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A prospective study was carried out to investigate any correlation between electrophysiological and sonographic findings in patients with a clinical diagnosis of carpal tunnel syndrome. A total of 113 patients (113 wrists) in 90 women and 23 men, with a mean age of 60 years, underwent sonographic and electrophysiological examination. Fifty-five patients (48%) had mild, 43 (38%) moderate and 12 (11%) had severe conduction disturbances and three patients had normal conduction. Sonographic measurements showed a cross-sectional area of the median nerve of 9.9 mm2 at the forearm and 17.8 mm2 at the tunnel inlet. The mean anteroposterior diameter (height) of the nerve at the tunnel inlet was 2.7 mm, and the lowest height inside the tunnel was 1.8 mm. No correlation was found between sonographic and electrophysiological parameters. [ABSTRACT FROM PUBLISHER]

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of ‘typical’ carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with (n = 45, 48%) or without (n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted. [ABSTRACT FROM PUBLISHER]

Chronic immunosuppressive therapy is currently the only effective method to prevent acute rejection of a transplanted organ. Unfortunately, the expected effect of treatment brings a number of grave side effects, one of the most serious being cardiovascular complications. In our study, we wanted to investigate how treatment with commonly used immunosuppressive drugs affects the occurrence of programmed cardiac cell death. For this purpose, five groups of rats were treated with different triple immunosuppressive regimens. Cardiac tissue fragments were subjected to the TUNEL assay to visualize apoptotic cells. The expression of Bcl-2 protein, Bax protein, caspase 3 and caspase 9 was also assessed. This study indicates that all immunosuppressive protocols used chronically at therapeutic doses result in an increased percentage of cells undergoing apoptosis in rat heart tissue. The greatest changes were recorded in the TMG (rats treated with tacrolimus, mycophenolate mofetil and glucocorticosteroids) and CMG (rats treated with cyclosporin A, mycophenolate mofetil and glucocorticosteroids) groups. The TRG (rats treated with rapamycin, tacrolimus and glucocorticosteroids) group showed the lowest percentage of apoptotic cells. The internal apoptosis pathway was confirmed only in the TMG group; in the remaining groups, the results indicate programmed cell death via the receptor pathway.

We present the case of a 23-year-old woman who reported weakness in the left upper limb, decreased warmth, numbness in the fingers, pain in the clavicular region, and a severe cold sensation in the limb. A thermal imaging camera examination was performed for diagnostic purposes, which guided further diagnostic and therapeutic management towards arterial thoracic outlet syndrome (aTOS). Following surgery and rehabilitation procedures, significant remission of symptoms was achieved and the patient's condition improved. This is the first report on the diagnosis of aTOS using thermal imaging, paving the way for further clinical research into this effective, rapid, and radiation-free method of diagnostic imaging. Conclusion: Thermal imaging is one of the most effective, readily available, and patient-safe methods for diagnosing vascular disease associated with flow disruption.

Using different three-drug immunosuppressive treatment regimens in a rat model, we aimed to determine the effects of long-term therapy on metalloproteinase-2 and metalloproteinase-9 activity and the expression of their inhibitors, as well as to assess the morphology of the animals' cardiac tissue. Our results suggest that chronic use of immunosuppressive drugs disrupts the balance between the activity of MMPs and TIMPs. Depending on the type of drug regimen used, this leads to abnormalities in the cardiac structure, collagen fiber accumulation, or cardiomyocyte hypertrophy. The information obtained in the present study allows us to conclude that the chronic treatment of rats with the most common clinical immunosuppressive regimens may contribute to abnormalities in the myocardial structure and function. The results presented in this study may serve as a prelude to more in-depth analyses and additional research into the optimal selection of an immunosuppressive treatment with the lowest possible risk of cardiovascular complications for patients receiving organ transplants., Competing Interests: The authors declare no conflicts of interest.

Thyroid neoplasms (tumors) are the most common pathology of the endocrine system that requires surgery, and in most cases changes are benign. The surgical treatment of thyroid neoplasms consists in total, subtotal, or one lobe excision. Our study aimed to assess the concentration of vitamin D and its metabolites in patients before thyroidectomy. The study included 167 patients with thyroid pathology. Before the thyroidectomy procedure calcidiol (25-OHD), calcitriol (1,25-(OH) 2 D), and vitamin D binding protein (VDBP), as well as basic biochemical parameters, were measured using an enzyme-linked immunosorbent assay kit. Data analysis showed that the cohort of patients has a significant 25-OHD deficiency and proper concentration of 1,25-(OH) 2 D. Before the surgery, more than 80% of patients have extreme vitamin D deficiency (<10 ng/mL), and only 4% of the study group has proper 25-OHD concentration. Patients undergoing thyroidectomy are exposed to many complications, including calcium reduction. Our research has shown that patients prior to surgery have a marked vitamin D deficiency, an indicator that may affect their subsequent convalescence and prognosis. The results suggest that determination of vitamin D levels prior to thyroidectomy may be useful for potential consideration of supplementation when vitamin D deficiency is marked and needs to be incorporated into the good clinical management of these patients.

Competing Interests: The authors declare that they have no conflict of interest

Competing Interests: The authors declare that they have no conflict of interest.

Local infiltration anaesthesia with a bloodless operation field (WALANT) allows for performing hand surgery without a tourniquet. This effect is obtained through an injection of greater than standard volume of the anaesthetic solution composed of lignocaine and adrenaline. The addition of adrenaline induces spasm of small arteries within the infiltration area, which inhibits bleeding and allows visualization of most of the subtle but important structures in the hand and fingers. This article presents a method of preparation of the anaesthetic solution and the technique of anaesthesia for several common procedures in hand surgery. In 2019, our centre performed 340 operations under WALANT anaesthesia, with no serious complications observed. Data from the literature are presented showing that this technique is attracting increasing popularity worldwide. Our centre was the first in Poland to introduce the WALANT method to hand surgery.

Competing Interests: The authors declare that there is no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Purpose:  Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition., Methods:  The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated., Results:  Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery., Conclusion:  Of all considered patient's and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome., Competing Interests: The authors declare that they have no conflict of interest, (© Georg Thieme Verlag KG Stuttgart · New York.)

Microsurgical training is organised almost exclusively in a post-graduate setting, usually for residents of various surgical specialities. The aim of this study was to present an undergraduate microsurgical training model directed toward medicine students of clinical years. Curriculum design and results. Two six-participant groups of students interested in training were recruited. The programme consisted of 15 three-hour classes (2 hours' work under the microscope) and divided into basic and advanced training parts. The simulation model used in this course was a chicken thigh. The basic training programme consisted of placing sutures on a latex glove followed by preparation of a chicken thigh neurovascular bundle and performing femoral nerve and artery anastomoses. The advanced part of the training consisted of practising the acquired skills and the introduction of new techniques such as end-to-side arterial anastomosis, artery and nerve repair with vein conduit. A "6-stitches test" was used as an outcome measure of the acquired microsurgical skills. After 15 weeks and 30 hours of training and performing 31 anastomoses the undergraduate microsurgical course was completed. CONCLUSION: The results of this study show that the undergraduate, facultative microsurgical training is effective in acquiring microsurgical skills, competence and confidence for participating students., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

The objective of this study was to investigate the incidence of familial carpal tunnel syndrome in patients admitted to the authors' institution for carpal tunnel release. Questionnaires completed by 120 patients: 92 women (77%) and 28 men (23%) at a mean age of 56 years at their baseline clinical examination were reviewed. Familial occurrence of the disease was noted in 21 patients (17%): 16 women and five men. Three family members were affected in three patients, two relatives in eight patients, and one relative in 10 patients, giving a total of 35 affected relatives. The patients' sisters (n = 16) were the most commonly involved, followed by mothers (n = 12), daughters (n = 2), brothers (n = 2), grandmothers (n = 2) and an aunt (n = 1). Bilateral manifestation of the disease was noted in 19 patients (90%) and in 31 (88%) of their affected relatives. The results suggest that carpal tunnel syndrome shows a moderate tendency to familial occurrence and, if so, it usually manifests bilaterally.

The objective of the study was a comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients' quality of life. One hundred and two patients, 79 women and 23 men with displaced distal radial fractures, were non-randomly allocated for either K-wire (n=72) or palmar plate (n=30) fixation. In general, simpler fractures were fixed by pins, while plates were used for those that were more severe. No statistically significant differences were seen at 3- and 6-month follow-up assessment in any of the analyzed variables: wrist range of motion, total grip and key-pinch strength, and the DASH and SF-36 scores. We conclude that being guided by the postulated algorithm in treatment-choice of distal radial fractures is a reasonable balance between clinical- and cost-effectiveness. We also failed to find any advantage in health-related quality of life as an outcome measure in distal radial fractures compared to standard measures.

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation., Patients and Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures., Results: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group., Conclusion: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

The objective of this study was assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017., Material and Methods: A questionnaire-survey has been conducted in a group of 100 of Polish students from the Medical Faculty just before the final test-exam in subject surgery. Main topics of the questionnaire items concerned students' opinion on the expected usefulness of acquired surgical knowledge for future medical practice, acquired manual skills, range of knowledge learned in particular academic years and on understanding the term "skill/competency-oriented teaching" surgery., Results: Knowledge from general and oncologic surgery was scored by students the highest as potentially most useful for future medical practice. Learning manual skills (mostly put stiches on a pig trotter) was considered the most valuable portion of surgical curriculum. Acquiring of manual skills was also believed as the closest of meaning the term "skill/competency-oriented teaching" surgery. Sixth (last) year of studying was considered the most effective in acquiring surgical knowledge. Most responders considered time assigned for teaching surgery in the university curriculum adequate, but not optimally employed. A critical discussion of the results was done in a light of the results of earlier studies and the literature., Conclusions: Outcomes of this study showed the students' expectations in teaching surgery in the medical university curriculum and what was a grade of its performance. Awareness of this may have effect on modification of the curriculum and methods of undergraduate teaching surgery.

Clinical presentation of carpal tunnel syndrome may differ in relation to certain factors like sex, age, duration of symptoms and severity of compression. The objective of this study was an investigation into the hypothesis that several distinct factors are predictive of the clinical profile for the condition. The records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years, were analysed. The whole group was divided into subgroups, depending on the variables analysed: sex, age, duration of the condition, severity of symptoms, severity of electrophysiological abnormalities and occurrence or lack of comorbidities., Results: Of all the considered variables, the Levine symptom scores had the greatest impact on the condition's clinical profile: the higher scores the more severe pain, poorer sensation, weaker grip and worse hand function. Also, ages greater than 80 years had a significant negative effect on most of the considered parameters. None of the remaining analysed variables had a substantial impact on the clinical profile of the condition., Competing Interests: The authors declare that they have no conflict of interest, (© Georg Thieme Verlag KG Stuttgart · New York.)

Records were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors' department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Conflict of Interest: The authors declare that they have no conflict of interest.

Non-traumatic perforation of the digestive tract occurs most often in the duodenum and stomach (peptic ulcer), as well as the colon (diverticulitis, cancer or ischemic lesions). Perforation of the small bowel is very rare. The Authors of the study presented a case of proximal jejunum perforation, which occurred in a patient with a history of duodenal peptic ulcer disease. Diagnosis posed no difficulties, and treatment included the excision of the ulceration and suturing of the bowel. The patient recovered without complications and the histological examination failed to reveal the nature of the ulcer. However, based on the medical history, one may suppose that it might be of peptic etiology, which makes this case exceptional.

Background: Teaching surgery during university curriculum comprises transferring theoretical knowledge traditionally and simultaneously acquiring manual skills, i.e., suturing, stitch removal, limb immobilization, catheterization, and assisting operations. Observations of doctors several years after graduation led to the reflection that teachers' ideas about surgical knowledge and skills that are useful in daily practice frequently fail to meet the facts of the case. The objective of this study was to determine which part of the surgical knowledge and skills taught via the university surgical curriculum proved to be useful in the daily practice of young doctors., Material and Methods: A custom-made questionnaire was designed and mailed to 200 randomly chosen doctors who had graduated from the medical faculty at the authors' university 5 to 6 years previously. The questionnaire comprised 9 items concerning the knowledge and skills that proved to be the most useful in participants' daily practice, regardless of their specialty., Results: A total of 64 completed questionnaires were returned (32% of 200 sent) and were the subject of analysis. The most useful knowledge in daily practice was that acquired from general surgery, followed by oncological and vascular surgery. The most useful was knowledge about the rational interpretation of clinical symptoms and signs acquired from examination of the patient, followed by arriving at an accurate diagnosis through logical analysis, and next developing "oncological sensitivity" to diagnosing neoplasms. The most effective teaching model was specialized outpatient clinic rounds, followed by training manual skills on a model and classical ward-round teaching. The most frequently learned (acquired) manual skills were removal of stitches, rectal examination, and examination of the abdomen. Of these skills, the most useful in daily practice appeared to be removal of stitches, catheterization of the urinary bladder, and wound suturing. Learning and practicing manual skills followed by classical ward-round teaching was considered "skill-/competency-oriented teaching" surgery by all respondents., Conclusion: The results of this study show some discrepancy between the knowledge and skills taught during university surgical curriculum and their actual usefulness in the daily practice of graduates. Awareness of this should have an effect on modification of the curriculum and methods for undergraduate surgery teaching., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

We present the case of an 82-year-old patient who had successfully replanted 2 of his 4 amputated fingers in the left, non-dominant hand. Amputation was caused by a circular saw and the patient was delivered to the hospital 3 h after injury with amputated part of the hand appropriately stored. The patient's general health status was good, with no serious systemic diseases. He also did not smoke. Post-operative course was uneventful for the replanted fingers, but after his return home the patient developed left-sided pneumonia, treated successfully with i.v. antibiotics. 8 months after replantation the patient presented with slight movement in the replanted fingers (AROM 45°), a total grip strength 8 Kg and the qDASH score 24; however, he could firmly grasp objects due to having an intact, well-functioning thumb., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The objective of the study was to assess the time of exposure of the surgeon's hands to radiation and calculate of the equivalent dose absorbed during surgery of hand and wrist fractures with C-arm fluoroscope guidance., Material and Methods: The necessary data specified by the objective of the study were acquired from operations of 287 patients with fractures of fingers, metacarpals, wrist bones and distal radius. 218 operations (78%) were percutaneous procedures and 60 (22%) were performed by open method. Data on the time of exposure and dose of radiation were acquired from the display of the fluoroscope, where they were automatically generated. These data were assigned to the individual patient, type of fracture, method of surgery and the operating surgeon., Results: Fixations of distal radial fractures required longer times of radiation exposure (mean 61 sec.) than fractures of the wrist/metacarpals and fingers (38 and 32 sec., respectively), which was associated with absorption of significantly higher equivalent doses. Fixations of distal radial fractures by open method were associated with statistically significantly higher equivalent doses (0.41 mSv) than percutaneous procedures (0.3 mSv). Fixations of wrist and metacarpal bone fractures by open method were associated with lower equivalent doses (0.34 mSv) than percutaneous procedures (0.37 mSv),but the difference was not significant. Fixations of finger fractures by open method were associated with lower equivalent doses (0.13 mSv) than percutaneous procedures (0.24 mSv), the difference being statistically non-significant. Statistically significant differences in exposure time and equivalent doses were noted between 4 surgeons participating in the study, but no definitive relationship was found between these parameters and surgeons' employment time., Conclusions: 1. Hand surgery procedures under fluoroscopic guidance are associated with mild exposure of the surgeons' hands to radiation. 2. The equivalent dose was related to the type of fracture, operative technique and - to some degree - to the time of employment of the surgeon.

Background: Recent studies have demonstrated ultrasonography as a valuable tool for confirming the diagnosis of carpal tunnel syndrome. The objective of this study was to investigate sonographic parameters of the median nerve in patients diagnosed clinically with carpal tunnel syndrome., Patients and Methods: 185 wrists in 185 patients, 149 women (81%) and 36 men (19%), with a mean age of 59 years, with the clinical diagnosis of carpal tunnel syndrome were examined sonographically. We measured cross-sectional area (CSA) of the median nerve at the forearm and at the carpal tunnel inlet, as well as the height (a-p dimension) of the nerve at the tunnel inlet and in the narrowest site in the carpal tunnel. Moreover, in all patients the severity of the disease was assessed by the Levine questionnaire., Results: A significant variability of sonographic data characterizing the median nerve was found: the mean CSA at the tunnel inlet was 17.6 mm2 (range: 7-36) and height of the nerve at the tunnel inlet was a mean of 2.7 mm (range: 1.3-4.5). No correlation was found between sonographic data and severity of the syndrome as expressed by the Levine scores., Conclusion: Sonography of the median nerve contributes little to the diagnosis of a clinically relevant carpal tunnel syndrome and its routine use is not justified., (© Georg Thieme Verlag KG Stuttgart · New York.)

A prospective study was carried out to investigate any correlation between electrophysiological and sonographic findings in patients with a clinical diagnosis of carpal tunnel syndrome. A total of 113 patients (113 wrists) in 90 women and 23 men, with a mean age of 60 years, underwent sonographic and electrophysiological examination. Fifty-five patients (48%) had mild, 43 (38%) moderate and 12 (11%) had severe conduction disturbances and three patients had normal conduction. Sonographic measurements showed a cross-sectional area of the median nerve of 9.9 mm(2) at the forearm and 17.8 mm(2) at the tunnel inlet. The mean anteroposterior diameter (height) of the nerve at the tunnel inlet was 2.7 mm, and the lowest height inside the tunnel was 1.8 mm. No correlation was found between sonographic and electrophysiological parameters.

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of 'typical' carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with (n = 45, 48%) or without (n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted.

Background: An observation of patients suffering from carpal tunnel syndrome shows distinct overweight, short stature and relatively thick hands in majority of them. Objective of this study was evaluation of the relationship of anthropometric and anatomical factors related to the hand with incidence of the syndrome., Patients and Methods: The anthropometric measurements of body weight and height, as well as anatomical of wrist girth, hand length and volume were performed in 105 patients, 84 women (80%) and 21 men (20%), aged a mean of 59 years, with idiopathic carpal tunnel syndrome. The same examinations were made in a control group consisting of 105 healthy individuals, age and gender matched., Results: Statistically significant differences (t-Student or U Mann-Whitney test, p < 0,05) were noted in all considered variables: patients with carpal tunnel syndrome were heavier (of a mean of 6%), shorter (of 1,5%) and had of a mean of 9% greater body mass index. They had also statistically significantly greater hand volume (of 13%), hand length (of 2%) and wrist girth (of 5%). Although all variables were statistically significantly greater in a study group, the clinically meaningful were considered only differences of hand volume, wrist girth, body weight and body mass index., Conclusion: Individuals with overweight and with thicker than average hands and wrists are more predisposed to carpal tunnel syndrome.

Most the of doctors, including surgeons, who deal with diagnosing and treatment of carpal tunnel syndrome believe that median nerve conduction studies are obligatory for accurate diagnosis of the syndrome, providing various arguments to support this opinion. Based on available, current literature, a critical analysis of such an attitude was conducted. There is no definitive scientific evidence supporting a greater diagnostic importance of abnormal conduction in median nerve, than classical symptoms and signs of carpal tunnel syndrome. There is no enough evidence that electrophysiological studies are necessary for differential diagnosis, because clinical features of other pathologies are sufficiently different from classical carpal tunnel syndrome to avoid a false diagnosis. Relief of the symptoms and signs, but not normalisation of the conduction in median nerve is enough substantial as an evidence of effective therapy. The available evidence suggests the need of treatment of patients with typical symptoms of carpal tunnel syndrome associated with normal conduction studies, and non-treatment of those, with abnormal conduction but asymptomatic. Electrophysiological studies are thus not really a gold standard for carpal tunnel diagnosis and doing them in all patients presenting with typical history is not justified. Presence of classical features is enough convincing to make a diagnosis and qualify to the treatment. Nerve conduction studies may be helpful in cases with atypical history, when more than one site of compression is suspected, in failures and complications of surgery. The presented approach is associated with undoubted advantages of reducing time from referral to operation, costs and workload of neurophysiologists. There is no account for fear that meeting these rules may deteriorate results of the treatment of carpal tunnel syndrome.