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  1. #1
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    Mar 2007
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    Default Nerve Conduction Study

    Can anyone tell me why a nerve conductive study is used to diagnose carpa tunnel syndrome, cubital tunnel syndrome and nerve damage .But when all is said and done they dont use the results for your impairment rating?

  2. #2
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    Feb 2007
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    Default Re: nerve conductive study!

    You can elect to do the study, but you are right they can not use the findings to help with the impairment rating. but the AMA does have a section based on nerve damage and loss of sensation. the doctor can use the findings from the study and cross referencing it with AMA there by coming up with the factual percentage. I did not do the study but I have losss of senation in my foot due to nerve damage. The only down fall is I had to wait over year to have the doctor say I would not feel anything there.

  3. #3
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    Mar 2007
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    Default Re: nerve conductive study!

    Slick i don't understand how they can give you an impairment rating without addressing the whole problem?I have had nerve conductive study six months after CTR surgery still showed medium severe carpal tunnel syndrome and not one WC doctor realy addressed the cubital tunnel syndrome ?

  4. #4
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    Default Re: Nerve conductive study!

    You would have to understand how to use the AMA Guides as to why you do not directly reference any type of study. I'm not going to try to explain other than to tell you that Impairment is a functional determination and so it's irrelevant what the study says, it's what does the physical exam objectively document as different from normal. You also would not know that the EMGNCV findings lag behind clinical resolution by 6 months or more so the results are again of no particular relevance. X-rays do also.

    It's not that lay people are deliberatly kept in the dark about all this , rather that we physicians have the requisite training to use the reference guidelines and a lay person would not be able to do it. There is an interpretative factor that's necessary.

  5. #5
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    Mar 2007
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    Default Re: Nerve conductive study!

    POR i understand the clinical part of all this,yet my question would refer to the fact that before they would say i had CTS they had to do the nerve conductive study.After that was done the attending physician informed me and work I had carpa tunnel syndrome cubital tunnel syndrome and nerve damage to arms and he prescribes physicak therapy.Now when i return to work am told i have appointment with specialist who tells me carpa tunnelsyndrome is nothing and his is worse then mine and i must be lying about the arm pain because even thought my right arm hurt to the bone the left showed worse on the NCS? After injecting my wrists and putting me in pure agony i was told that it couldnt hurt in phone call to his office.next appointment he says i need surgery,now would anyone in their right mind let someone with medium severe carpa tunnel syndrome operate on them?when you do your clinical evaluation do you look at all the records and check whole arm movement or just wrist and ability to grip?
    As an added thought i have had both CTR operations and was released no MMI back to work no restrictions,even though attending physician told me if i was still in pain go see a nurologist.Eventually our insurance paid a DR.that injected elbows and lessened the constant 24/7 bone pain.Now it happens after driving half hour or so and doig any lifting for prolonged periods like carrying a bucket of water !
    Last edited by disposable_worker; 03-15-2007 at 12:57 PM.

  6. #6
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    Feb 2007
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    775

    Default Re: Nerve conductive study!

    was there a question in there somewhere ?
    I guess I misunderstood your original post and thought you were referring to a permanent partial impairment determination exam. Sorry.

  7. #7
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    Mar 2007
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    Default Re: Nerve conductive study!

    question was how can they say they have to have a NCS to decide you have CTS but when all is said and done no one uses it to decide if your arm or hand or wirst have a problem?And then they give you a back to work no MMI rating ?and yet six months later a NCS shows you have medium severe CTS.wWhen we talk clinically its observation and past history?

  8. #8
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    Mar 2007
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    67

    Default Re: Nerve conductive study!

    In another way of putting it ! If a NCS shows a problem then supposedly the problem is fixed why is a NCS not done after MMI to evaluate the improvement?

    If i had a automobile and changed a flat tire i could say it was fixed but if a piece of protruding metal cuts second tire then i dont have a spare and am gonna need other assistance?

  9. #9
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    Feb 2007
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    Default Re: Nerve conductive study!

    Very true it makes you wonder.

  10. #10
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    Default Re: Nerve conductive study!

    oh..well it's because the test can remain positive while the hand has completely recovered for quite some time. "Improvement" is a clinical, functional determination and does not rely on the test. The test itself is operator and machine dependant so open to variability. Other problems unrelated can affect the outcome of the study, such as room temperature, diabetes, obesity etc etc. Again - the test makes no real difference and actually is not even necessary to make the diagnoses so there is no medical literature that suggests following with serial NCS's.

    That's not to say some people don't get worse over time and so we do order another NCS's for clinical deterioration. Sounds more like you have a double crush syndrome aand not a primary CTS. Good luck

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