AANEM Consensus-Based Guideline for Grading the Severity of Carpal Tunnel Syndrome

Electrodiagnostic (EDX) reports for patients with carpal tunnel syndrome (CTS) often include a description of severity, but considerable variability in approach creates confusion for referring physicians, patients, and EDX practitioners. The purpose of this project was to establish a consensus-based recommendation for a single grading system for CTS severity. A literature review, a survey of EDX practitioners, a Delphi consensus methodology (physician and non-physician stakeholders), and expert rankings were used to select a single recommended grading system for CTS severity. Twelve different CTS grading systems have been published. Of 1,253 survey respondents, only 43% of surveyed used solely nerve conduction results to determine severity; often symptoms or a mixture of EDX and clinical features were used. Twenty-seven percent of respondents did not use a particular grading system. The consensus of 18 EDX clinicians, other clinicians, and patients was that seven elements are essential to a grading system: consistency, comprehensibility, validity, objectivity, uniformity, responsiveness, and ordinality. An assessment of the 12 published scales, using these seven essential elements for rating, concluded that the Bland grading system best meets these criteria. It is recommended that the Bland neurophysiologic grading system be used for consistently grading the severity of CTS. This scale is objective, reliable, readily understood, and sensitive to change. It has also been validated with outcomes after surgical release. The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) believes that widespread, preferably ubiquitous, use of this grading system will ensure consistency of grading across laboratories and will ultimately improve patient care.