOGRAPHY*
|
NERVE CONDUCTION STUDIES*
|
| Mild
|
Shorter than one year
|
Normal
|
Absent
|
Absent
|
No denervation
|
No to mild velocity decrease
|
| Moderate
|
Shorter or longer than one year
|
Possible abnormality
|
Minimal presence
|
Minimal presence
|
No to mild denervation
|
No to mild velocity decrease
|
| Severe
|
Longer than one year
|
Marked abnormality
|
Marked presence
|
Marked presence
|
Marked denervation
|
Marked velocity decrease
|
| Clinical & Sonographic Evaluation
|
Score
|
| Provocative Tests
|
|
| No Positive Tests
|
0
|
| Any Positive Test
|
1
|
| Symptom Severity Rating (BCTQ)
|
|
| Rating < 1.62
|
0
|
| Rating > 1.62
|
1
|
| Functional Deficit Rating (BCTQ)
|
|
| Rating < 1.22
|
0
|
| Rating > 1.22
|
1
|
| Median Nerve Cross-Sectional Area (CSA)
|
|
| (i.e., largest CSA in the carpal tunnel region)
|
|
| < 12.10 mm2
|
0
|
| 12.10 mm2 to 13.73 mm2
|
1
|
| 13.73 mm2 to 15.36 mm2
|
2
|
| > 15.36 mm2
|
3
|
| Longitudinal Irregularity
|
|
| Absent
|
0
|
| Present
|
1
|
|
| Total Score
|
0–7
|
|
| Score Interpretation
|
|
| 0–1 = Negative
|
|
| 2–3 = Pre-Clinical
|
|
| 3–4 = Mild CTS
|
|
| 5–6 = Moderate CTS
|
|
| 7 = Severe CTS
|
References