Jewish World Review June 11, 2002 / 1 Tamuz, 5762

Experts issue carpal tunnel diagnosis plan

By Peggy Peck | (UPI) A new treatment guideline issued yesterday by carpal tunnel syndrome experts directs doctors to rely on sophisticated nerve-conduction studies for diagnosis of the condition that causes pain in the wrist, hand and fingers, as well as tingling or numbness.

The pain and numbness are caused by compression of the median nerve, which passes through the carpal tunnel at the wrist. About 1 in 1,000 Americans is diagnosed with carpal tunnel syndrome every year.

Earlier this year the United States Supreme Court ruled a diagnosis of carpal-tunnel syndrome is not enough to fulfill the definition of disability under the Americans with Disabilities Act.

"Since this isn't a life-threatening disease," there has been a somewhat laissez-faire attitude about diagnosis, said Dr. Michael Andary, a member of the task force that wrote the new guideline.

He said, however, misdiagnosis of carpal tunnel syndrome can lead to either unnecessary surgery -- or if the condition is wrongly diagnosed -- permanent nerve damage can result.

The new guideline is an attempt to resolve some of the debate that has surrounded carpal tunnel diagnosis and treatment, he said.

Andary, an associate professor at Michigan State University College of Osteopathic Medicine in East Lansing, said three organizations -- the American Academy of Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation -- worked together for two years to produce the new guideline, which is published in the June issue of Neurology.

Included in the same journal issue is a study that promotes the use of MRI for diagnosis of carpal tunnel syndrome, as well as an editorial about the difficulties of diagnosing the condition.

The imaging study concludes an MRI can accurately diagnose carpal tunnel syndrome about 80 percent of the time, depending on the skill of the radiologist who performs the test, while nerve studies can accurately diagnose the syndrome in 85 percent of people regardless of operator.

Dr. Nortin M. Hadler, professor of medicine at University of North Carolina, Chapel Hill, agreed the only way to accurately diagnose carpal tunnel syndrome is with nerve-conduction studies. He said, however, even these studies will not rule out over diagnosis, which is a real concern.

Hadler, who did not help write the new guideline, said many normal, healthy people can have occasional "nerve slowing" or may simply have nerve slowing that is "normal in that person."

Andary agreed even with the new guideline, diagnosing carpal tunnel syndrome may be more art than science, but he said the new guideline is likely to discourage unnecessary surgery.

He said no one should have surgery before first undergoing nerve-conduction studies. Hadler agreed and noted that in Washington State, the law "requires a nerve study before anyone is cut."

The Washington law is result of a spate of workmen's compensation claims for carpal tunnel syndrome treatment, including a record number of wrist surgeries, he said.

If the studies do suggest nerve slowing, which would indicate compression of the medial nerve inside the carpal tunnel, "the patient can try using a wrist splint before undergoing surgery," he said.

Andary pointed out that even if carpal tunnel syndrome is diagnosed, not all patients want surgery.

"If the problem is just some pain for 20 minutes or an hour a day, some people may decide to put up with it rather than have surgery," he said.

Andary said he urges patients to "find out what is causing the pain."

"Sometimes you have people who have left arm pain and they think they are having a heart attack. Or you have other people who continuously ignore the pain, and they are at risk for developing a dead nerve," he added.

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© 2002, United Press International