Comparison of Various Clinical Scales with Electrophysiological Scales for Carpal Tunnel Syndrome

J Korean Assoc EMG Electrodiagn Med 2005;7(2):79-89.
Published online May 10, 2005.

Abstract

Objectives: To evaluate various carpal tunnel syndrome (CTS) clinical scales through a comparison with electrophysiological severity scales and to select the most reliable clinical scale. Methods: One hundred eighty hands (mean age 56.43 years) with suggestive symptoms and signs of CTS were prospectively assessed by three clinical scales and three electrophysiological scales. The clinical scales adopted were the Boston carpal tunnel syndrome questionnaire (BCTQ), quantitative clinical scale by Simovic (Simovic clinical scale) and Historical-Objective (Hi-Ob) scale. The scales for electrophysiological assessment were the Bland classification, Padua scale and Mondelli scale. Results: All the clinical scales showed highly significant, positive correlation with the electrophysiological scales (p<0.001). The physician-measured clinical scales showed higher correlation coefficients with the electrophysiological assessment than the patient-oriented one. Among the electrophysiological scales, the Bland and Padua scales showed very similar distribution patterns, but the Mondelli scale, especially the motor subscale, showed left-skewed distribution of data leading to the misdiagnosis of CTS patients as normal. Conclusion: The BCTQ, Hi-Ob and Simovic clinical scale are all reliable but the physician-measured scales showed stronger correlation with the electrophysiological scales. Knowledge of the characteristics of the scales and the precise cut-offs are important in the electrophysiological assessments.

Key Words: Carpal tunnel syndrome, Clinical scales, Electrophysiological scales, Nerve conduction studies