Although some typical patients may be diagnosed with sufficient certainty from clinical signs alone, no one will openly argue “needle EMG is unnecessary for the diagnosis of ALS” or “nerve conduction studies (NCS) are useless for the diagnosis of CIDP”. These criteria are usually composed of sub-criteria regarding clinical symptoms and signs, EDX tests, other supportive laboratory tests, and exclusion of other disorders.

Several neurological disorders to which EDX tests make significant contributions have widely-approved diagnostic criteria, such as amyotrophic lateral sclerosis (ALS) ( de Carvalho et al., 2008, Brooks et al., 2009) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) ( Van den Bergh et al., 2010).

In the Opinions below, we argue that there are three main reasons for NCS in CTS: (i) to make a diagnosis of median neuropathy at the wrist (MNW), thereby supporting the clinical diagnosis of CTS, (ii) to assess the severity of the MNW because that can help guide treatment decisions, and (iii) to detect abnormalities suggesting other conditions, if relevant.Ģ. Masahiro Sonoo: Review of existing guidelines and diagnostic criteria, and the role of nerve conduction study in CTS evaluation It is beyond the scope of this task to consider the value of ultrasound which (i) is a valuable complementary tool, (ii) assesses anatomy not function, and (iii) is less valuable for assessing functional severity. The authors were tasked to discuss the value of nerve conduction studies (NCS) in CTS. In discussing issues, the authors assume that “best-practice” is followed in the choice of test and how to perform them, and refer readers to the AANEM Guidelines (see Sonoo’s commentary, and Anon, 1993a, Jablecki et al., 1993, Jablecki et al., 2002). The opinions expressed below are not designed to constitute yet-another set of “Guidelines”. It is not a systematic review of the field and, while the authors agree on the general principles and conclusions, this is not a consensus document. This document presents the views of the authors, based on individual experience and literature. Triggered by the comprehensive systematic review performed by the American Orthopedic Association ( AAOS, 2016), and in the light of the Editorial by Fowler (2017), the Editors and Editorial Board commissioned Commentaries on these issues. Views differ between different craft groups, and it is relevant for the readers of this journal that a recent Editorial asserted that, in carpal tunnel syndrome, nerve conduction studies may be an “unnecessary evil” ( Fowler, 2017). There are many misconceptions about the condition, its underlying pathophysiology, patient demographics and optimal treatment.

Carpal tunnel syndrome is perhaps the commonest cause of referral for neurophysiological testing, herein referred to as electrodiagnostic testing or EDX.

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