Carpel Tunnel Syndrome (CTS) Grading Tool Study
Research type
Research Study
Full title
A study at the Neurophysiology Clinic to further develop and refine Carpel Tunnel Syndrome (CTS) nerve conduction Grading Tool
IRAS ID
217925
Contact name
Salim Hirani
Contact email
Sponsor organisation
BCUHB
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Background, Introduction & Study Rationale
The first part of this submitted work is a literature review; which is a critical analysis of the present grading scales used in the United Kingdom to assess Carpal Tunnel Syndrome, from the physiologist’s perspective. The second part of the work is a research proposal, which aims to revise the grading system in order to increase the level of accuracy in assessing carpal tunnel syndrome according to it’s severity.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is identified as, “a neuropathy caused by entrapment of the median nerve at the level of the carpal tunnel” (Alfonso, 2010 in Ibrahim et al, 2012). It is diagnosed through the use of Nerve Conduction Studies (NCS) with objective tests that assess the physiological status of the median nerve across the carpal tunnel (Ibrahim et al, 2012).
Literature Search
A literature search was carried out on a number of key biomedical and nursing based databases. Due to the limited number of relevant literature retrieved from the databases which discussed about the grading of CTS, non-peer reviewed articles were also sought via Researchgate, a social networking website for scientists and researchers. The result of the literature search is given in the table below based on either qualitative or quantitative or mixed method data base.
Prominent contemporary grading system in the UK at present
Padua et al (1996) and Bland (2000) are the most commonly utilised grading systems; in particular, Bland (2000), due to its depth of detail. In 2014 the Association of Neurophysiological Science (ANS), in collaboration with the British Society for Clinical Neurophysiology (BSCN) published guidelines outlining the accepted grading of CTS in the United Kingdom, which follows Bland’s grading system. The reason given was that it focuses on the clinical physiologist specialism as well as its element of flexibility.
The Bland (2000) grading system enables the neurophysiologist to differentiate between the level of severity whilst enabling the consultant to obtain clear clinical reasoning data which will ascertain conservative treatment or the need for surgical treatment, and thus enable a diagnosis predictor for the client (Leventoglu & Kuruoglu, 2006). However, the lack of numerical grading does not enable the level of severity to be fully ascertained.
Summary of necessity for research to better refine current clinical grading in carpel tunnel syndrome (CTS)
In conclusion, there are many different grading systems, and whilst Bland (2000) remains the most utilised, it is not without its shortcomings. There is a multitude of grading subjectivity as demonstrated by the study discussions of Bland but there is a lack of neurophysiological focus (Carvalho et al 2007). Possible alternatives cannot be fully generalised (Ajeena et al 2013) and many lack robustness of data collection (Jeong & Kim, 2014).
It appears that whilst there is an acceptance of the dominance of both, there is also an acceptance of their limitations with the Bland (2000) and Padua et al (1996) grading system. The following proposal will suggest a study to enable a more accurate grading tool for CTS to be devised.
REC name
London - Queen Square Research Ethics Committee
REC reference
17/LO/0750
Date of REC Opinion
4 May 2017
REC opinion
Favourable Opinion