Nerve Conduction Studies – Carpal Tunnel Syndrome

Nerve Conduction Studies (NCS) are used in the diagnosis of Carpal Tunnel Syndrome (CTS).

We are examining this routine testing as it is apparent – both from instructing Claimant’s and upon review of medical literature – that there is a possibility the Carpal Tunnel Syndrome exists, with the results of NCS returning negative or vice-versa, that Carpal Tunnel Syndrome does not exist and the result return positive.

Presenting Symptoms & Investigations

A person presenting to the G.P. what he/she believes to be Carpal Tunnel Syndrome will experience (not limited to) the following symptoms:

• Aches or pains in the fingers, hand, arm & wrist
• Numb fingers, hand and/or wrist
• Tingling and/or pins and needles
• Weakness in the hand center around the thumb and difficult in symptoms

The NHS and other medical practitioners will usually go onto examine the affected area and treat conservatively, by providing painkillers and asking you to return should the symptoms persist.

Should they persist, returning the G.P. is the best course of action where they may, or may have already, performed some simple tests known a Tinel’s and Phalen’s tests. These are tests which indicate to the G.P. whether there is potentially swelling around a nerve within your wrist. It also allows them to rule out or consider other potential issues.

The G.P. is thereafter likely to suggest you are referred onto the hospital to see an orthopedic hand surgeon for further investigations.

There are a number of personal and clinical signs that an orthopedic specialist is concerned with when considering a diagnosis of CTS, these are:

• The above-described symptoms
• The outcome of the Phalen’s/Tinel’s test
• Occupational history – i.e. vibrating tools, repetitive tasks, overexertion of the hands/wrists
• Personal health issues – i.e. age, height, gender, BMI (Weight)
• Lifestyle factors – i.e. smoking, physical activity

However, these signs are not sufficient for the orthopedic consultant to suggest any sort of invasive surgery to resolve the symptoms straight away. Conservative treatment is the most likely course of action to determine whether the symptoms resolve of their own accord. Conservative treatment includes:

• Rest
• Splinting
• Cortisone injections into the wrist

Whilst this is ongoing it is possible, but not guaranteed, that the consultant will likely order that you undergo Nerve Conduction Studies, otherwise known as Electrodiagnostic testing. This test, however, is what we are considering in this article as – it is debated among medical experts – what relevance it has toward the diagnosis of CTS.

Nerve Conduction Studies(NCS)/Electrodiagnostic Testing

This is a relatively non-invasive form of testing that involve placing electrodes on your finger, thumb, inside of your wrist and inside of your elbow in some circumstances. An electric current is then sent down the electrodes and the response times in your wrist, finger and thumb are recorded. These response times are then used to decide whether you have a compressed nerve in your wrist otherwise known as Median Nerve Neuropathy of the wrist.

Therefore, as you may notice, an NCS test doesn’t strictly diagnose Carpal Tunnel Syndrome but confirms that you have a Median Nerve Neuropathy in the wrist. Median Nerve Neuropathy is indicative of CTS and therefore aids a diagnosis but this does not prevent you from having CTS.

Should your results show a negative NCS you may very well still have CTS and it is perhaps best practice to have the NCS repeated or for further investigations to be undertaken. There are other tests such as Needle EMG (rather more invasive) and ultrasound/MRI scans that can be undertaken to aid the diagnosis.

It is important to note that NCS are not the gold standard in diagnosis of CTS, and therefore can only be regarded as a tool to aid diagnosis and guide prognosis. NCS are very good when repeated in intervals, both as a diagnostic tool and to determine the effectiveness of any treatment of symptoms or at conclusion of surgery. CTS, being a syndrome, is a host of symptoms which usually occur together and therefore there is no single independent test that can completely rule in or out a diagnosis of CTS.

Investigations & Treatment – Continued

Once NCS studies have been completed, it is likely that any treating consultant will consider the best way forward for your treatment. Should the NCS studies show a slight to mild median nerve neuropathy it is likely that conservative treatment will continue however there is the potential that you may be offered surgery if symptoms persist or worsen.

Should NCS studies show mild to severe results, it is likely that you will be offered surgery in order to avoid wasting of the thenar muscle, which can result from a severely compressed median nerve. This, of course, could cause a real detriment to your ability to use your hand and ensure a reasonable level of grip in the future.

Of course, we must ask what is the likely position should you end up with negative NCS result? It appears that orthopedic consultants are relatively well versed in dealing with CTS and it doesn’t preclude a course of action to aid your clearly troubling symptoms.

It is likely, and we have seen in practice, that medical experts will go onto treating you conservatively, but should symptoms not abate then they may still offer you surgery on the basis that you are fully aware that they may perform surgery and find nothing that they can treat. Of course, in most patients’ eyes, it is worth the chance of reduced symptoms to go ahead and have surgery regardless of the outcome.

We hope this article has given you an insight into the likelihood of what treatment will be given if you are suffering from the above symptoms. Of course, this isn’t an absolute guide and each practicing region of the NHS is likely to treat you differently, and each orthopedic expert is likely to treat you differently also.

We hope that regardless of your present position of treatment that this helps you understand what may happen and is possible moving forward.

If you are suffering from the symptoms of Carpal Tunnel Syndrome, please always consider the work you have performed and enquire with a solicitor as to whether you may be able to consider making a claim for compensation as a result of the problems.

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