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The authorship by a neurophysiologist of an article strongly advocating nerve conduction studies for diagnosing carpal tunnel syndrome seems something of an undeclared competing interest.1 Fortunately, not all Bland's colleagues support his enthusiasm. Clinicians involved in managing this syndrome mostly agree that because of the high rate of false negatives, the test should only be advocated for cases with unusual diagnostic difficulty. Carpal tunnel syndrome usually presents in the early hours of the morning because of extracirculatory shifts in body fluids, so to be truly accurate, nerve conduction tests would also need to be performed at this time of day. Until Bland's department can provide a round the clock service, willy-nilly requests for nerve studies are more likely to bankrupt the NHS than provide helpful pointers towards firm diagnosis.
As for the article's guidance on treatments, splintage certainly helps with symptoms but does nothing for the underlying condition, and who really wants to go to bed every night wearing a cumbersome splint? As for steroids, as Bland tells us, relapse is common. Am I, therefore, like him also at risk of a conflict of interest in declaring that expert surgery is the only definitive solution?
Competing interests: None declared.