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Misdiagnosis of Carpal Tunnel Syndrome: A Systematic Misclassification or Error of Omission

Mireles, Matthew C. PhD, MPH; Miller, Jerry A. PhD; Paske, William C. PhD

Journal of Clinical Engineering: April-June 2009 - Volume 34 - Issue 2 - p 99-102
doi: 10.1097/JCE.0b013e3181a0c43f
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Carpal tunnel syndrome (CTS) screening is problematic and often inaccurate. Surgical treatment for CTS, involving open-hand or endoscopic ligament releases, accounts for 11% of all surgeries performed. Of these surgeries, about 50% fail. We compared the sensitivity and specificity of CTS screening tests. Using multiple screening tests is believed to increase accuracy, but the results showed specificity decreases to 48% or less. Most misdiagnoses were false negatives, suggesting that many surgical treatments were unnecessary. This systematic misclassification based on imprecise screening tests is also an error of omission when physicians have only these tests to use. A new screening method and test are considered.

Carpal tunnel syndrome (CTS) screening is problematic and often inaccurate. Surgical treatment for CTS, involving open-hand or endoscopic ligament releases, accounts for 11% of all surgeries performed. Of these surgeries, about 50% fail. We compared the sensitivity and specificity of CTS screening tests. Using multiple screening tests is believed to increase accuracy, but the results showed specificity decreases to 48% or less. Most misdiagnoses were false negatives, suggesting that many surgical treatments were unnecessary. This systematic misclassification based on imprecise screening tests is also an error of omission when physicians have only these tests to use. A new screening method and test are considered.

From the Community Medical Foundation for Patient Safety, Bellaire, Texas (Drs Mireles and Miller); and Red Oak Instruments, Sugar Land, Texas (Dr Paske).

Corresponding author: Matthew C. Mireles, PhD, MPH, Community Medical Foundation for Patient Safety, Suite 288, 6300 West Loop South, Bellaire, TX 77401. mirelesmc@earthlink.net.

Matthew C. Mireles, PhD, MPH, earned his undergraduate degree in bioengineering from Texas A&M University and his master in public health and PhD in epidemiology from the University of Texas Health Science Center at Houston, School of Public Health. After college, he joined the US Navy and attended flight schools at Pensacola, Florida. After his military training, he worked as a clinical engineer at a large teaching hospital in Texas. Presently, he is the president and chief executive officer of Community Medical Foundation for Patient Safety, a nonprofit medical research and education organization based in the Houston area and a leader in patient safety research.

Jerry A. Miller, PhD, is the current vice president of research at the Community Medical Foundation for Patient Safety. He earned his BS in psychology at the University of Pittsburgh and his master of science and PhD, both in epidemiology, at the University of Texas Health Science Center at Houston, School of Public Health. He completed his postdoctoral as research fellow at Centers for Disease Control and Prevention (CDC). Dr Miller's research interests include infectious diseases and traumatic brain injury. He leads and supervises many of the research projects at the foundation and gives presentations on various patient safety topics.

William C. Paske, PhD, is the vice president of research and development of Red Oak Instruments, LLC, earned his BA in physics and math from the Alaska Methodist University and his master of science in nuclear physics and his PhD in atomic and molecular physics at the University of Oklahoma. He completed his postdoctoral in atomic and molecular physics at the same institution. Dr Paske's work experience has been primarily in the oil and gas exploration industry. He holds 30 US and international patents for devices and equipment, including the SKG System and the FAsT System approved by the U.S. Food and Drug Administration (FDA) to measure fine motor control of the hands.

© 2009 Lippincott Williams & Wilkins, Inc.