Readers respond to treatment guidelines, Medicare strategy

CTS CLINICAL GUIDELINES
I generally welcome the clinical guidelines the Academy publishes (AAOS Now, July 2007), but wish to take exception to the recommendation, in the Clinical Guideline on Diagnosis of Carpal Tunnel Syndrome (CTS), regarding electrodiagnostic tests:

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)

A good history and physical exam will usually yield a reliable diagnosis of carpal tunnel syndrome. I feel the recommendation should read:

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