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multifactorial, including anatomic, physiologic, biochemical, mechanical, histologic,
as well as pathological components, which integrate to explain and characterize this
syndrome [ 8 ].
Meta-analysis and systematic literature review reveal that no one test could be
identifi ed as a “gold standard” for carpal tunnel syndrome diagnosis. Currently
available evidence showed that neither clinical tests for CTS nor nerve conduction
tests alone could reliably diagnose CTS. Though some studies reported that when
both clinical tests and neurophysiologic tests were combined, this composite had a
statistically signifi cant correlation with positive postsurgical outcomes in CTS
patients; there is no defi nitive conclusion available about which combination of
clinical and neurophysiologic tests could provide the best performance [ 9 ].
Patient reported outcome measures (PROMs) are critical measures of manage-
ment effi cacy as the “patient perceived benefi t” is considered the ultimate treatment
goal. Therefore, they should be considered as supplement to data derived from physi-
cal examination as they provide the context of the impact on the patient’s ability to
carry out activities of daily living as well as quality of life. Over the past years,
PROMs have attained further reputation following the recent recommendations of
taking a patient-centered approach in standard clinical practice [ 10 ]. The lack of a
gold standard in the CTS diagnosis and management highlighted the need for a com-
mon consensus regarding the assessment of the patient’s condition as well as report-
ing of treatment outcomes. Utilizing a validated set of commonly accepted outcome
measures reported by the patient has been implemented in several studies to assess
for the natural history of the disease as well as monitoring of response to treatment.
This chapter will discuss the different patient reported outcome measures tools
available for CTS and outline their role in the diagnosis and management of CTS. It
aims at improving the quality and effi ciency of the patients’ care in standard practice.
Challenges in Carpal Tunnel Syndrome
Diagnosis and Evaluation of the Cases
The CTS diagnosis is based on a mix of clinical subjective criteria. The American
Academy of Neurology proposed that: paresthesia, swelling, pain, weakness or
clumsiness of the hand, provoked or worsened by sleep, sustained hand or arm posi-
tion, repetitive action of the hand or wrist that is alleviated by changing posture or by
shaking of the hand, sensory defi cit in the median nerve innervated part of the hand,
as well as motor defi cit of the median nerve innervated thenar muscles represent the
characteristic CTS manifestations [ 11 ]. Evaluation of patients presenting with CTS
manifestations has long relied on their clinical symptoms as well as neurophysiolog-
ical assessment [ 12 ]. However, although standard CTS symptoms and positive pro-
vocative testing may enable the diagnosis in some cases, the subjectivity and
sensitivity of these measures resulted in very poor reliability and diagnostic accuracy
[ 13 – 16 ]. Similarly, though earlier studies revealed sensitivity and specifi city data in
Y. El Miedany