7 doctors weighed in:

Can carpal tunnel be present if nerve conduction study is negative? Thank you

7 doctors weighed in
Dr. Barry Press
Surgery - Plastics
3 doctors agree

In brief: Yes.

Yes. The diagnosis of carpal tunnel syndrome (cts) has classically been made on clinical grounds, i.
e. The symptoms and physical findings that the patient exhibits. Nerve conduction studies and electromyography (EMG) can be helpful in determining the severity of median nerve compression, but in patients with classical symptoms and signs, I do not believe they are necessary to make the diagnosis.

In brief: Yes.

Yes. The diagnosis of carpal tunnel syndrome (cts) has classically been made on clinical grounds, i.
e. The symptoms and physical findings that the patient exhibits. Nerve conduction studies and electromyography (EMG) can be helpful in determining the severity of median nerve compression, but in patients with classical symptoms and signs, I do not believe they are necessary to make the diagnosis.
Thank
Dr. Jeffrey Wint
Surgery - Hand Surgery
2 doctors agree

In brief: Yes

Yes it can.
The nerve study is another piece of information. There can be a "false negative" still with a negative nerve study you should take home that even if you have carpal tunnel, oddds are it is not a severe case. Make sure your symptoms match what is typical for carpal tunnel. Too often people are told they have carpal tunnel or "it may be carpal tunnel" and they are sent off for a test without a good exam to qualify the symptoms. As dr. Ring alludes to, a positive test with minimal symptoms or even symptoms that do not match the positive test puts one at risk for surgery in our world. That being said a negative test doesnt mean that carpal tunnel cannot exist but diminshes the likleihood or reduces significantly the impact of carpal tunnel as one of the diagnoses.

In brief: Yes

Yes it can.
The nerve study is another piece of information. There can be a "false negative" still with a negative nerve study you should take home that even if you have carpal tunnel, oddds are it is not a severe case. Make sure your symptoms match what is typical for carpal tunnel. Too often people are told they have carpal tunnel or "it may be carpal tunnel" and they are sent off for a test without a good exam to qualify the symptoms. As dr. Ring alludes to, a positive test with minimal symptoms or even symptoms that do not match the positive test puts one at risk for surgery in our world. That being said a negative test doesnt mean that carpal tunnel cannot exist but diminshes the likleihood or reduces significantly the impact of carpal tunnel as one of the diagnoses.
Thank
Dr. David Ring
Surgery - Hand Surgery
1 doctor agrees

In brief: A

A very good and highly debated question.
I think that doctors on both sides of the debate would agree that if it's possible to have carpal tunnel syndrome (cts) and normal electrodiagnostic testing, then that carpal tunnel syndrome is very, very mild. Very close to normal, in fact. Very, very mild carpal tunnel syndrome should be easily managed with night splinting to help you sleep. My concern is that "emg negative cts" is a diagnosis that is applied to patients that do not have symptoms characteristic of cts (intermittent or constant numbness in the thumb, index, long and half of the ring fingers; symptoms at night relieved by splinting; weakness of the thenar intrinsic muscles, etc.). I think this is a diagnosis that is misapplied to people that have pain with activity. It's a myth that pain with typing is cts. Since cts is eventually treated with surgery, people that are misdiagnosed with cts are at risk for unnecessary surgery.

In brief: A

A very good and highly debated question.
I think that doctors on both sides of the debate would agree that if it's possible to have carpal tunnel syndrome (cts) and normal electrodiagnostic testing, then that carpal tunnel syndrome is very, very mild. Very close to normal, in fact. Very, very mild carpal tunnel syndrome should be easily managed with night splinting to help you sleep. My concern is that "emg negative cts" is a diagnosis that is applied to patients that do not have symptoms characteristic of cts (intermittent or constant numbness in the thumb, index, long and half of the ring fingers; symptoms at night relieved by splinting; weakness of the thenar intrinsic muscles, etc.). I think this is a diagnosis that is misapplied to people that have pain with activity. It's a myth that pain with typing is cts. Since cts is eventually treated with surgery, people that are misdiagnosed with cts are at risk for unnecessary surgery.
Thank
Dr. Monica Wood
Surgery - Hand Surgery

In brief: I

I agree with the other surgeons here: carpal tunnel syndrome is a clinical diagnosis based on symptoms and exam findings.
Up to 20% of people with carpal tunnel syndrome will have normal nerve conduction tests. That being said, in the labor & industries world, the nerve conduction studies are taken as the only "objective" measure and they will not authorize surgery if they are normal--even with motor and sensory loss on exam. Normal conduction can occur if only a few fibers of the nerve are not affected, even if the rest are severely affected. That being said, there is no standard definition of carpal tunnel syndrome and no "gold standard" test. That is, it is a complex pattern of symptoms and exam findings that varies between patients. There is a group in canada working on a scoring system, combining symptoms and physical exam findings, but it has not yet been validated. Textbook carpal tunnel syndrome involves numbness and tingling in the thumb, index, middle, and half the ring fingers. Symptoms tend to be worse at night and with activities such as driving and holding a phone. Pressure on the nerve or tapping on the nerve reproduces the symptoms. However, many people have atypical presentations, such as predominantly wrist pain or numbness involving the whole hand. Here is where a good physical exam can be helpful. If i'm really not sure, i sometimes use an injection in the carpal tunnel to see if the symptoms improve. A good response to an injection usually indicates a good response to surgery. As the other surgeons have alluded, carpal tunnel syndrome is primarily a surgical condition. Studies have shown surgery to be more cost-effective than therapy and injections. 80% of people who get relief from injections will go on to need surgery. Only early, mild cases respond to bracing. A thorough examination of the nerves in the forearm and hand can help establish the diagnosis and differentiate carpal tunnel syndrome from other nerve compressions or other causes of numbness and tingling. This is where a hand surgeon is often better than a general orthopaedic surgeon or other type of clinician. A good neurologist can also help with the diagnosis.

In brief: I

I agree with the other surgeons here: carpal tunnel syndrome is a clinical diagnosis based on symptoms and exam findings.
Up to 20% of people with carpal tunnel syndrome will have normal nerve conduction tests. That being said, in the labor & industries world, the nerve conduction studies are taken as the only "objective" measure and they will not authorize surgery if they are normal--even with motor and sensory loss on exam. Normal conduction can occur if only a few fibers of the nerve are not affected, even if the rest are severely affected. That being said, there is no standard definition of carpal tunnel syndrome and no "gold standard" test. That is, it is a complex pattern of symptoms and exam findings that varies between patients. There is a group in canada working on a scoring system, combining symptoms and physical exam findings, but it has not yet been validated. Textbook carpal tunnel syndrome involves numbness and tingling in the thumb, index, middle, and half the ring fingers. Symptoms tend to be worse at night and with activities such as driving and holding a phone. Pressure on the nerve or tapping on the nerve reproduces the symptoms. However, many people have atypical presentations, such as predominantly wrist pain or numbness involving the whole hand. Here is where a good physical exam can be helpful. If i'm really not sure, i sometimes use an injection in the carpal tunnel to see if the symptoms improve. A good response to an injection usually indicates a good response to surgery. As the other surgeons have alluded, carpal tunnel syndrome is primarily a surgical condition. Studies have shown surgery to be more cost-effective than therapy and injections. 80% of people who get relief from injections will go on to need surgery. Only early, mild cases respond to bracing. A thorough examination of the nerves in the forearm and hand can help establish the diagnosis and differentiate carpal tunnel syndrome from other nerve compressions or other causes of numbness and tingling. This is where a hand surgeon is often better than a general orthopaedic surgeon or other type of clinician. A good neurologist can also help with the diagnosis.
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