Utilization of Neurophysiological Classification Systems in Determining Interventions for Patients with Carpal Tunnel Syndrome.

BACKGROUND: Median mononeuropathy at or distal to the wrist, or carpal tunnel syndrome (CTS), is the most common peripheral nerve compression disorder in the upper extremity. Neurophysiological classification systems for patients with CTS have been developed and implemented to provide health care providers an enhanced system of electrophysiological evaluation with a grading scale, so that they may evaluate their patients with CTS within a system that confers relative severity. Electrophysiological data collected within these classification systems includes either nerve conduction studies (NCS), or both NCS and electromyography (EMG) test results. The purpose of this study was to assess the utilization of neurophysiological classification systems in determining interventions for patients with carpal tunnel syndrome (CTS). METHODS: To assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS, an on-line survey of referring providers to NCS/EMG (electrophysiological testing) clinics was developed. These clinical sites were asked to submit three referring providers of their NCS/EMG services. The survey was emailed to the referring providers with a letter of introduction that included an overview and purpose of the study and specifically stated their responses were completely anonymous and analyzed data would be in an aggregate form. RESULTS: Of the 35 referring providers of NCS/EMG services for their patients with CTS contacted to participate in this study, 14 providers completed the on-line survey (40%). This included 12 physicians (MD), one osteopathic physician (DO), and one nurse practitioner (NP). Twelve of the referring providers (85.7%) were familiar with clinical electrophysiological classification systems for patients with CTS. Nine referring providers use a neurophysiological classification system (Greathouse Ernst Hall Shaffer (GEHS) and Bland-six; GEHS only-two; alternate system-one). Five respondents did not use a neurophysiological classification system, two of which were not familiar with these classification systems. The nine providers who use a neurophysiological classification system for their patients with CTS found these systems useful in assessing patient prognosis, treatment planning, and communicating back to referral services. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications. CONCLUSION: Referring providers of NCS/EMG services completed an on-line survey to assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications. A method for using a neurophysiological classification system for patients with CTS in a clinical report is provided. Additional research to assess the prognostic validity and utilization of carpal tunnel classification systems as longitudinal outcome measures is needed.

An Unusual Radial Neuropathy.

A 23-year-old woman presented to her physician for left forearm pain of insidious onset, inability to extend the wrist, and numbness in the dorsal hand. An electromyogram (EMG) and nerve conduction study (NCS) demonstrated radial neuropathy, while magnetic resonance imaging (MRI) of the left elbow/forearm, performed 2 months later, revealed edema and atrophy of the wrist extensor muscles, but no compressive lesion. Following a lack of improvement and consultation with an orthopaedic surgeon, a second, more detailed EMG/NCS was performed, revealing a severe radial motor and sensory neuropathy, with compression between the lateral and long heads of the triceps. J Orthop Sports Phys Ther 2019;49(7):558. doi:10.2519/jospt.2019.7927.

GEHS neurophysiological classification system for patients with neuropathy of the ulnar nerve at the elbow.

BACKGROUND: Neuropathy of the ulnar nerve at the elbow is one of a number of muscle-related and nerve-related disorders that affect people performing intensive work with their hands and upper extremities, and is the second most prevalent peripheral nerve mononeuropathy. There are several classification systems currently being used by the medical community for patients with neuropathy of the ulnar nerve at the elbow. However, few of these classification systems include the clinical electrophysiologic parameters nerve conduction (NCS) and electromyographic (EMG) studies. PURPOSE: This article describes the GEHS (Greathouse, Ernst, Halle, and Shaffer) neurophysiological classification system for patients with neuropathy of the ulnar nerve at the elbow and includes 2 case studies of patients with electrophysiological evidence of neuropathy of the ulnar nerve at the elbow. CASE STUDIES: Two case studies of patients with electrophysiological evidence of neuropathy of the ulnar nerve at the elbow are presented. The GEHS neurophysiological classification system is incorporated into the discussion of these case studies. SUMMARY AND CLINICAL RELEVANCE: This article describes the GEHS neurophysiological classification system for patients with neuropathy of the ulnar nerve at the elbow which incorporates findings for both the NCS and EMG components of the electrophysiological examination. Availability of expanded electrophysiological data that includes both NCS and EMG testing provides the healthcare team and the patient with more detailed information that may be useful in determining next treatment steps as well as long-term prognosis. Future research comparing the psychometric properties and prognostic utility of the GEHS neurophysiologic classifications is warranted.

GEHS Neurophysiological Classification System for Patients with Carpal Tunnel Syndrome.

BACKGROUND: Median neuropathy at or distal to the wrist or carpal tunnel syndrome (CTS) is one of a number of muscle, tendon, and nerve-related disorders that affect people performing intensive work with their hands. Following a thorough history and physical examination, electrophysiological examination including both nerve conduction studies (NCS) and electromyography (EMG) testing may be performed and currently serve as the reference standard for the diagnosis of CTS. The EMG and NCS exams should identify the peripheral nerve, specific location in the nerve pathway, involvement of sensory and/or motor axons, and the presence of myelinopathy and/or axonopathy neuropathic process. NEUROPHYSIOLOGICAL CLASSIFICATION SYSTEMS: Clinical electrophysiologists now have 2 neurophysiological classification systems for patients with CTS from which to choose when preparing their electrophysiological testing reports. The Bland (2000) and GEHS (2012) neurophysiological classification systems for patients with CTS are discussed. CASE STUDIES: Two case studies of patients with electrophysiological evidence of CTS are presented. Application and comparison of categorizations by the Bland and GEHS neurophysiological classification systems are incorporated into the presentation and discussion of these case studies. SUMMARY AND CLINICAL RELEVANCE: This article describes 2 neurophysiological classification systems for patients with CTS. The Bland system documents the distribution of patients with CTS on a scale based upon nerve conduction study findings, but it does not include any EMG findings in its grading scale. The GEHS neurophysiological classification system includes findings for both the NCS and EMG components of the electrophysiological examination. The GEHS classification system provides electrophysiological evidence of myelinopathy and/or axonopathy for patients with CTS. Additional research comparing the psychometric properties and prognostic utility of the Bland and GEHS neurophysiologic classifications is warranted.

Does a participant's perceived self-efficacy of healthcare professions improve following a week-long informational camp for high school students?

PURPOSE: The purpose of this study was to determine if a week-long summer day camp for high school students to learn about various healthcare professions could influence the students' perceived self-efficacy and knowledge of healthcare careers related to sports medicine. Additionally, we investigated if there was a relationship between level of parent education and the participants' self-efficacy scores before and after camp. SUBJECTS: We recruited 13 male and 13 female (n=26) students from five area high schools with an average age of 15.8 yrs (range, 15 to 17 yrs). Participants were predominantly of Hispanic origin. METHODS: A pre- and post-intervention survey was used to collect participants' demographic data and to assess participants' perceived self-efficacy towards the healthcare field and their knowledge of different healthcare careers. A paired, two-tailed t-test was used to determine if perceived self-efficacy scores before and after the camp differed. A linear regression analysis was run to determine if parental education was a predictor for the difference in self-efficacy scores. RESULTS: We found a statistically significant difference between perceived self-efficacy scores before and after the camp. Parental education was not found to be a significant predictor for the difference in participants' self-efficacy scores. CONCLUSIONS: The evidence suggests that attendance at a summer program that allowed students to learn about and interact with various healthcare professionals significantly improves perceived self-efficacy towards pursuing a career in the healthcare field. Parental education may not be a predicting factor for the change in perceived self-efficacy after attendance at such educational camps.