Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Lars B. Dahlin, Lund University, Sweden
- Second opponent: Professor Anna Rostedt Punga, Uppsala University, Sweden
- Third member and chair of the evaluation committee: Professor Morten Ingvar Lossius, University of Oslo
Chair of the Defence
Professor II Bjørnar Hassel, University of Oslo
Principal Supervisor
Senior Researcher, Senior Consultant, PhD Kristian Bernhard Nilsen, University of Oslo
Summary
Diagnosis of Carpal tunnel syndrome (CTS) is often based on clinical assessment and nerve conduction studies (NCS). However, it is unclear how to perform and combine clinical assessment and NCS for optimal information, leading to variations in the standards for diagnostic workup and challenges in research concerning risk factors for CTS such as hand-arm vibration (HAV) exposure for CTS.
The work in this thesis aims to provide clinicians and researchers with increased understanding about how to use and combine NCS and clinical assessment in the study of CTS. Using cross sectional studies, we assessed agreement between NCS tests, measurement properties of the Norwegian versions of the most widely used self-reported instruments and the association between carpal tunnel syndrome and use of vibrating tools.
We found that even small changes to NCS technique reduced the agreement between two variants of a NCS test comparing the median and ulnar nerves.
We found acceptable to good measurement properties of the Norwegian versions of the the CTS-6 item score (CTS-6) and the Boston Carpal Tunnel Questionnaire (BCTQ) and the hand diagram. Further, all three tools provided complementary information to NCS, suggesting their role in determing pretest probability (hand diagram) and in severity assessment (CTS-6 and BCTQ).
Using a combination of a comprehensive NCS protocol and clinical assessment, we found an association between CTS, ulnar neuropathy and HAV exposure. However, the strength of the associations depended on the tool category, indicating a role of ergonomic factors.
This thesis concludes that NCS and clinical assessment provide complementary information about CTS. Instead of using single NCS tests solely to confirm a CTS diagnosis, we advocate to use a more comprehensive NCS protocol able to reflect all severity grades of nerve injury and to interpret NCS findings in light of the clinical picture.
Additional information
Contact the research support staff.