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Utilization of Neurophysiological Classification Systems in Determining Interventions for Patients with Carpal Tunnel
Greg Ernst1, Scott W Shaffer2, John S Halle3
1Associate Professor, Department of Physical Therapy, UT Health Science Center, San Antonio, TX, and Clinical Electrophysiologist, Hand Center of San Antonio, TX.
Background:
Median mononeuropathy at or distal to the wrist, or carpal tunnel syndrome (CTS), is the most common peripheral nerve compression disorder in the upper extremity. Neurophysiological classification systems for patients with CTS have been developed and implemented to provide health care providers an enhanced system of electrophysiological evaluation with a grading scale, so that they may evaluate their patients with CTS within a system that confers relative severity. Electrophysiological data collected within these classification systems includes either nerve conduction studies (NCS), or both NCS and electromyography (EMG) test results. The purpose of this study was to assess the utilization of neurophysiological classification systems in determining interventions for patients with carpal tunnel syndrome (CTS).
Methods:
To assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS, an on-line survey of referring providers to NCS/EMG (electrophysiological testing) clinics was developed. These clinical sites were asked to submit three referring providers of their NCS/EMG services. The survey was emailed to the referring providers with a letter of introduction that included an overview and purpose of the study and specifically stated their responses were completely anonymous and analyzed data would be in an aggregate form.
Results:
Of the 35 referring providers of NCS/EMG services for their patients with CTS contacted to participate in this study, 14 providers completed the on-line survey (40%). This included 12 physicians (MD), one osteopathic physician (DO), and one nurse practitioner (NP). Twelve of the referring providers (85.7%) were familiar with clinical electrophysiological classification systems for patients with CTS. Nine referring providers use a neurophysiological classification system (Greathouse Ernst Hall Shaffer (GEHS) and Bland-six; GEHS only-two; alternate system-one). Five respondents did not use a neurophysiological classification system, two of which were not familiar with these classification systems. The nine providers who use a neurophysiological classification system for their patients with CTS found these systems useful in assessing patient prognosis, treatment planning, and communicating back to referral services. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications.
Conclusion:
Referring providers of NCS/EMG services completed an on-line survey to assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications. A method for using a neurophysiological classification system for patients with CTS in a clinical report is provided. Additional research to assess the prognostic validity and utilization of carpal tunnel classification systems as longitudinal outcome measures is needed.
