title: Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity.
abstract: OBJECTIVE
  Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients.
  
  
  METHODS
  One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ) and visual analog scale (VAS) were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS). Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS) was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test.
  
  
  RESULTS
  There was significant correlation of BCTSAQ with VAS (P= 0.001), HADS anxiety score (P< 0.001), and HADS depression score (P= 0.01). CEPSS had no significant correlation with VAS (P= 0.103), HADS anxiety score (P= 0.211), or HADS depression score (P= 0.55). CEPSS had a borderline correlation with BCTSAQ (P= 0.048).
  
  
  CONCLUSIONS
  While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.
authors.affiliation: Department of Neurology, Mother Hospital, Thrissur, Kerala, India.
authors.forename: Firosh
authors.initials: F
authors.lastname: Khan
authors.affiliation: Psycho-Oncology, Department of Radiotherapy and Oncology, Government Medical College, Thrissur, Kerala, India.
authors.forename: Abdulkhader
authors.initials: A
authors.lastname: Shehna
authors.affiliation: Department of Neurosurgery, Jubilee Mission Medical College Hospital, Thrissur, Kerala, India.
authors.forename: Sivaramakrishnan
authors.initials: S
authors.lastname: Ramesh
authors.affiliation: Department of Neurology, Mother Hospital, Thrissur, Kerala, India.
authors.forename: Kakkassery Sankaran
authors.initials: KS
authors.lastname: Sandhya
authors.affiliation: Department of Neurology, Renai Medicity, Kochi, Kerala, India.
authors.forename: Reji
authors.initials: R
authors.lastname: Paul
keywords: Carpal tunnel syndrome; composite electrophysiology score; psychological status