Nerve studies are not that useful in diagnosis

doi:10.1136/bmj.39317.513438.80

BMJ 2007;335:414 (1 September), doi:10.1136/bmj.39317.513438.80

Letters

Carpal tunnel syndrome

Nerve studies are not that useful in diagnosis

The first 150 words of the full text of this article appear below.

The authorship by a neurophysiologist of an article stronglyadvocating nerve conduction studies for diagnosing carpal tunnelsyndrome seems something of an undeclared competing interest.¹Fortunately, not all Bland's colleagues support his enthusiasm.Clinicians involved in managing this syndrome mostly agree thatbecause of the high rate of false negatives, the test shouldonly be advocated for cases with unusual diagnostic difficulty.Carpal tunnel syndrome usually presents in the early hours ofthe morning because of extracirculatory shifts in body fluids,so to be truly accurate, nerve conduction tests would also needto be performed at this time of day. Until Bland's departmentcan provide a round the clock service, willy-nilly requestsfor nerve studies are more likely to bankrupt the NHS than providehelpful pointers towards firm diagnosis.

As for the article's guidance on treatments, splintage certainlyhelps with symptoms but does nothing for the underlying condition,and who . . . [Full text of this article]

Peter J Mahaffey, consultant plastic and hand surgeon

Bedford Hospital, Bedford MK42 9DJ

pjm10@tiscali.co.uk

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