Can electrodiagnostic tests be omitted from surgical decision-making for typical carpal tunnel syndrome? - A randomized controlled trial

Abstract

Background: Although carpal tunnel syndrome (CTS) is common and frequently seen in daily practice, diagnostic criteria remain the subject of debate. Some authors consider electrodiagnostic tests as essential, whereas others view them as an unnecessary luxury. Objective: The objective is to investigate whether electrodiagnostic tests are necessary for surgical decision-making for typical CTS. Materials and Methods: The study was planned as a randomized controlled trial. After determining normative values for the population of the geographic region, 101 consecutive cases of typical CTS of the hand (suffering palmar dysesthesia that waking from sleep at night) were enrolled in the study. Hands were randomized into two groups using simple randomization. The first group comprised patients whose surgical candidacy was evaluated without electrodiagnostic tests, and the second group comprised patients whose surgery decisions were based on the results of electrodiagnostic testing. The patients were evaluated at 1, 3, and 12 months postoperatively. Results: Sixty-one hands were randomized to the first group and 40 hands were randomized to the second group. Four cases in the second group received medical treatment because their electrodiagnostic test results were within the normal limits, despite the presence of typical CTS symptoms. There were no differences in favor of the second group regarding any evaluation criteria during the entire follow-up period; however, the first group reported significantly more positive outcomes regarding awakening at the 3-month follow-up and regarding satisfaction at the 1-month follow-up. Conclusion: Additional electrodiagnostic tests may not be mandatory to clinically identify classical CTS or make surgical decisions in these cases. However, many cases may be caused by entrapment of the median nerve in the carpal tunnel, but they may lack typical CTS symptoms, such as waking from night-time sleep. In such cases, properly applied electrodiagnostic tests may be of immense help.