title: A carpal tunnel grading system including combined sensory index-diagnosed mild cases: Relation to presenting features and outcomes.
abstract: BACKGROUND
  Prior studies have demonstrated superiority of the combined sensory index (CSI) algorithm in diagnosing mild carpal tunnel syndrome (CTS) and have compared presenting symptoms to CTS grade. However, CTS symptoms, signs, and outcomes, including CSI-diagnosed cases, have not been compared with CTS grade.
  
  
  METHODS
  We retrospectively studied 294 CTS hands from 2010 to 2013; stratified them into mild, moderate, and severe grades; and analyzed the association between CTS grade and presenting symptoms/signs and outcomes.
  
  
  RESULTS
  Sensorimotor symptoms (P = 0.017) and signs (P < 0.001) were significantly associated with CTS grade. Regardless of CTS grade, 94% of hands improved with surgery compared with 42% with conservative treatment (P < 0.001). Even in mild CTS, 100% improved with surgery vs. 33% with conservative management (P = 0.011).
  
  
  CONCLUSIONS
  These results corroborate prior studies that compared symptoms to CTS grade and suggest that more objective signs associate even better. CTS grades associate with outcomes, but additional studies are required. Muscle Nerve 57: 45-48, 2018.
authors.affiliation: Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center Neuropsychiatric Institute (M/C 796), 912 S. Wood Street, Chicago, Illinois, 60612-7330, USA.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Zeidman
authors.affiliation: Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center Neuropsychiatric Institute (M/C 796), 912 S. Wood Street, Chicago, Illinois, 60612-7330, USA.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Pandey
mesh_terms: D000465:Algorithms; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000601:surgery*; D000072700:Conservative Treatment; D004568:Electrodiagnosis; D004576:Electromyography; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D012189:Retrospective Studies; D012677:Sensation; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: carpal tunnel release surgery; carpal tunnel syndrome; combined sensory index (CSI); grading system; median neuropathy at the wrist