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Physician survey: Electrodiagnostic test for carpal tunnel release not necessary
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A survey of American Society for Surgery of the Hand members revealed that while most surgeons followed the American Academy of Orthopaedic Surgeons’ guidelines for carpal tunnel syndrome by ordering electrodiagnostic tests prior to carpal tunnel release, more than half of respondents did so to avoid potential medicolegal issues.
The survey also indicated that most surgeons consider patient’s positive response to cortisone injection a sufficient indication for carpal tunnel release.
“A majority of respondents were more likely to order electrodiagnostic as a result of the guidelines, but 57% do because of potential medicolegal ramifications,” Lewis B. Lane, MD, Chief of Hand Surgery and Residency Program Director for the Department of Orthopaedics, at Hofstra North Shore Long Island Jewish School of Medicine, told Orthopedics Today. “Of the 70% who do use cortisone, half said that a positive response to a cortisone injection is a sufficient indication for surgery and an electrodiagnostic study is not always necessary.”
Survey of ASSH members
To determine physician practice patterns for treatment of carpal tunnel syndrome and to assess whether medicolegal concerns influenced these patterns, the investigators emailed a 28-item questionnaire to ASSH members. They received 705 responses to the survey. Of the respondents, nearly 80% identified themselves as having a primary specialty of orthopedics, 13.2% considered themselves plastic surgeons and 7.7% marked other. Overall, 67.9% of respondents had more than 10 years in practice and 38.8% of them performed more than 100 carpal tunnel releases (CTRs) within the last year of completing the survey.
Eighty percent of respondents reported that they would order electrodiagnostic studies before surgery based on the guidelines, Mikael Starecki, MD, a 4th year resident and study co-author, said but 57% of those said they would do so to avoid potential medicolegal ramifications.
Seventy-two percent of respondents reported that they considered relief from one cortisone injection a sufficient indication for CTR, according to Starecki. Almost 50% of surgeons stated they would never or rarely order electrodiagnostic studies before surgery if a cortisone injection provided several months of relief. Approximately 60% of those surveyed said they would perform CTR if one cortisone injection provided several months of relief.
Role of electrodiagnostic studies
“Despite guidelines recommending electrodiagnostic studies should be obtained prior to surgery, the majority responded that a positive response to a cortisone injection is sufficient indication for carpal tunnel release,” Starecki said during a recent presentation. “The majority of respondents were more likely to order electrodiagnostic studies based on the American Academy of Orthopaedic Surgeons guidelines because of potential medicolegal ramifications. Electrodiagnostic studies are not necessary in these cases. Fifty-nine percent of respondents also said they would perform surgery in the face of normal electrodiagnostic studies if cortisone helped completely.”
Starecki cited the small survey demographic and use of hypothetical case scenarios among the limitations of the study.
“Although the surveys were mailed to over 2,500 members, only 27% responded,” he said. “This introduces bias and errors, as the survey does not include the opinions of 73% of American Society for Surgery of the Hand members.” – by Renee Blisard Buddle
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Mikael Starecki, MD, can be reached at the Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY, 11040; email: mstarecki@gmail.com.
Disclosures: Lane and Starecki have no relevant financial disclosures.