Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (original) (raw)
Related papers
Journal of Medical Sciences and Health
Background: Sonologic evaluation of the median nerve has been shown to be a useful tool in carpal tunnel syndrome diagnosis. Neurosonology supplants clinical and electrodiagnostic work up. Objectives: To determine the median nerve ultrasound parameters in carpal tunnel syndrome (CTS) patients and find their correlation with patient reported clinical data and electrophysiology findings,to assess diagnostic accuracy of nerve ultrasound in CTS in comparison to clinical evaluation combined with electrodiagnosis as reference standard. Methods: 23 consecutive patients with carpal tunnel syndrome symptoms (46 wrists-35 with nerve conduction study confirmed CTS, 11 without CTS) underwent neurosonologic evaluation with high resolution ultrasound including median nerve cross sectional area(CSA) at carpal tunnel inlet, flattening ratio, Wrist/forearm CSA ratio measurements. Patient reported measures were recorded using Boston carpal tunnel syndrome questionnaire (BCTQ). Results: Statistically ...
Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome
Muscle & Nerve, 2012
Introduction: The purpose of this study was to develop an evidence-based guideline for the use of neuromuscular ultrasound in the diagnosis of carpal tunnel syndrome (CTS). Methods: Two questions were asked: (1) What is the accuracy of median nerve cross-sectional area enlargement as measured with ultrasound for the diagnosis of CTS? (2) What added value, if any, does neuromuscular ultrasound provide over electrodiagnostic studies alone for the diagnosis of CTS? A systematic review was performed, and studies were classified according to American Academy of Neurology criteria for rating articles of diagnostic accuracy (question 1) and for screening articles (question 2). Results: Neuromuscular ultrasound measurement of median nerve cross-sectional area at the wrist is accurate and may be offered as a diagnostic test for CTS (Level A). Neuromuscular ultrasound probably adds value to electrodiagnostic studies when diagnosing CTS and should be considered in screening for structural abnormalities at the wrist in those with CTS (Level B).
Ultrasound features of carpal tunnel syndrome: a prospective case-control study
Skeletal Radiology, 2007
Purpose The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Material and methods Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29-78) in the symptomatic and 45.1 years (range 24-82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination.
Role of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome
Al-Azhar Medical Journal, 2017
Background: Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. Recent studies have demonstrated advantages of sonographic techniques in the diagnosis of carpal tunnel syndrome (CTS). Objective: Assessing the utility of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) and grading its severity. Patients and Methods : Sixty hands in 46 patients with clinically and electro-physiologically confirmed carpal tunnel syndrome, and sixty asymptomatic hands in 34 healthy individuals as control group were included in the study and underwent high-resolution ultrasonography of the wrists. In ultrasonographic assessment the cross-sectional area (CSA) of the median nerve at the distal crease of the wrist and flattening ratio (FR) of the median nerve in the carpal tunnel as well as palmar bowing (PB) of the flexor retinaculum were measured. Ultrasonographic Data from the patients group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) curve analysis. Sensitivity and specificity of ultrasonographic measurements were evaluated. Ultrasonographic measurements were correlated with severity of CTS according to nerve conduction studies (NCS). Results: The CSA of the median nerve and PB of the flexor retinaculum were significantly larger in the CTS hands compared to the normal control hands. However, FR of the median nerve showed no significant difference between both groups. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a CSA cutoff value of 10 mm² provided a diagnostic sensitivity of 93.3 % and specificity of 98.3 % and PB cutoff value of 3.3 mm provided a diagnostic sensitivity of 90 % and specificity of 85 %. No significant differences in CSA and PB were found among patients with mild, moderate and severe carpal tunnel syndrome so that CSA and PB did not reflect the severity of the condition. Conclusion: Ultrasonography is a useful non-invasive method for the diagnosis of carpal tunnel syndrome but not assessing its severity.
Archives of Medical and Clinical Research, 2021
Background: Although nerve conduction study (NCS) represents the commonly performed test to functionally confirm the presence of carpal tunnel syndrome (CTS) in the daily clinical practice, the value of ultrasonography (U/S) is well established as a diagnostic tool for structural evaluation of CTS. Τhe purpose of this study was to compare U/S and nerve conduction velocity in patients with clinically diagnosed CTS, for assessing the usefulness of U/S in determining CTS severity. Material and Methods: A cross-sectional study with prospective data collection was carried out. 71 patients (100 hands) with clinically diagnosed idiopathic CTS were included in this study. Τhe protocol was comprised of a NCS and an U/S where the cross sectional area (CSA) and the flattening ratio (FR) of the median nerve at the carpal tunnel inlet (level of the pisiform) were measured. Results: In 94 hands (65 patients) out of 100 hands (71 patients), CTS was electrophysiologically confirmed. The CSA increase of the median nerve was proportional to the electrophysiological severity of the CTS. ROC analysis demonstrated good diagnostic value in both CSA and FR (CSA: AUC = 0.974, p<0.001, FR: AUC = 0.928, p <0.001). The CSA at the tunnel inlet with a threshold of 10.5 mm 2 had the best diagnostic accuracy with a sensitivity of 94.7% and a specificity of 92.5%, as well as the FR with a threshold of 3.1 had the best diagnostic accuracy with a sensitivity and a specificity of 78.7% and 98.8%, respectively. Furthermore, ROC curve analysis for CTS electrophysiological severity showed a superior performance of the CSA (AUC=0.911, p<0.001) compared to the FR (AUC=0.647, p=0.023). The optimal cutoff point of 15.5 mm 2 for CSA at the carpal tunnel inlet was defined to determine severe CTS, which yielded a sensitivity of 82.8% and a specificity of 92.3%. Conclusions: The U/S of the median nerve combined with electrodiagnostic study, increases significantly the sensitivity and reliability of the patient's diagnostic approach suffering from CTS. It can also be used for the assessment of CTS severity, replacing NCS, as its benefits such as low cost, non-invasive procedure, less time and patient's convenience are remarkable.
Validity of Ultrasonography in Diagnosis of Carpal Tunnel Syndrome
Journal of Medical Science And clinical Research, 2020
Introduction: Carpal tunnel syndrome (CTS), a common peripheral entrapment neuropathys due to impairment of median nerve function. Diagnosis of CTS is based on clinical signs and symptoms and confirmed by electrodiagnostic studies. Ultrasound imaging is noninvasive, offers high temporal and spatial resolutions and can provide dynamic anatomical information regarding structure and kinetics. Aims and Objectives: 1.To find the validity of using ultrasonography before and after provocative exercises for diagnosed CTS patients with nerve conduction studies. 2. To find out the cut off values of median nerve cross sectional area in our population in diagnosis of CTS and to compare it with NCS using a Receiver Operating Characteristic (ROC) curve. Methodology: This is a study of diagnostic test tool evaluation. 29 patients diagnosed as CTS with nerve conduction studies, were taken for ultrasound before and after exercise and studied the cross sectional area of median nerve at wrist and tabulated. Results: the cut off values of median nerve area in diagnosis of moderate and severe CTS is calculated. Predictive power of median nerve cross sectional area also is calculated. Conclusion: As per the present study, the mean value of cross sectional area is 0.108 (pre exercise) and 0.125 (post exercise) is diagnostic.
Background: Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population. Methods: Sixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitis or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group . High resolution ultrasound (US) was performed to assess cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd) . Results: There was a...
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021
Introduction: Carpal Tunnel Syndrome (CTS) is the entrapment neuropathy which is diagnosed based on the clinical history, examinations and the electrophysiological findings. The Cross- sectional Area (CSA) measurement of the median nerve has emerged as an alternative to Nerve Conduction Studies (NCS) for diagnosis of CTS. This study was done to correlate NCS and Ultrasonography (USG) in clinically diagnosed CTS patients. Aim: To evaluate the diagnostic value of Cross-sectional Area (CSA) of median nerve at carpal tunnel inlet in patients with clinically and NCS confirmed Carpal Tunnel Syndrome (CTS) and to assess severity of the syndrome by NCS and its correlation with USG results. Materials and Methods: This was a hospital based, case-control study done on a total of 109 patients of CTS and analysed during the period from June 2017 to June 2019. Total 203 hands of the patients with abnormal NCS formed case group while 101 hands from healthy volunteers constituted the control group....
The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome
Clinical Neurophysiology, 2008
Objective: Peripheral nerve ultrasound is an emerging tool in the diagnosis of carpal tunnel syndrome (CTS). Although numerous publications have cited an increased median nerve area at the wrist to be the diagnostic of CTS, there has been considerable variability in the published normal values for this measurement. Our objective is to collect data on the wrist-to-forearm ratio (WFR) of median nerve area in patients with CTS and healthy controls. Methods: Patients with electrodiagnostically proven CTS underwent ultrasonography of the median nerve at the wrist and forearm. The median nerve area was measured at these points and compared to values from asymptomatic volunteers. Results: The WFR of median nerve area in asymptomatic volunteers was 1.0 ± 0.1. The WFR in patients presenting with CTS was 2.1 ± 0.5. Conclusions: The WFR in patients with CTS is elevated as compared to asymptomatic controls. A WFR of P1.4 gave 100% sensitivity for detecting patients with CTS while using only median nerve area at the wrist resulted in a sensitivity of 45-93%, depending on the cutoff value used. Significance: The WFR of median nerve area promises to be a valid means of diagnosing CTS, and may be superior to measuring median nerve area at the wrist alone.
Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests
Acta neurologica Belgica, 2018
To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. US can help the clinicians with the diagnosis of carpal tunne...