Which hand is worse? Concordance between patient perception and electrodiagnostic results in carpal tunnel syndrome

In patients with clinically diagnosed carpal tunnel syndrome (CTS) the more symptomatic hand may be different from the more severely affected hand on electrodiagnostic testing. This study aims to determine the level of agreement which should be expected between these measures and consequently the level of suspicion for co-occurring pathology which is warranted if there is discordance.

This was a single center retrospective review of 252 patients referred for upper extremity electrodiagnostic evaluation who were diagnosed subsequently with CTS. Comparison was made between the patient's perceived worst side and the more abnormal side on electrodiagnostic studies.

We found a significant level of agreement (κ = 0.676) between patient symptoms and electrodiagnostic testing when identifying the side with more severe CTS.

Discordance between patient perception and electrodiagnostic results regarding which hand is affected more severely in patients with CTS should alert the clinician to possible coexisting nonneurologic pathology and prompt regional musculoskeletal examination as indicated.