Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome.

Sears ED, Lu YT, Wood SM, Nasser JS, Hayward RA, Chung KC, Kerr EA. Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome. The Journal of hand surgery. 2017 Aug 1; 42(8):623-629.e1.

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Abstract:

PURPOSE: We sought to evaluate how often physicians who perform carpal tunnel release in the state of Michigan routinely request electrodiagnostic studies (EDS) or other diagnostic tests prior to an initial consultation and whether provider or practice characteristics had an influence on requirements for preconsultation diagnostic tests. METHODS: Through online data sources, we identified 356 providers in 261 practices throughout the state of Michigan with profiles confirming hand surgery practice or surgical treatment of carpal tunnel syndrome (CTS). We recorded American Society for Surgery of the Hand (ASSH) membership, teaching facility status, practice size, and primary specialty for each provider. Using a standardized telephone script, 219 providers were contacted by telephone to determine whether any diagnostic tests were needed before an appointment. Using multivariable logistic regression, we evaluated the relationship between the requirement for preconsultation testing and surgeon and practice characteristics. RESULTS: Among the 134 providers who were confirmed to perform carpal tunnel release, 57% (n  = 76) required and 9% (n  = 12) recommended a diagnostic test prior to the initial consultation. Of the 88 physicians who required/recommended testing, 85% (n  = 75) requested EDS, 22% (n  = 19) requested magnetic resonance imaging, 13% (n  = 11) requested a computed tomography scan, and 9% (n  = 8) requested an x-ray. Patients were asked to have multiple studies by 19 (22%) of the 88 surgeons who requested/recommended testing. In the multivariable analysis, ASSH membership, size of practice, and teaching facility status did not have a significant relationship with the requirement for preconsultation testing. CONCLUSIONS: Most surgeons who treat CTS in the state of Michigan routinely request EDS before evaluation, rather than reserving the test for cases in which the diagnosis is unclear. CLINICAL RELEVANCE: In the quest for high-value care, providers must consider whether the benefit of diagnostic tests for CTS likely outweighs the costs, inconvenience, and potential for treatment delay.