Background: The severity of carpal tunnel syndrome (CTS) may be categorized in a number of ways utilizing one of a range of presently available grading tools. Detail grading system explained in this paper with case presentation.

The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current CTS nerve conduction grading tool, and to give idea to improve the present grading system which is 25 years old. The revised grading system confirms the previously publish research paper in 2019. 

The proposed revised grading system is based on descriptive categories, ranging from Normal to Early Sensory, Mild Sensory, Mild Sensory Motor, Moderate Sensory, Moderate Sensory Motor, Severe Sensory Motor, Extremely Severe Sensory Motor, and Complete absence. 

Method: One case of each grading category was introduced for the understanding of each grade. All previously raised questions and their answers was also included which was raised in different National and International Neurophysiology conferences. 

Result: Each grade shows a clear information of each grading which was previously recommended in my research paper in 2019. This research paper was published in BMC Journal in 2019.

Conclusion: The revised grading tool clearly offer a more numerical grading to the Clinical Physiologist. This could help the surgeon to ascertain the level of severity in order to decide on either a conservative or surgical approach to treatment if they decide to use the proposed grading.

Audience Take Away Notes:

The revised grading tool could offer a more numerical grading to the Clinical Physiologist and could help the surgeon to ascertain the level of severity in order to decide on either a conservative or surgical approach to treatment if they decide to use the proposed grading which could support them to defend their decision in cases of litigation.

He studied BSc in Karachi University, Pakistan in 1990. He is Reg. Technologist from ECNE board UK in 1999. He have completed my on-the-job training in the field of Physiological Measurement services of one year 6 months from The Aga Khan University Hospital, Karachi Pakistan in 1989. He is registered with RCCP. He have almost 28 years’ experience in Neurophysiology and 5 years in Cardiopulmonary field. He worked in three different countries in the field of Neurophysiology. Salim Hirami established a new Neurophysiology department in Torbay Hospital.  His paper on Refine grading of CTS published in MBC open access journal which achieve great welcome. Few other research papers has been published on ulnar nerves study in different stages, across wrist and across elbow and double crush syndrome which are available on google website as open access.