Model for prediction of the degree of neurography in carpal tunnel syndrome

Abstract

Neuropathy of the median nervecaused bytheentrapment of this nerveasit passesthrough the carpal tunnel is very common. Its symptoms and signs are known as carpal tunnel syndrome (CTS), whose diagnosticand therapeutic approach consumes important health resources as it is a highly prevalent pathology. Electroneurography (ENG) or neurographyisconsidered the gold standard in its evaluation, as it allows for quantifying the nerve injury degree, but the generalization of its use sometimes results in its performance even before a careful clinical evaluation and conservative treatment. A sensory and motor involvement of the nerve is usually a criterion for considering a surgical approach, leading to conservative treatment in the rest of the cases. We present a cohort of 816 patients referred to our service for ENG for suspected CTS. A clinical reassessment was carried out, classifying the symptoms as typical or atypical for CTS according to criteria, and ENG was performed in all cases. The correlation of a series of demographic and clinical characteristics of patients with a degree of sensory and motor involvement (≥ 3 on our scale) was studied and a statistical model was generated to predict the degree of neuropathy before ENG. Presenting typicalclinicalsymptoms, male gender,age over 50 years, bilateralsymptoms, or presenting them in the dominant hand, as well as positivity of Tinel’s sign and Phalen’s hand correlated with a higher degree of neuropathy.