Criteria: Table 15-23 Entrapment / Compression Neuropathy Impairment (449)
Accurately define diagnosis, and assess history, physical examination findings, and clinical studies, as explained in Section 15.1 (385-386) and 15.4f (432-450). It is imperative that the diagnosis be accurate with the study confirmed by electrodiagnostic testing.Criteria for electrodiagnostic studies are provided in Appendix 15-B (487-490) and must be met, both to define diagnosis and grade severity. Ratings are only provided if carpal tunnel syndrome is electrodiagnostically confirmed. The individual must be at maximum medical improvement, as explained on pages 447 and 448. Lesions may take 6 to 9 months for maximum recovery. Ratings are based on consideration of test findings, history, physical findings, and functional scale. History requirements are explained on page 433 and grade modifiers for history are based on interference in activities of daily living as indicated in Table 15-22 (445). If the patient has symptoms, this is most often “mild, intermittent symptoms that are not constant”. Physical examination findings includes evaluation of sensibility alterations, muscle strength, range of motion, muscle reflexes, and provocative tests, i.e. Tinel and Phalen tests. It is important to assure the findings are reliable. Sensory findings are subjective self-reports and strength findings may be self-limited. Functional scores are based on the use of the QuickDASH functional assessment tool (Appendix 15-A). The rating is determined using Table 15-22, Entrapment / Compression Neuropathy Impairment (449) and is based on average factors of test findings, history and physical findings to define Grade Modifier. Once Grade Modifier is defined, the QuickDASH score is used to assign specific impairment. Impairment values are converted from UEI to hand or WPI using Table 15-11 (420). Impairment for CTS may range from 0% to 9% UEI, which is equivalent to 0% to 10% hand or 0% to 6% WPI.
