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Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies

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Abstract

The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79 %; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm2). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86 %, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3 %. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.

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References

  1. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45:373–6.

    Article  PubMed  Google Scholar 

  2. Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013;17:28–33.

    Article  PubMed  Google Scholar 

  3. Buchberger W, Schon G, Strasser K, Jungwirth W. High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med. 1991;10:531–7.

    CAS  PubMed  Google Scholar 

  4. Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve. 2003;27:26–33.

    Article  PubMed  Google Scholar 

  5. Leonard L, Rangan A, Doyle G, Taylor G. Carpal tunnel syndrome—is high-frequency ultrasound a useful diagnostic tool? J Hand Surg (Edinburgh, Scotland). 2003;28:77–9.

    Article  CAS  Google Scholar 

  6. Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology. 2004;232:93–9.

    Article  PubMed  Google Scholar 

  7. Klauser AS, Halpern EJ, De Zordo T, 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.

    Article  PubMed  Google Scholar 

  8. Mallouhi A, Pulzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color-Doppler sonography. AJR Am J Roentgenol. 2006;186:1240–5.

    Article  PubMed  Google Scholar 

  9. Nakamichi K, Tachibana S. Restricted motion of the median nerve in carpal tunnel syndrome. J Hand Surg (Edinburgh, Scotland). 1995;20:460–4.

    Article  CAS  Google Scholar 

  10. Sarria L, Cabada T, Cozcolluela R, Martinez-Berganza T, Garcia S. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol. 2000;10:1920–5.

    Article  CAS  PubMed  Google Scholar 

  11. Keles I, Karagulle Kendi AT, Aydin G, Zog SG, Orkun S. Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome. Am J Phys Med Rehabil. 2005;84:443–50.

    Article  PubMed  Google Scholar 

  12. Karadag YS, Karadag O, Cicekli E, et al. Severity of carpal tunnel syndrome assessed with high-frequency ultrasonography. Rheumatol Int. 2010;30:761–5.

    Article  PubMed  Google Scholar 

  13. Altinok T, Baysal O, Karakas HM, et al. Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome. Clin Radiol. 2004;59:916–25.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM quality assurance committee. Muscle Nerve. 1993;16:1392–414.

    Article  CAS  PubMed  Google Scholar 

  16. Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve. 2004;29:515–22.

    Article  PubMed  Google Scholar 

  17. Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol. 2008;67:146–52.

    Article  CAS  PubMed  Google Scholar 

  18. Ooi CC, Png MA, Tan BHA, et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography. Skeletal Radiol. 2013;42:886–7.

    Google Scholar 

  19. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000; 20 Spec No: S199–213; discussion S213–197

  20. Ziswiler HR, Reichenbach S, Vogelin E, Bachmann LM, Villiger PM, Juni P. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum. 2005;52:304–11.

    Article  PubMed  Google Scholar 

  21. Bayrak IK, Bayrak AO, Tilki HE, Nural MS, Sunter T. Ultrasonography in carpal tunnel syndrome: comparison with electrophysiological stage and motor unit number estimate. Muscle Nerve. 2007;35:344–8.

    Article  PubMed  Google Scholar 

  22. Beekman R, Visser LH. High-resolution sonography of the peripheral nervous system—a review of the literature. Eur J Neurol. 2004;11:305–14.

    Article  CAS  PubMed  Google Scholar 

  23. Chen SF, Lu CH, Huang CR, et al. Ultrasonographic median nerve cross-section areas measured by 8-point “inching test” for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms. BMC Med Imaging. 2011;11:22.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Dejaco C, Stradner M, Zauner D, et al. Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann Rheum Dis. 2013;72:1934–9.

    Article  PubMed  Google Scholar 

  25. Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol. 2012;198:W181–4.

    Article  PubMed  Google Scholar 

  26. Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo JC, Erausquin C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome? Clin Exp Rheumatol. 2007;25:853–9.

    CAS  PubMed  Google Scholar 

  27. Hunter JM. Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy. Hand Clin. 1991;7:491–504.

    CAS  PubMed  Google Scholar 

  28. Korstanje JW, Scheltens-De Boer M, Blok JH, et al. Ultrasonographic assessment of longitudinal median nerve and hand flexor tendon dynamics in carpal tunnel syndrome. Muscle Nerve. 2012;45:721–9.

    Article  PubMed  Google Scholar 

  29. Padua L, Pazzaglia C, Caliandro P, et al. Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol. 2008;119:2064–9.

    Article  CAS  PubMed  Google Scholar 

  30. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999;173:681–4.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Ms. Sally Lee for her invaluable assistance in statistical analysis. This study was supported by SGH Research Grant (Grant number: SRG #04/2011).

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Singapore General Hospital, Block 2, level 1, Outram Road, 169608, Singapore, Singapore

    Chin Chin Ooi, Siew Kune Wong, Rafidah Abu Bakar, Shy Yunn Goh, P. Chandra Mohan & Meng Ai Png

  2. Department of Hand Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore

    Agnes B. H. Tan, Andrew Y. H. Chin & Robert T. J. Yap

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  1. Chin Chin Ooi
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  2. Siew Kune Wong
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Correspondence to Chin Chin Ooi.

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Ooi, C.C., Wong, S.K., Tan, A.B.H. et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal Radiol 43, 1387–1394 (2014). https://doi.org/10.1007/s00256-014-1929-z

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  • DOI: https://doi.org/10.1007/s00256-014-1929-z

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