Distinguishing in a puddle the water from two rains: a crucial methodological issue.

摘要

Carpal Tunnel Syndrome (CTS) is a very common disease with a heterogeneous clinical picture which may have a complex clinical. The diagnosis of CTS is based on both clinical and electrophysiolog-ical findings (Jablecki et al., 2002), but a specific and sensitive diagnostic gold standard is not available. On the one hand some authors (Nordstron et al., 1997; Akkus et al., 2002; Nora et al., 2005) tried to identify which symptoms are specific to CTS and which are instead due to co-morbidities (arthritis, muscular and joint involvement); on the other hand the available electrophysio-logical techniques may have high sensitivity and specificity in detecting nerve disfunction but, with a concomitant autoimmune or diabetic polyneuropathy, they may provide misleading results. In this context, the effort made by Gazioglu et al. (2011) in this issue is welcome. The authors aimed at identifying the best neuro-physiologic technique for diagnosing CTS in patients with diabetic polyneuropathy. With such an objective, it was unavoidable to consider the clinical diagnosis as the gold standard for CTS.