Diagnostic scales, questionnaires, and hand diagrams in comparison to nerve conduction studies in the matter of the diagnostic dilemma of carpal tunnel syndrome: a review

Carpal tunnel syndrome (CTS) is considered as the most common peripheral nerve pathology, as it affects 1 to 3 persons per 1000, with a percentage of 3.8%, in a female-to-male ratio of 3 : 1. A lot of attempts have been made to set specific diagnostic criteria to facilitate the process of diagnosis and to minimize the cost of investigations, conservatively with splinters, steroid injection, electrotherapy, and manual therapy. Thus, this study aimed to reconstruct a summarized and accessible database regarding costless diagnosis of CTS to limit the cost of investigations and minimize surgical interventions as much as possible. For this purpose, the selection of articles was conducted through a literature search in Google Scholar, PubMed, and Cochrane databases. The strategy was to identify studies and report on their accuracy, specificity, and sensitivity in diagnosing CTS using different methods which include diagnostic scales, questionnaires, hand symptoms diagram (HSD), and nerve conduction. It was found that Kamath and Stothard built a questionnaire (KSQ) and HSD are good choices as the initial step in the diagnosis of CTS. However, in the presence of nerve conduction studies (NCS), it must be considered a gold standard diagnostic modality, and the previous measures could not replace it due to the large differences in accuracy. Furthermore, surgical decompression should not be standardized based on either KSQ or HSD because only precise severity grading by NCS is trustworthy to establish the indication for surgical intervention.