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AAOS Clinical Guideline on Diagnosis of Carpal Tunnel Syndrome

Summary of Recommendations

Recommendation 1.1
The physician should obtain an accurate patient history. (Level V, Grade C)

Recommendation 2.1
The physician should perform a physical examination of the patient that may include:

  • personal characteristics (Level V, Grade C)
  • performing a sensory examination (Level V, Grade C)
  • performing manual muscle testing of the upper extremity (Level V, Grade C)
  • performing provocative tests (Level V, Grade C), and/or
  • performing discriminatory tests for alternative diagnoses (Level V, Grade C)

Recommendation 3.1a
The physician may obtain electrodiagnostic tests to differentiate among diagnoses. (Level V, Grade C)

Recommendation 3.1b
The physician may obtain electrodiagnostic tests in the presence of thenar atrophy and/or persistent numbness. (Level V, Grade C)

Recommendation 3.1c
The physician should obtain electrodiagnostic tests if clinical and/or provocative tests are positive and surgical management is being considered. (Level II and III, Grade B)

Recommendation 3.2
If the physician orders electrodiagnostic tests, the testing protocol should follow the American Academy of Neurology/American Association of Neuromuscular and Electrodiagnostic Medicine/American Academy of Physical Medicine and Rehabilitation guidelines for diagnosis of Carpal Tunnel Syndrome. (Level IV and V, Grade C)

Recommendation 3.3
The physician should not routinely evaluate patients suspected of having carpal tunnel syndrome with new technology, such as magnetic resonance imaging (MRI), computerized axial tomography (CAT), and pressure specified sensorimotor devices (PSSD) in the wrist and hand. (Level V, Grade C)

July 2007 AAOS Now
http://www.aaos.org/news/bulletin/jul07/clinical4.asp

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