MODERATE RECOMMENDATION The evidence shows that MRI and Upper Limb Neurodynamic testing should not be used for carpal tunnel syndrome. For the use of MRI, only one moderate quality study (Jarvik 2002) was reviewed which reported there was low specificity with moderate sensitivity using this tool to diagnosis carpal tunnel of any severity. Their findings suggest MRI was a poor tool in the diagnostic algorithm for Carpal Tunnel syndrome. Similarly, the use of Neurodynamic testing is as a tool for the diagnosis of Carpal Tunnel Syndrome was evaluated in a randomized controlled trial (Beddaa 2022) with high quality evidence demonstrating poor specificity (47%) and moderate sensitivity (76%) compared to the reference standard of Electrodiagnostic testing. Overall, the recommendation above is based on moderate evidence with limited to moderate strength that MRI and Upper Limb Neurodynamic Testing should not be used in the standard work up for the diagnosis of carpal tunnel syndrome.
Benefits/Harms of Implementation
Based on available evidence with low Specificity and moderate Sensitivity for both MRI and Neurodynamic testing, outcomes show that neither test provides benefit in the diagnosis of carpal tunnel syndrome compared to other more appropriate tools (CTS-6, Ultrasound, electrodiganostics). These tests have associated costs to patients and health systems and appear to provide no improved accuracy in the diagnosis of this condition.
Outcome Importance
Given the availability of alternative methods of diagnosis, and the importance of appropriate diagnostic clarity for patients, the use of these tools for diagnosis is not recommended.
Cost Effectiveness/Resource Utilization
Considering the associated costs of MRI and Neurodynamic testing they provide poor cost effectiveness in the standard work up for a patient presenting with Carpal Tunnel syndrome. This is important given the relative cost and availability differences between these tools and clinical exam testing (CTS-6) and the low-cost availability of alternatives.
Acceptability
Overall, the acceptability of this recommendation is expected to be high as obtaining MRI and Neurodynamic testing is not common practice. In addition, the associated costs and the potential for poor diagnostic clarity given the limited specificity of these tests make the value attached to use poor.
Feasibility
Because of the alternative diagnostic options for carpal tunnel syndrome, including exam alone (CTS-6), it is feasible to not utilize MRI or neurodynamic testing in the evaluation of a patient for carpal tunnel syndrome.
Future Research
Additional high-quality studies should compare MRI and Neurodynamic testing against other standards of diagnosis outside of CTS-6, ultrasound, or electrodiagnostic testing if there were a hypothesis on a diagnostic advantage (e.g., improved specificity/sensitivity compared to alternate tests).
- Beddaa, H., Kably, B., Mouhi, I., Marzouk, B., Marfak, A., Nafai, S., Ouazzani, R., Birouk, N.. (2022). The validity of the upper limb neurodynamic test 2A in women with a clinical diagnosis of carpal tunnel syndrome: a prospective diagnostic accuracy study. The Pan African medical journal, 42(0), 61.
- Jarvik, J. G., Yuen, E., Haynor, D. R., Bradley, C. M., Fulton-Kehoe, D., Smith-Weller, T., Wu, R., Kliot, M., Kraft, G., Wang, L., Erlich, V., Heagerty, P. J., Franklin, G. M.. (2002). MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology, 58(11), 1597-602.