This is the current release of the guideline.

Carpal tunnel syndrome (CTS)

Diagnosis
Technology Assessment

Neurology

Physicians

To offer the opinion of the American Association of Electrodiagnostic Medicine (AAEM) regarding what the current literature reveals with respect to the clinical utility of the Nervepace Digital Electroneurometer (NDE) in the diagnosis and treatment of carpal tunnel syndrome (CTS)

Patients with suspected carpal tunnel syndrome (CTS)

Use of the following diagnostic devices to assess carpal tunnel syndrome:

1. Nervepace Digital Electroneurometer (NDE)
2. Neurosentinel (NS)

Note: The American Association of Electrodiagnostic Medicine (AAEM) concludes that the current literature does not support the substitution of the Nervepace Digital Electroneurometer and Neurosentinel for standard electrodiagnostic studies in the clinical evaluation of patients with carpal tunnel syndrome (CTS).

Reliability (sensitivity and specificity) of Nervepace Digital Electroneurometer (NDE) and Neurosentinel (NS) in clinical evaluation of patients with suspected carpal tunnel syndrome (CTS)

Searches of Electronic Databases

At the time of the original review, five reports, all dealing with the nervepace digital electroneurometer (NDE)’s usefulness in diagnosing carpal tunnel syndrome (CTS), were available for review. In the present updated review, an expanded literature search was performed using PubMed and the dates 1966 to 2001. The search for literature included only articles written in English. The following search terms were used: "electroneurometer," "NervePace," "Nervepace Digital Electroneurometer." This repeat search generated seven additional articles not included in the original review. One article was rejected as it principally dealt with evaluation of a different novel technique, employing the NDE only as a minor adjunct, without specific assessment of the utility of the NDE. An analysis of the remaining six articles was incorporated into the original review, which forms the content of present literature review. An additional search was conducted in July 2002 using PubMed (1966 to 2002) utilizing the original search terms and adding the search term "neurosentinel". No new articles were identified.

5 source documents were identified for the original review and 6 additional articles were identified for the present updated review

Expert Consensus

Not applicable

Systematic Review

All reports were evaluated by the authors utilizing the six criteria for classification of CTS literature used by the American Association of Electrodiagnostic Medicine (AAEM), American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation in developing a Practice Parameter related to the electrodiagnosis of CTS. The criteria are:

1. Prospective study
2. Clinical diagnosis of CTS independent of the results of electrodiagnostic studies
3. Sufficiently detailed description of the stimulating and recording methods to permit duplication of the studies
4. Limb temperature monitored and reported
5. Reference values:
   1. Obtained either with concomitant studies of a reference population, or
   2. Obtained with previous but identical studies of a reference population in the same laboratory and
   3. Reported in the article
6. The cited article mentioned the criteria of abnormality obtained from the reference population and the article defined this in statistical terms such as mean, standard deviation, and/or range.

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

The guideline was approved by the American Association of Electrodiagnostic Medicine (AAEM) Board in July 2002.

It is the opinion of the American Association of Electrodiagnostic Medicine (AAEM) that all of the literature reviewed and describing the nervepace digital electroneurometer (NDE) and neurosentinel (NS) are flawed. Limb temperature, which affects the speed of nerve conduction, was controlled in only one study. In most reports, reference populations were not studied to provide a scientifically based source for control values. Standard statistical measures of latency values (mean, standard deviation, and range) were not specified in most reports. Moreover, most studies comparing NDE and NS to standard nerve conduction studies (NCSs) make an incorrect assumption: that distal motor latency or an isolated digital sensory latency value are sensitive measures for diagnosing median nerve entrapment at the wrist. In fact, detailed sensory NCSs, including segmental stimulation across the palm-to-wrist segment or in comparison to adjacent sensory nerves, is by far the more sensitive technique in this regard and is probably the earliest finding in median nerve entrapment at the wrist.

It is the opinion of the AAEM that the NDE, as well as the newer NS, are experimental and are not effective substitutes for standard electrodiagnostic studies in clinical evaluation of patients with suspected CTS. For more details refer to the "Critique of the Technology" section in the original guideline document.

None provided

The recommendations are based on a critical review of the current scientific and clinical information.

The information provided in the literature review will aid physicians in choosing appropriate electrodiagnostic procedures in patients with carpal tunnel syndrome.

Not stated

This report is provided as an educational service of the American Association of Electrodiagnostic Medicine (AAEM) and is provided for informational purposes only. It is based on an assessment of the current scientific and clinical information. It is not intended to include all possible methods of care of a particular clinical problem, or all legitimate criteria for choosing to use a specific procedure. Neither is it intended to exclude any reasonable alternative methodologies. It addresses the use of the nervepace digital electroneurometer (NDE) in the diagnosis of carpal tunnel syndrome (CTS). This statement is not intended to address all uses of the NDE. The AAEM recognizes that specific patient care decisions are the prerogative of the patient and his/her physician and are based on all of the circumstances involved. This review was not written with the intent that it be used as a basis for reimbursement decisions.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness

Not applicable: Guideline was not adapted from another source.

2003 Mar

American Association of Neuromuscular and Electrodiagnostic Medicine - Medical Specialty Society

American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)

Not stated

Primary Authors: William S. David, MD, PhD; Vinay Chaudhry, MD; Andrew H. Dubin, MD, MS; Robert W. Shields, Jr., MD

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on December 1, 2003.