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The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

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Clinical Orthopaedics and Related Research®

Abstract

Background

Carpal tunnel syndrome (CTS) is the most commonly diagnosed compression neuropathy of the upper extremity. Current AAOS recommendations are to obtain a confirmatory electrodiagnostic test in patients for whom surgery is being considered. Ultrasound has emerged as an alternative confirmatory test for CTS; however, its potential role is limited by lack of adequate data for sensitivity and specificity relative to electrodiagnostic testing.

Questions/purposes

In this meta-analysis we determined the sensitivity and specificity of ultrasound in the diagnosis of CTS.

Methods

A PubMed/MEDLINE search identified 323 articles for review. After applying exclusion criteria, 19 articles with a total sample size of 3131 wrists were included for meta-analysis. Three groups were created: a composite of all studies, studies using clinical diagnosis as the reference standard, and studies using electrodiagnostic testing as the reference standard.

Results

The composite sensitivity and specificity of ultrasound for the diagnosis of CTS, using all studies, were 77.6% (95% CI 71.6–83.6%) and 86.8% (95% CI 78.9–94.8%), respectively.

Conclusions

The wide variations of sensitivities and specificities reported in the literature have prevented meaningful analysis of ultrasound as either a screening or confirmatory tool in the diagnosis of CTS. The sensitivity and specificity of ultrasound in the diagnosis of CTS are 77.6% and 86.8%, respectively. Although ultrasound may not replace electrodiagnostic testing as the most sensitive and specific test for the diagnosis of CTS given the values reported in this meta-analysis, it may be a feasible alternative to electrodiagnostic testing as the first-line confirmatory test.

Level of Evidence

Level III, systematic review of Level III studies. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedics, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, USA

    John R. Fowler MD & Asif M. Ilyas MD

  2. Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA, USA

    John P. Gaughan PhD

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  1. John R. Fowler MD
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  3. Asif M. Ilyas MD
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Correspondence to John R. Fowler MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at Temple University Hospital.

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Fowler, J.R., Gaughan, J.P. & Ilyas, A.M. The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis. Clin Orthop Relat Res 469, 1089–1094 (2011). https://doi.org/10.1007/s11999-010-1637-5

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  • DOI: https://doi.org/10.1007/s11999-010-1637-5

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