Can we define severity of carpal tunnel syndrome by ultrasound?

Authors

1 Department of Neurology, Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Neurology, Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences; Department of Medical Sciences, Najafabad Branch, Islamic Azad University, Isfahan, Iran

3 Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.
Materials and Method: This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.
Results: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm 2 (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm 2 (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm 2 (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).
Conclusion : In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.

Keywords

1.
Wilbourn AJ. Diabetic entrapment and compression neuropathies. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. Philadelphia: Saunders; 1999. p. 481-508.  Back to cited text no. 1
    
2.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153-8.  Back to cited text no. 2
    
3.
Roquelaure Y, Ha C, Pelier-Cady MC, Nicolas G, Descatha A, Leclerc A, et al. Work increases the incidence of carpal tunnel syndrome in the general population. Muscle Nerve 2008;37:477-82.  Back to cited text no. 3
    
4.
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: Value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250:171-7.  Back to cited text no. 4
    
5.
Descatha A, Huard L, Duval S. Letter to the editor: The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: A meta-analysis. Clin Orthop Relat Res 2011;469:901-2.  Back to cited text no. 5
    
6.
Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: A Meta analysis. Clin Orthop Relat Res 2011;469:1089-94.  Back to cited text no. 6
    
7.
American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002;25:918-22.  Back to cited text no. 7
    
8.
Sarría L, Cabada T, Cozcolluela R, Martínez-Berganza T, García S. Carpal tunnel syndrome: Usefulness of sonography. Eur Radiol 2000;10:1920-5.  Back to cited text no. 8
    
9.
Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002;58:1589-92.  Back to cited text no. 9
    
10.
Lew HL, Date ES, Pan SS, Wu P, Ware PF, Kingery WS. Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil 2005;86:12-6.  Back to cited text no. 10
    
11.
Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003;4:9.  Back to cited text no. 11
    
12.
Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: A critical review of the literature. Muscle Nerve 2003;27:26-33.  Back to cited text no. 12
    
13.
Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67:146-52.  Back to cited text no. 13
    
14.
Ajeena IM, Al-Saad RH, Al-Mudhafar A, Hadi NR, Al-Aridhy SH. Ultrasonic assessment of females with carpal tunnel syndrome proved by nerve conduction study. Neural Plast 2013;2013:754564.  Back to cited text no. 14
    
15.
Practice parameter for carpal tunnel syndrome (summary statement): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993;43:2406-9.  Back to cited text no. 15
    
16.
You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in CTS. Muscle Nerve 1999;22:497-501.  Back to cited text no. 16
    
17.
Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46:1914-21.  Back to cited text no. 17
    
18.
Sucher BM. Grading severity of carpal tunnel syndrome in electrodiagnostic reports: Why grading is recommended. Muscle Nerve 2013;48:331-3.  Back to cited text no. 18
    
19.
Kuo MH, Leong CP, Cheng YF, Chang HW. Static wrist position associated with least median nerve compression: Sonographic evaluation. Am J Phys Med Rehabil 2001;80:256-60.  Back to cited text no. 19
    
20.
Miwa T, Miwa H. Ultrasonography of Carpal Tunnel Syndrome: Clinical Significance and Limitations in Elderly Patients. Intern Med 2011;50:2157-61.  Back to cited text no. 20
    
21.
Chen SF, Huang CR, Tsai NW, Chang CC, Lu CH, Chuang YC, et al. Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas. BMC Med Imaging 2012;12:15.  Back to cited text no. 21
    
22.
Prime MS, Palmer J, Khan WS, Goddard NJ. Is there light at the end of the tunnel? Controversies in the diagnosis and management of carpal tunnel syndrome. Hand (N Y) 2010;5:354-60.  Back to cited text no. 22
    
23.
Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: Diagnostic usefulness of sonography. Radiology 2004;232:93-9.  Back to cited text no. 23
    
24.
Descatha A, Huard L, Aubert F, Barbato B, Gorand O, Chastang JF. Meta-Analysis on the Performance of Sonography for the Diagnosis of Carpal Tunnel Syndrome. Semin Arthritis Rheum 2012;41:914-22.  Back to cited text no. 24
    
25.
Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. J Clin Ultrasound 2009;37:389-93.  Back to cited text no. 25
    
26.
Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 2002;26:798-803.  Back to cited text no. 26
    
27.
Karadað YS, Karadað O, Ciçekli E, Oztürk S, Kiraz S, Ozbakir S. Severity of carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int 2010;30:761-5.  Back to cited text no. 27
    
28.
Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies. J Clin Ultrasound 2009;37:125-31.  Back to cited text no. 28
    
29.
Mohammadi A, Afshar AR, Masudi S, Etemadi A. Comparison of high resolution ultrasonography and nerve conduction study in the diagnosis of carpal tunnel syndrome: Diagnostic value of median nerve cross-sectional area. Iran J Radiol 2009;3:47-152.  Back to cited text no. 29
    
30.
El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: Substantive or complementary tests? Rheumatology (Oxford). 2004;43:887-95.  Back to cited text no. 30
    
31.
Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Diagnosis of carpal tunnel syndrome: Ultrasound versus electromyography. Radiol Clin North Am 1999;37:859-72.  Back to cited text no. 31