La radiologia medica

, Volume 116, Issue 3, pp 489–496

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

  • M. Rahmani
  • A. R. Ghasemi Esfe
  • S. M. Bozorg
  • M. Mazloumi
  • O. Khalilzadeh
  • H. Kahnouji
Musculoskeletal Radiology / Radiologia Muscoloscheletrica

Abstract

Purpose

The diagnosis of carpal tunnel syndrome (CTS) is established by electrodiagnostic testing (EDT). Nonetheless, in a portion of patients complaining of the typical signs and symptoms of CTS, the EDT is negative, and yet no paraclinical tool has been acknowledged for confirming the diagnosis. The aim of this study was to investigate the value of ultrasound imaging in diagnosing clinically suspicious patients with normal EDT findings.

Materials and methods

Thirty-four patients, with clinical evidence of CTS but without abnormal findings on electromyography, and 41 healthy controls were enrolled. Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity and hypervascularity of the median nerve were evaluated. Multivariate logistic regression analysis was used to formulate a prediction model for CTS.

Results

CSA of the median nerve in the wrist and wrist-to-forearm ratio were significantly higher in patients compared with controls. Patients had significantly higher hypoechogenicity [odds ratio (OR) 4.317; 95% confidence interval (CI) 1.23–15.11) and hypervascularity (OR 5.004,; 95% CI 1.02–21.15) in the median nerve. Clinical evidence of CTS was predicted using a model comprising three ultrasonographic determinant factors, including hypoechogenicity, hypervascularity and wrist CSA of the median nerve. The probability of clinical evidence of CTS in a person with one, two, or three ultrasonographic signs of CTS was estimated to be 35%, 70%, and 90%, respectively.

Conclusions

Ultrasound imaging is a useful technique in diagnosing CTS patients when EDT results are not confirmatory and the patient is suspected of having neuropathy.

Keywords

Carpal tunnel syndrome Electrodiagnostic tests Ultrasonography Electromyography 

Correlazioni ecografiche nella sindrome del tunnel carpale nei pazienti con test elettrodiagnostici negativi

Riassunto

Obiettivo

La diagnosi di sindrome del tunnel carpale (STC) viene posta mediante test elettrodiagnostici (TED). Ciò nonostante, pur in presenza di sintomi tipici di STC non sempre i TED risultano positivi ed ancora non sono state definite ed accettate indagini alternative che consentano di confermare la diagnosi. L’obiettivo dello studio è di indagare l’utilità dell’imaging ultrasonografico per la diagnosi di STC in pazienti con profili elettrofisiologici nei limiti di norma.

Materiali e metodi

Sono stati arruolati e sottoposti ad indagine ecografica 34 pazienti con sintomi tipici di STC in assenza di anomalie nei tracciati elettrodiagnostici e 41 controlli sani. Per ogni indagine sono stati rilevati i seguenti parametri: area in sezione trasversale (CSA), ipoecogenicità ed ipervascolarizzazione del nervo mediano. Al fine di stabilire un modello predittivo per la diagnosi di STC è stata applicata un’analisi di regressione logistica multivariata.

Risultati

L’area del nervo mediano calcolata in sezione trasversale a livello del polso ed il rapporto tra questa e l’area stimata a livello dell’avambraccio sono risultati significativamente superiori nel gruppo dei pazienti rispetto ai controlli sani. I coefficienti di ipoecogenicità [odds ratio (OR) 4,317; intervallo di confidenza (IC) del 95%] e di ipervascolarizzazione [OR 5,0004; 95% IC 1,02–21,15] del nervo mediano sono risultati significativamente più elevati nel gruppo dei pazienti rispetto ai controlli. Ipoecogenicità, ipervascolarizzazione ed area in sezione trasversale del nervo mediano rappresentano i tre fattori determinanti nel predire la STC mediante sola indagine ecografica. La probabilità di evidenza clinica di STC in presenza di uno, due o tutti questi segni ecografici è stata rispettivamente del 35%, 70% e 90%.

Conclusioni

L’imaging ecografico è utile nella diagnosi di STC in pazienti con sospetta neuropatia e TED non conclusivi.

Parole chiave

Sindrome del tunnel carpale Test elettrodiagnostici Ecografia Elettromiografia 

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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • M. Rahmani
    • 1
  • A. R. Ghasemi Esfe
    • 1
  • S. M. Bozorg
    • 1
  • M. Mazloumi
    • 1
  • O. Khalilzadeh
    • 1
  • H. Kahnouji
    • 2
  1. 1.Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imaging Medical Center, Imam HospitalTehran University of Medical SciencesTehranIran
  2. 2.Department of Neurology, Imam HospitalTehran University of Medical SciencesTehranIran

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