Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome
Erika D. Sears, MD, MS, Yu-Ting Lu, MPH, Rodney A. Hayward, MD, Eve A. Kerr, MD, MPH, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
Purpose: We sought to evaluate how often physicians who perform carpal tunnel release (CTR) routinely request electrodiagnostic studies (EDS) or other tests prior to an initial consultation, and whether provider characteristics had an influence on testing requirements.
Methods: Through online data sources, we identified providers throughout the state of Michigan with profiles confirming surgical treatment of carpal tunnel syndrome (CTS). We recorded American Society for Surgery of the Hand (ASSH) membership, teaching facility status, practice size, and primary specialty for providers. Using a standardized telephone script, we contacted 219 providers by telephone to determine whether any diagnostic tests were needed before an appointment. Using multivariable logistic regression, we evaluated the relationship between the requirement for pre-consultation testing and surgeon characteristics.
Results: Among the 134 providers who were confirmed to perform CTR, 57% (n=76) required and 9% (n=12) recommended a diagnostic test prior to the initial consultation. EDS was requested by 56% (n=75), 14% (n=19) requested an MRI, 8% (n=11) requested a CT scan, and 6% (n=8) requested an X-ray. Patients were asked to have multiple studies by 19/88 (22%) of the surgeons who requested/recommended testing. ASSH membership, size of practice and teaching facility status did not have a significant relationship with pre-consultation testing requirements.
Conclusion: The majority of surgeons who treat CTS use EDS indiscriminately, rather than reserving use of the test for patients with unclear diagnoses. Patients should be included in the decision to obtain tests if they are used for purposes other than informing treatment decisions.
Back to 2017 Program