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October/November 2014 (vol. 11/3)

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Research Plus

Pre-placement nerve conduction studies for CTS

Post-offer pre-placement nerve-conduction studies (NCS) for carpal tunnel syndrome (CTS) are neither sufficiently sensitive nor cost effective to be of practical value, this prospective longitudinal study finds. CTS is a common upper-limb disorder causing considerable time off work, with direct medical costs of over $1 billion in the US (where healthcare costs are generally borne by the employer’s workers’ compensation scheme). After excluding those with a previous history of CTS or peripheral neuropathy, a total of 1,027 new recruits (65% male, mean age 30 years) doing hand-intensive work in construction, healthcare, service and clerical jobs were included in the study. They were given baseline physical examinations and NCS of the median and ulnar nerves, and completed surveys at baseline and at six, 18 and 36 months. Thirty-three CTS cases were identified during the follow up. Although abnormal NCS results at baseline were statistically significant predictors of future CTS, sensitivity was low and positive predictive value poor. Various cost–benefit analyses were carried out, assuming $150 for the cost of screening and $20,000 treatment costs, but none showed screening to be cost effective. 

Dale AM, Gardner BT et al. The effectiveness of post-offer pre-placement nerve conduction screening for Carpal Tunnel Syndrome. Journal of Occupational and Environmental Medicine 2014; 56(8): 840–847. 

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Occupational Health at Work October/November 2014 (vol. 11/3) pp45