1. THE DIAGNOSTIC UTILITY AND COST EFFECTIVNESS OF USING A
HANDHELD CARPAL TUNNEL SYNDROME TESTING DEVICE AT A
DISTRICT GENERAL HOSPITAL
DAMJANA DERHAM , D. HARLE, R. BASSI, J. FISCHER, M. WASEEM,
MACCLESFIELD DISTRICT GENERAL HOSPITAL (MDGH), EAST CHESHIRE, UK
25847
REFERENCES
Normal Findings Moderate Abnormality
Severe Abnormality No Peaks From Ring Finger
• The peripheral nerves are stimulated with
electric pulses at the ring finger first
• The nerve responses are recorded by elec-
trodes on the palmar aspect of the wrist be-
tween the median and ulnar nerves.
• Peak latency measurements from median and
ulnar nerves are automatically relayed to a PC
with Mediracer Analysis Centre (MAC) soft-
ware.
• The nerve response data from median and
ulnar nerves are compared together in MAC
and displayed on the screen to gather
information to establish if the median nerve is
compressed in the Carpal Tunnel.
• The diagnosis of carpal tunnel syndrome (CTS) is primarily based on clinical symptoms and
physical signs (1,3). Nerve conduction studies (NCS) objectively determine the severity and pre
-treatment baseline status of median nerve lesion in CTS and facilitates differential
diagnosis (1,4).
• This handheld NC device measures SNC ( Sensory Nerve Conduction) in the median and ulnar
nerves and uses the difference in these readings as an indicator of abnormality.
• The authors identified the cost effectiveness of NCS performed by ESP (Extended Scope Practi-
tioner) at a District General Hospital compared with Neurophysiological Testing by an external
provider.
• 141 patients were tested with a handheld
nerve conduction measuring device
• Total overall saving £16,850 between
September 2009 and June 2010.
• Waiting time for the NCS reduced from three
weeks to one.
• Waiting time for the carpal tunnel decompres-
sion was halved (12 to 6 weeks).
• Patient flow is different - fewer outpatient visits
RESULTSINTRODUCTION
• Compared to the traditional NCS this
method provides the
examiner with quick and reliable results.
• It is cost effective offering the
opportunity for significant savings.
• The tester should be used for NCS only
in cases with clinical suspicion of CTS.
• If the signs and symptoms originally
suggest a diagnosis other than CTS,
such as Generalised Neuropathy,
Radiculopathy or more Proximal Nerve
CONCLUSIONS
• 141 patients with carpal tunnel syndrome over
a 9 month period were tested. All patients
were referred from the outpatients clinic at the
Orthopaedic Unit.
• All patients were tested by ESP who had spe-
cific training in the use of the machine.
• 18 out of 141 (12.8%) had to undergo further
neurophysiological testing by an external pro-
vider.
• The selection criteria for inclusion for testing
was based on the Boston Carpal Tunnel
Questionnaire (BCTQ) including both primary
and secondary symptoms.
• In house neurophysiological confirmation of
CTS altered patient flow. Typical in house test-
ing: involves GP Referral, in house testing in
the outpatient department and then listing for
surgery.
• External testing involves GP Referral, outpa-
tient clinic, external testing, outpatient clinic for
review and then list for surgery as appropriate
MATERIALS & METHODS
A new handheld NC device measures sensory
nerve conduction (SNC) in the median and ul-
nar nerves and uses the difference in these
readings as an indicator of abnormality.
• Patients suspected of having carpal tunnel syndrome (CTS) have traditionally been sent to a
specialist for NCS (Nerve Conduction Study) and nEMG (needle electromyography)
• A new handheld test device accelerates the electrodiagnostic confirmation of CTS. It is easy to
use and the examination can be carried out by appropriately trained health care professionals.
• Reliable results are obtained within minutes.
Patients referred for surgery following NCS by ESP
DISCUSSION
• In patients examined for CTS suspicion,
this new small handheld portable NC
measuring device agreed with the
findings of traditional NCS in 88% of
cases.
• This method has certain limitations. The
tester should be used for NCS only in
cases with clinical suspicion of CTS.
• If signs and symptoms originally suggest
a diagnosis other than CTS, traditional
NCS is needed.
Number of patients
requiring further
consultant review (58%)
Number of patients
listed for surgery by
ESP (42%)
1 Padua L, Padua R, Lo Monaco M, April I,
Tonali, P. Multiperspective assessment of
carpal tunnel syndrome: A Multicenter study.
Italian CTSS Study Group.
Neurology 1999; 53: 1654-9
2. American Association of Electrodiagnostic
Medicine. American Academy of Neurology,
and American Academy of Physical
Medicine and Rehabilitation.
Practice parameter for electrodiagnostic
Studies in carpal tunnel syndrome: sum-
mary
statement. Muscle Nerve 2002; 25: 918-22
3. De Campos CC, Manzano GM, Leopoldino
JF, et al. The relationship between symtoms
and electrophysiological detected
compression of the median nerve at the
wrist.
Acta neurol Scand 2004; 110: 398-402
4. Kilmer DD, Davis BA. Electrodiagnosis in
CarpalTunnel Syndrome. Hand Clin 2002;
18:243-55.