Aim of the research:
• To establish using best available evidence, a clinically appropriate revision of the current CTS nerve conduction Grading Tool.
• To redeveloped scale designed from a clinical physiologist perspective and is based on numerical values of nerve conduction findings.
• It helps Clinical Physiologist to differentiate the level involvement of the sensory or motor pathways.
The grading system devised by Bland (Bland, 2000) and used to grade the levels of severity of CTS over the last 17 years within the UK has certain limitations, and the author believes system needs modification in order to accommodate current practice. The revised grading system for CTS is based on a review of a current and past literature.
Bland (Bland, 2000) and Padua (Padua at al, 1996) both limited the DML and CV in motor study and amplitude potentials and CV for sensory study. I follow the same rule and proceed the study with below given cut off values to grade them accordingly. Most of the Clinical laboratory in UK uses the above criteria of cut off values for sensory and motor study to create their own normative values. Presently, there is no standard of CTS grading followed throughout the UK due to their limitations, the propose grading scale, preferably was felt to be an acceptable and useable tool for intervention allocation.
The revised grading tool using a physiological basis offers a more precise numerical grading, which is both objective and repeatable. This will enable the surgeon to precisely ascertain the level of severity and decide on a conservative or surgical approach to treatment. Although surgeons have to take their own decision for the treatment of CTS, if they want to consider the treatment on the basis of the Nerve conduction study grading, this will allow defend of their decisions for the court. Surgeons could consider proposed Grade 1-3 for conservative treatment and Grade 4-7 for surgical intervention where the chances of full recovery. Surgeon has to think for surgical intervention for Grade 8 cases whether it would be beneficial or not for the age and other medical history of the patient. Future studies looking at prognosis may be helpful in looking at the outcomes from different interventions for those with different gradings of severity and to look at the implications of motor involvement compared with just sensory fascicle involvement.