American Association of Neuromuscular & Electrodiagnostic Medicine

View all recommendations from this society

September 1, 2022

Don’t use neuromuscular ultrasound (NMUS) to evaluate the severity of carpal tunnel syndrome.

While NMUS may be used as a reasonable alternative to electrodiagnostic evaluation (nerve conduction studies and electromyography) for the diagnosis of carpal tunnel syndrome in some patients, its ability to determine severity is uncertain.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Professional Practice Committee (PPC) of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) developed this list of recommendations. The PPC includes both neurologists and physical medicine and rehabilitation (PMR) physicians who come from varying practice settings and also includes the AANEM’s representatives to the American Medical Association (AMA) Current Procedural Terminology Panel and Relative Value Update Committee. The PPC members identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence-based research/support in the literature. The committee’s recommendations were discussed at an AANEM Board meeting that included chairs from AANEM committees. The PPC reviewed the feedback from this group and voted on the final Top Ten recommendations. These were then approved by the AANEM Board of Directors.

AANEM’s disclosure and conflict of interest policy can be found at


Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, Werner RA, Shook SJ, Thomas TD, Primack SJ, Walker FO; American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93. doi: 10.1002/mus.23389. PMID: 22806381.

Pelosi L, Arányi Z, Beekman R, Bland J, Coraci D, Hobson-Webb LD, Padua L, Podnar S, Simon N, van Alfen N, Verhamme C, Visser L, Walker FO, Shik Yoon J, Cartwright MS. Expert consensus on the combined investigation of carpal tunnel syndrome with electrodiagnostic tests and neuromuscular ultrasound. Clin Neurophysiol. 2022 Mar;135:107-116. doi: 10.1016/j.clinph.2021.12.012. Epub 2022 Jan 6. PMID: 35074720

Martikkala L, Himanen SL, Virtanen K, Mäkelä K. The Neurophysiological Severity of Carpal Tunnel Syndrome Cannot Be Predicted by Median Nerve Cross-Sectional Area and Wrist-to-Forearm Ratio. J Clin Neurophysiol. 2021 Jul 1;38(4):312-316. doi: 10.1097/WNP.0000000000000696. PMID: 32224714.