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© 2009 the American Academy of Orthopaedic Surgeons
Diagnosis of Carpal Tunnel Syndrome
This clinical practice guideline was approved by the American Academy of Orthopaedic Surgeons.
Dr. Keith is Professor, Orthopaedics and Biomedical Engineering, and Chief, Hand Surgery Service, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. Dr. Masear is Orthopaedic Surgeon, Orthopaedic Specialists of Alabama, Birmingham, AL. Dr. Chung is Professor, Plastic Surgery, University of Michigan Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI. Dr. Maupin is Orthopaedic Surgeon, Michigan Hand Center, Grand Rapids, MI. Dr. Andary is Professor, Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI. Dr. Amadio is Orthopaedic Surgeon, Mayo Clinic, and Professor of Orthopedics, Mayo Clinic College of Medicine, Rochester, MN. Dr. Barth is Chief, Section of Orthopaedic Surgery, and Chief, Section of Hand Surgery, Sibley Memorial Hospital, Washington, DC, and a member of the Board of Councilors, American Academy of Orthopaedic Surgeons, Rosemont, IL. Dr. Watters is Orthopaedic Surgeon, Bone and Joint Clinic of Houston, Houston, TX. Dr. Goldberg is Chief, Skeletal Dysplasia Clinic, Seattle Children’s Hospital, Seattle, WA. Dr. Haralson is Executive Director of Medical Affairs, American Academy of Orthopaedic Surgeons. Dr. Turkelson is Director, Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons. Ms. Wies is Manager, Clinical Practice Guidelines Unit, American Academy of Orthopaedic Surgeons.
Dr. Masear or a member of her immediate family serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand and is affiliated with the publication The American Journal of Orthopedics. Dr. Chung or a member of his immediate family has received research or institutional support from Stryker. Dr. Andary or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Pfizer and Allergan. Dr. Amadio or a member of his immediate family serves as a board member, owner, officer, or committee member of the Orthopaedic Research Society, and Immanuel St. Joseph Hospital; is affiliated with the publication/publishers Journal of Orthopaedic Research and Saunders/Mosby-Elsevier; has received research or institutional support from Musculoskeletal Transplant Foundation and the National Institutes of Health (NIAMS and NICHD); has stock or stock options held in Johnson & Johnson, Merck, and Procter & Gamble; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Journal of Bone and Joint Surgery American. Dr. Barth or a member of his immediate family has stock or stock options held in Amgen, Merck, and Pfizer. Dr. Watters or a member of his immediate family serves as a board member, owner, officer, or committee member of Bone and Joint Decade USA, North American Spine Society, Intrinsic Therapeutics, Work Loss Data Institute, and American Board of Spine Surgery; is affiliated with the publication The Spine Journal; serves as a paid consultant to or is an employee of Blackstone Medical, Medtronic Sofamor Danek, Stryker, Intrinsic Therapeutics, and McKessen Health Care Solutions; and has stock or stock options held in Intrinsic Therapeutics. Dr. Goldberg is affiliated with the Journal of Pediatric Orthopedics and the Journal of Children’s Orthopaedics. Dr. Haralson or a member of his immediate family serves as a paid consultant to or is an employee of Medtronic and Medtronic Sofamor Danek and has stock or stock options held in Orthofix. Ms. Wies or a member of her immediate family has stock or stock options held in Shering Plough. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Keith, Dr. Maupin, and Dr. Turkelson.
This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of carpal tunnel syndrome. The methods used to develop this clinical practice guideline were designed to combat bias, enhance transparency, and promote reproducibility. The guideline’s recommendations are as follows: The physician should obtain an accurate patient history. The physician should perform a physical examination of the patient that may include personal characteristics as well as performing a sensory examination, manual muscle testing of the upper extremity, and provocative and/or discriminatory tests for alternative diagnoses. The physician may obtain electrodiagnostic tests to differentiate among diagnoses. This may be done in the presence of thenar atrophy and/or persistent numbness. The physician should obtain electrodiagnostic tests when clinical and/or provocative tests are positive and surgical management is being considered. If the physician orders electrodiagnostic tests, the testing protocol should follow the American Academy of Neurology/American Association of Neuromuscular and Electrodiagnostic Medicine/American Academy of Physical Medicine and Rehabilitation guidelines for diagnosis of carpal tunnel syndrome. In addition, the physician should not routinely evaluate patients suspected of having carpal tunnel syndrome with new technology, such as magnetic resonance imaging, computed tomography, and pressure-specified sensorimotor devices in the wrist and hand. This decision was based on an additional nonsystematic literature review following the face-to-face meeting of the work group.
This article has been cited by other articles:
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  K. L. Weber The AAOS Clinical Practice Guidelines J. Am. Acad. Ortho. Surg., June 1, 2009; 17(6): 335 - 336. [Full Text] [PDF]
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