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J Hand Surg Am. 2019 Mar;44(3):181-185. doi: 10.1016/j.jhsa.2018.11.010. Epub 2019 Jan 8.

False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome.

Author information

1
Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA. Electronic address: Johnfowler10@gmail.com.
2
Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA.
3
First State Orthopaedics, Newark, DE.

Abstract

PURPOSE:

The purpose of the study was to determine the rate of false positives for nerve conduction studies (NCSs) and ultrasound (US) in a population without signs and symptoms of carpal tunnel syndrome (CTS) using a CTS-6 score of 0 as the reference standard.

METHODS:

Patients were included in this study if they were referred for NCSs for a reason other than CTS (cubital tunnel syndrome and/or cervical radiculopathy) and they had a CTS-6 score of 0. An US measurement of the cross-sectional area (CSA) of the median nerve at the level of the carpal tunnel inlet was performed by a certified ultrasound technician. An a priori CSA cutoff of 10 mm2 or greater measured using US at the carpal tunnel inlet qualified as a positive diagnosis. The NCSs were performed and interpreted according to national standards by a certified electrodiagnostician. All patients in this study were considered to not have a diagnosis of CTS based on the CTS-6 of 0.

RESULTS:

Forty hands with a CTS-6 of 0 were included in this study. The US was positive in 9 of 40(23%) and NCS was positive in 17 of 40 (43%). There were only 2 patients with a false-positive US that did not also have a positive NCS. However, there were 11 patients who had a false-positive NCS that did not have a positive US.

CONCLUSIONS:

This prospective cohort series has demonstrated that US has a lower false-positive rate than NCSs in asymptomatic patients as measured by the CTS-6 diagnostic tool. Studies with a low false-positive rate are preferred when ordering a confirmatory diagnostic test. Therefore, if a confirmatory diagnostic test is desired, we recommend that US be used rather than NCSs.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Diagnostic II.

KEYWORDS:

Ultrasound; carpal tunnel syndrome; false positive; nerve conduction studies

PMID:
30635201
DOI:
10.1016/j.jhsa.2018.11.010

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