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Erschienen in:
18.02.2015 | Clinical Faceoff
Clinical Faceoff: Routine Electrodiagnostic Testing is Not Helpful in the Management of Carpal Tunnel Syndrome
Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 8/2016
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There is substantial variation in the way that electrodiagnostic tests are used, and continued debate regarding the value of such tests (Table 1). In this Clinical Faceoff, I ask two expert hand surgeons to debate the issue of routine electrodiagnostic testing prior to surgery for carpal tunnel syndrome. Dr. Brent Graham is Chief of the Orthopaedic Division at the Toronto Western Hospital, will be the next Editor-In-Chief of the Journal of Hand Surgery, American Volume, and creator of a diagnostic tool for carpal tunnel syndrome based on symptoms and signs alone. Dr. Warren Hammert is Professor of Orthopaedic and Plastic Surgery at the University of Rochester.
Table 1.
Views from clinical faceoff experts on carpal tunnel syndrome and the value of electrodiagnostic tests
|
Dr. Graham
|
Dr. Hammert
|
|
|---|---|---|
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Is the surgeon’s job to treat bothersome symptoms or prevent nerve damage?
|
Symptoms
|
Neuropathy
|
|
Does untreated median neuropathy at the carpal tunnel always progress to nerve damage?
|
No
|
Yes
|
|
Is atrophy and constant numbness from severe median neuropathy permanent and unresponsive to surgery?
|
No
|
Yes
|
|
Which is worse: Surgery for symptoms without pathophysiology or surgery for pathophysiology without symptoms?
|
Surgery for pathophysiology without symptoms is worse
|
Surgery for symptoms without pathophysiology is worse
|
|
Can the average surgeon manage the normal human tendency to misperception, biases, and stress contagion and account for it?
|
Yes
|
No
|
|
Can the average patient understand the normal human tendency to misperception and bias and account for it?
|
Yes
|
No
|
|
If surgeons cannot agree on the best role for electrodiagnostic testing, should the patient help decide?
|
No
|
Yes
|