Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Prospective study on carpal tunnel syndrome at CDHB: a comparative study between clinical assessment, neurophysiology, MRI and ultrasonography with PREMs and PROMs profiles as key health performance indicators (871)

Eric Tan 1 , Terrence Creagh 2 , Dylan James 2 , Mark Coates 3 , Wei Lun Wong 2 , Erin Coleman 4 , Simon Nicholson 2
  1. Waikato DHB, Christchurch, CANTERBURY, New Zealand
  2. Plastic Surgery, Christchurch Hospital, Christchurch, Canterbury, NZ
  3. Radiology, Christchurch Hospital, Christchurch, Canterbury, NZ
  4. Neurology, Christchurch Hospital, Christchurch, Canterbury, NZ

Carpal tunnel decompression is commonly performed in hand surgery. The pathway in establishing diagnosis, investigation, treatment and post surgery assessment can be challenging with inter-rater variability in reported  clinical findings and non clinical investigation profiles. Opinions were diverse from different specialties and geographical locations in determining the optimal way to investigate and diagnose carpal tunnel syndrome (CTS).

We conducted a comparative study looking at the efficacy of clinical and non clinical diagnostic tools for carpal tunnel syndromes in 16 patients (19 hands) in the department. Each case will be assessed by 2 senior medical officers (SMO) in Plastic Surgery to be diagnosed with CTS and investigated with comprehensive neurophysiology tests, high resolution 3D ultrasonography and Magnetic Resonance imaging (MRI). 

The surgery will be carried out by a SMO. A repeat neurophysiology profile will repeated with each case 6 weeks post surgery.    

At Canterbury District Health Board, we are passionate in delivering high standards of care in Plastic Surgery. Patient reported outcome measure (PROM) and patient reported experience measure (PREM) are 2 key performance indicators that are concurrently being used in New Zealand health system and worldwide to asses the quality of healthcare delivery and patient experience of the service while being care. In this study, we have also investigated the PREM and PROM of the 16 patients managed for CTS with validated questionnaires like CARE forms and Boston Carpal Tunnel  Questionnaire pre and post operatively.

We would like to share our experience from performing (to the best of our knowledge), the first of such comparative study looking at three non clinical investigating modalities (MRI, ultrasonography and neurophysiology) and clinical assessment of carpal tunnel syndrome in a single setting. We would like to share how PREMs and PROMs can be used to benchmark high standards of care in carpal tunnel surgery.