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Updated: Apr 26, 2026
Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome
Ann Marie Dale1, Bethany T Gardner, Angelique Zeringue
1From the Department of General Medical Sciences (Dr Dale, Dr Gardner, Ms Zeringue, and Dr Evanoff), Washington University School of Medicine; School of Public Health (Ms Zeringue), St Louis University, St Louis, Mo; and Department of Environmental and Health Sciences (Dr Werner and Dr Franzblau), University of Michigan School of Public Health, Ann Arbor.
Objective:
We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness.
Methods:
A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs.
Results:
Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds.
Conclusions:
Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.
