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Updated: Jul 20, 2025
Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
Development and validation of a clinical model for predicting the severity of carpal tunnel syndrome
Behnaz Aalaie1, Javad Sadeghi2, Tanya Mohammadi3
1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran.
Objectives:
To develop a clinical instrument to assess carpal tunnel syndrome (CTS) severity before electrodiagnostic testing.
Methods:
Data from 1037 patients with CTS (39.1% male) were included. The mean (SD) age was 58.0 (10.8) years. The severity of CTS was based on electrodiagnostic findings.
Results:
We devised a composite index incorporating a pain numeric rating scale (NRS) rated from 0 (no pain at all) to 10 (the worst pain ever possible), thenar muscle weakness or atrophy (TW), cross-sectional area (CSA) of the median nerve (mm2), and nocturnal pain (NP). The index was calculated as [scale(NRS)+scale(CSA)+NP+TW]/4, where NP and TW are binary features (0 or 1). The accuracy and area under the curve of the index were 0.85 and 0.71, respectively (Cohen's Kappa = 0.51, McNemar's test P = 0.249). The index increased pretest probabilities by 1.6, 1.8, and 3.3 times with positive likelihood ratios of 3.3, 2.5, and 13.5, and false-positive rates of 26.6, 17.6, and 4.8% for mild, moderate, and severe CTS, respectively. The index thresholds for mild, moderate, and severe CTS were <0.8, ≥0.8 to <1.1, and ≥1.1, respectively.
Conclusion:
Using a composite index, patients with CTS can be categorized for the severity of the syndrome.
