Clinical and Electro-Diagnostic Quantification of the Severity of Carpal Tunnel Syndrome

Objectives: To quantify the severity of carpal tunnel syndrome clinically and electro-diagnostically and to assess the electro-diagnostic differences between groups with clinically mild to moderate CTS and severe CTS. Study Design: Hospital based cross sectional comparative study. Setting: Neuro-diagnostic room of neurology unit, Govt: Lady Reading Hospital Peshawar.Duration of Study: One year study from May 2010 to June 2011. Patients and Methods: This study was conducted on 66 consecutive patients. All adult patients of either gender were studied who were referred with symptoms consistent with CTS and having confirmatory findings on NCS. The clinical grade of CTS was designated as mild to moderate or as severe, according to the modified criteria of the Italian CTS Study Group. Electro-diagnostically CTSgrades 0-3 were grouped as mild to moderate (group 1) and grades 4-6 as severe (group 2). The statistical analysis was carried out by the SPSS program, windows version 15.0. Independent t test was employed for quantitative data and Chi square testing was used for qualitative data. A p value of less than 0.05 was considered statistically significant. Results: Out of 66 patients with CTS, females were 72.7% and males were 27.3%. The mean age at presentation was 51.39 + 12.252 years. The classic history of CTS (56.1%); paraesthesias (77.3%); numbness (63.6%), pain that worsens at night (56.1%) and tactile hypoesthesia (21.2%) were reported by our studied patients. Weakness or wasting of APB was less frequent (19.7%) and (13.6%) respectively. Tinel’s test and Phalen’s sign were positive in 48.5% and 59.1% patients respectively. Sensory and motor distal latencies and SNAP were significantly different between clinically mild to moderate CTS and severe CTS (p 0.005, p 0.01 and p 0.03 respectively). Based on clinical assessment 74.3% had mild to moderate CTS and 25.7% had severe CTS. However as classified by NCS, there were 62.1% patients with mild to moderate CTS and 37.9% with severe CTS. Conclusion: Carpal tunnel syndrome was more common in females. Patients with higher grades of CTS were of higher age. Sensory symptoms and dominant hand involvement were more common. Nerve conduction studies (NCS) provide additional, independent objective evidence in the diagnosis and severity assessment of CTS.