Skip to main content


Log in

Diagnosis of carpal tunnel syndrome assessed using high-frequency ultrasonography: cross-section areas of 8-site median nerve

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript


This study aimed to determine the most suitable site for diagnosis of carpal tunnel syndrome (CTS) by examining an 8-site measurement of the median nerve’s cross-sectional area (CSA). A total of 36 wrists of 26 patients with nerve conduction study (NCS) proven CTS, along with 34 wrists of 23 controls whose age and gender were matched with the patients, were evaluated with ultrasonography. The CSAs of the median nerve at eight predetermined sites including at the sites of 3, 2, and 1 cm proximal to the wrist crease, wrist crease, as well as at the sites of 1, 2, 3. and 4 cm distal to the wrist crease were obtained. The correlation between CSA and NCS severity, and duration of clinical CTS symptoms was analyzed. Receiver operating characteristic (ROC) curves was applied to determine the optimum cut-off point and to evaluate the diagnostic sensitivity and specificity of sonographic measurements. The CSAs of the median nerves at the eight sites were significantly higher in the CTS subjects, relative to the controls. Moreover, anatomical variation of the median nerve was found in the CTS group. ROC results indicated the areas under curve (AUC) at the site of 4 cm distal to the wrist crease were the largest with 0.874 cm2, and an optimal cut-off value of 0.095 yielded a sensitivity of 88.9 % and a specificity of 76.5 %. The CSAs of “CTS-wrists” positively correlated with NCS severities and the CTS symptoms duration. Using 8-site CSAs measurement of the median nerve from inlet to outlet has positive correlations with NCS severity and duration of CTS symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Kim HS, Joo SH, Cho HK, Kim YW (2013) Comparison of proximal and distal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index in subjects with carpal tunnel syndrome. Arch Phys Med Rehab 94:2151–2156

    Article  Google Scholar 

  2. Werner RA, Andary M (2002) Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 113:1373–1381

    Article  PubMed  Google Scholar 

  3. Ziswiler HR, Reichenbach S, Vögelin E, Bachmann LM, Villiger PM, Jüni P (2005) Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum 52:304–311

    Article  PubMed  Google Scholar 

  4. ElMiedany Y, Ashour S, Youssef S et al. (2007) Sensitivity to change of the carpal tunnel syndrome global severity scoring system—a prospective study. Rheumatol: Oxford Univ Press Great Clarendon St, Oxford OX2 6dp, England. I123-I123

  5. Wright P, Crenshaw A (1992) Carpal tunnel and ulnar tunnel syndromes and stenosing tenosynovitis. Campbell’s Opera Orthopaed 8:3435–3437

    Google Scholar 

  6. Redmond MD, Rivner MH (1988) False positive electrodiagnostic tests in carpal tunnel syndrome. Muscle Nerve 11:511–518

    Article  CAS  PubMed  Google Scholar 

  7. Visser LH, Smidt MH, Lee ML (2008) High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosur Ps 79:63–67

    Article  CAS  Google Scholar 

  8. Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS (2004) Carpal tunnel syndrome: diagnostic usefulness of sonography 1. Radiology 232:93–99

    Article  PubMed  Google Scholar 

  9. Yesildag A, Kutluhan S, Sengul N et al (2004) The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clinica Radiol 59:910–915

    Article  CAS  Google Scholar 

  10. Wong S, Griffith J, Hui A, Tang A, Wong K (2002) Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 46:1914–1921

    Article  CAS  PubMed  Google Scholar 

  11. Hammer H, Hovden I, Haavardsholm E, Kvien T (2006) Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology 45:584–588

    Article  CAS  PubMed  Google Scholar 

  12. Hobson-Webb LD, Massey JM, Juel VC, Sanders DB (2008) The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 119:1353–1357

    Article  PubMed  Google Scholar 

  13. Visser LH, Smidt MH, Lee ML (2008) Diagnostic value of wrist median nerve cross sectional area versus wrist-to-forearm ratio in carpal tunnel syndrome. Clin Neurophysiol 119:2898–2899

    Article  PubMed  Google Scholar 

  14. Won SJ, Kim BJ, Park KS, Yoon JS, Choi H (2013) Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 47:864–871

    Article  PubMed  Google Scholar 

  15. Mondelli M, Filippou G, Gallo A, Frediani B (2008) Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome. Arthritis Care Res 59:357–366

    Article  Google Scholar 

  16. Padua L, Pazzaglia C, Caliandro P et al (2008) Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 119:2064–2069

    Article  CAS  PubMed  Google Scholar 

  17. Altrocchi P, Daube J, Frishberg B et al (1993) Practice parameter for carpal-tunnel syndrome. Neurology 43:2406–2409

    Article  Google Scholar 

  18. Padua L, LoMonaco M, Gregori B, Valente E, Padua R, Tonali P (1997) Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 96:211–217

    Article  CAS  PubMed  Google Scholar 

  19. Klauser AS, Halpern EJ, Faschingbauer R et al (2011) Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement. Radiology 259:808–815

    Article  PubMed  Google Scholar 

  20. Filippucci E, Iagnocco A, Meenagh G et al (2006) Ultrasound imaging for the rheumatologist. II. Ultrasonography of the hand and wrist. Clinical Exp Rheumatol 24:118

    CAS  Google Scholar 

  21. Thoirs K, Williams MA, Phillips M (2008) Ultrasonographic measurements of the ulnar nerve at the elbow role of confounders. J Ultras Med 27:737–743

    Google Scholar 

  22. Chen S, Wu S (2011) Cross-sectional area reference values for normal median nerve by high-resolution ultrasonography. Chin J Clin 5:759–762

    Google Scholar 

  23. Seror P (2008) Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Europ J Radiol 67:146–152

    Article  CAS  Google Scholar 

  24. Chen S-F, Lu C-H, Huang C-R et al (2011) Ultrasonographic median nerve cross-section areas measured by 8-point. BMC Med Imaging 11:22

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pierre-Jerome C, Smitson RD Jr, Shah RK, Moncayo V, Abdelnoor M, Terk MR (2010) MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance. Surg Radiol Anat 32:315–322

    Article  PubMed  Google Scholar 

  26. Bayrak IK, Bayrak AO, Kale M, Turker H, Diren B (2008) Bifid median nerve in patients with carpal tunnel syndrome. J Ultras Med 27:1129–1136

    Google Scholar 

Download references


This study was supported by a grant from the science and technology office of Liaoning (2011225013) and by a grant from the Science and Technology Bureau of Dalian(2011E15SF123).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Zhe Wang.

Ethics declarations

Compliance with ethical standards

Our study was approved by the ethical committee of The First Affiliated Hospital of Dalian Medical University. Moreover, prior to the investigation, all participants signed written informed consent.



Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, G., Chen, Q., Wang, D. et al. Diagnosis of carpal tunnel syndrome assessed using high-frequency ultrasonography: cross-section areas of 8-site median nerve. Clin Rheumatol 35, 2557–2564 (2016).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: