A revised electrodiagnosis-based severity classification for carpal tunnel syndrome

Area of Science:

• Neurology
• Electrophysiology
• Orthopedics

Background:

• Carpal tunnel syndrome (CTS) diagnosis and severity assessment rely on electrodiagnostic evaluations.
• Current classification systems may not fully capture the spectrum of CTS severity.
• Accurate stratification is crucial for effective patient management and treatment planning.

Purpose of the Study:

• To propose and validate a revised electrophysiological classification for carpal tunnel syndrome (CTS).
• To define a new intermediate CTS group based on specific electrodiagnostic findings.
• To correlate this new classification with clinical and sonographic parameters.

Main Methods:

• Retrospective cross-sectional study of 1,069 CTS hands from 850 patients.
• Patients classified into mild, moderate, and severe groups based on Stevens' criteria.
• A novel intermediate group defined by normal motor nerve conduction and abnormal electromyography.
• Pain assessed via numeric rating scale; physical and sonographic evaluations performed.

Main Results:

• 522 mild (48.8%), 281 moderate (26.3%), and 266 severe (24.9%) cases initially identified.
• 49 severe cases were reclassified into the new intermediate group.
• The intermediate group showed significantly different median cross-sectional areas compared to the severe group.
• Pain scores in the intermediate group were significantly different from the moderate group.

Conclusions:

• The newly defined intermediate CTS group exhibits clinical features between moderate and severe CTS.
• This revised classification refines electrophysiological assessment for carpal tunnel syndrome.
• The findings support a more nuanced approach to CTS severity stratification.