Clinic-based nerve conduction studies reduce time to surgery and are cost effective: a comparison with formal electrophysiological testing

Abstract

INTRODUCTION Carpal tunnel syndrome is the most common compression neuropathy affecting the upper limb. Clinical diagnosis is not always clear and electrophysiological testing can be indicated when considering a patient for decompression surgery. The downside of electrophysiological testing is cost and increased time to surgery. Newer methods of performing nerve conduction studies in clinic have become available. MATERIALS AND METHODS We investigated the use of a clinic-based, handheld, non-invasive electrophysiological device (NC-stat®) in 71 patients with suspected carpal tunnel syndrome presenting to our hand clinic in a district general hospital. We compared this to a similar cohort of 71 age-matched patients also presenting to our unit in whom formal nerve conduction studies were performed at a local neurophysiology unit. Our outcome measures were time from presentation to carpal tunnel decompression, the cost of each pathway and the practicalities of using the device in a busy hand unit. RESULTS AND CONCLUSIONS The NC-stat® proved to be a successful device when compared with referring patients out for more formal nerve conduction studies, shortening the time from presentation to surgery from 198 days to 102 days (p<0.0001). It was also cost effective with a calculated saving to the hospital of more than £70 per patient. The device is easy to use and acceptable to patients and no adverse effects were noted.