The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

Muscle Nerve. 2020 Jul;62(1):60-69. doi: 10.1002/mus.26874. Epub 2020 Jun 1.


Introduction: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures.

Methods: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures.

Results: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures.

Discussion: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.

Keywords: carpal tunnel syndrome; electrodiagnosis; functional status; health-care expenditures; occupational diseases; patient-reported outcomes; quality measures; surgical appropriateness.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Carpal Tunnel Syndrome / diagnosis
  • Carpal Tunnel Syndrome / economics
  • Carpal Tunnel Syndrome / surgery*
  • Electrodiagnosis / economics
  • Electrodiagnosis / standards*
  • Female
  • Health Expenditures / standards*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Occupational Health Services / economics
  • Occupational Health Services / standards*
  • Patient Reported Outcome Measures*
  • Quality Indicators, Health Care / economics
  • Quality Indicators, Health Care / standards*
  • Treatment Outcome