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Table 8 Reference standards

From: Diagnostic accuracy of sensory and motor tests for the diagnosis of carpal tunnel syndrome: a systematic review

Authors and year

Reference Standard Test

Reference Standard Test Methodology

Positive Results Criteria

Borg & Lindblom 1988 [20]

Examined the efficacy of a combined battery of tests

Not described.

Not described.

Buch-Jaeger & Foucher 1994 [21]


Four criteria were examined.

Nerve conduction studies were taken as positive when the distal motor latency in the abductor brevis muscle was greater than 4 ms and the speed of sensory nerve conduction through the carpal tunnel was less than 50 m/s.

Dale et al. 2011 [8]

Modified Katz Hand Diagram

A team of three health professionals (two physicians and an occupational therapist) independently rated each Katz hand diagram as “Unlikely,” “Possible,” “Probable,” or “Classic” for CTS.

CTS symptoms of the hand defined as a “classic” or “probable” rating on the modified Katz hand diagram.


Examiners performed median and ulnar sensory and motor nerve conduction studies at the wrist bilaterally using the NC-Stat automated nerve conduction testing device (NEUROMetrix, Inc., Waltham, MA). They calculated median-ulnar sensory latency difference (MUDS).

Abnormal median nerve conduction, defined as sensory latency > 3.5 ms (14 cm) or motor latency > 4.5 ms or MUDS of > 0.5 ms (14 cm).

The Consensus Criteria CTS Case Definition

CTS Symptoms Plus Abnormal Median Nerve Conduction.

A CTS case definition drawn from the consensus criteria of Rempel et al. [1998] requiring both symptoms (a “classic” or “probable” rating on a modified Katz hand diagram) and abnormal median nerve conduction (as defined above).

Franzblau et al. 1993 [22]

1) NCS

Bilateral limited electrophysiologic testing of the median and ulnar nerves at the wrists. Measured parameters included sensory amplitude, peak latency and takeoff latency in each nerve tested.

A difference of at least 0.5 milliseconds between median and ulnar sensory peak latencies in the same wrist.

2) NCS + various surveillance symptom definitions for CTS

The self-administered questionnaire focused on demographic information, prior medical conditions, occupational history, current health status, and symptoms which may be related to upper extremity cumulative trauma disorders.

Eight CTS cases were defined.

3) Physical examination findings combined with various surveillance symptom definitions for CTS

The physical examination included inspection, palpation, active and passive range of motion of joints, elicitation of reflexes (biceps, triceps, and brachioradialis), Tinel’s test, Phalen’s test, Finkelstein’s test, and 2-point discrimination.


Katz et al. 1990 [23]


The protocol included bilateral median and ulnar sensory and motor testing and electromyographic recording from the abductor pollicus brevis on the most symptomatic hand. Testing was done with standard techniques on a Disa 1500 (Copenhagen, Denmark) or Teca 42 (Pleasantville, New York) apparatus.

If patients had median motor latency greater than 4.0 ms, sensory latency greater than 3.7 ms, or sensory velocity less than 50 m/s. performed by neurologist

Kucukakkas & Yurdakul 2019 [7]


All the electrophysiological examinations were performed according to the American Association of Electrodiagnostic Medicine (AAEM) guidelines for CTS by one examiner using a Neuropack S1 MEB 9400 (Nihon Kohden Corporation, Tokyo, japan).

AAEM guidelines

Kuhlman et al. 1997 [24]


Six different NCS methods were performed on all 228 hands.

In addition to the subjective symptoms of CTS, one of the three objective electrodiagnostic criteria must have been met for a patient to be diagnosed with CTS.

MacDermid et al. 1994 [25]

Clinical profile of CTS

The electrodiagnostic testing was performed in the hospital laboratory using the laboratory standards for abnormality of median nerve conduction velocity and/or distal sensory latency.

A clinical profile of CTS determined by hand surgeons based on history and gross motor and sensory inspection, combined with independently obtained electrodiagnostic evidence of CTS.

MacDermid et al. 1997 [26]

NCS and positive clinical examination from experienced hand surgeons

Physical examination included detailed history of symptoms and aggravating factors, two-point discrimination and light touch sensory evaluation and strength testing of abductor pollicis brevis by manual muscle testing. Nerve conduction tests and electromyographic testing performed by blinded staff neurologists.

Evaluation of normality was considered in the context of the entire neurophysiologic examination, which induced testing of ulnar, radial and proximal nerves as sources of pathology and examination of distal latencies, amplitudes and conduction times for motor and sensory nerves.

Makanji et al. 2013 [11]


All of the patients had electrophysiological testing (nerve conduction velocity and electromyography) in the same office. Median nerve conduction studies were performed across the wrist.

standards based on the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM).

Naranjo et al. 2007 [9]


Tests were performed with the guidance of two neurologists following the American Academy of Neurology protocol. These include performing a median sensory or motor nerve conduction studies.

An initial latency over 3.4 ms was considered abnormal.

Pagel et al. 2002 [27]


All electrodiagnostic testing was performed with a Nicolet Viking IV D (Nicolet, Madison, WI). The median and ulnar nerves were stimulated in the palm, and the response was recorded 8 cm proximally at the wrist.

If a patient had a median ulnar latency difference of 0.3 msec or an absent median response and a normal ulnar response.

Raudino 2000 [28]


motor latencies of median and ulnar nerve were recorded using surface electrodes placed over the abductor pollicis brevis and abductor digiti minimi respectively, and stimulating supramaximal at the wrist at a distance of 6 cm.

According to their normal values (mean + 2 SD), latencies greater than 3 ms were considered abnormal.

Sartorio 2017 [10]


Subjects with suspected CTS was subdivided into 4 groups based on EMG (severe/extreme-GrA, moderate-GrB, mild/minimal-GrC, negative-GrD)

The presence of CTS was defined as positive EMG (GrAGrC), while subjects with negative EMG included in the GrD were considered healthy.

Szabo et al. 1999 [29]


Bilateral median and ulnar motor and sensory nerve conduction testing were the electrodiagnostic parameters considered in this study.

Abnormal if the latency was ≥4.5 ms or ≥ 3.5 ms across the wrist, respectively. If either one or both were abnormal, the patient was considered to have a positive electrodiagnostic test.

Yildirim & Gunduz 2015 [6]


The instrument used was a Medelec Sapphire 4 ME. Bilateral median motor and sensory nerve conduction potentials were recorded using standard techniques according to the practice parameters for the electrodiagnosis of CTS outlined by the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

Abnormal electrophysiological findings suggesting CTS were categorized into three grades according to Stevens’ classification: mild, moderate, and severe.