A Comparative Analysis Between Ultrasound and Electromyographic and Nerve Conduction Studies in Diagnosing Carpal Tunnel Syndrome (CTS): A Systematic Review and Meta-Analysis

Abstract

Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy. The disease initially manifests as a sensory disorder in the form of paresthesia, numbness, or tingling of the fingers. The diagnosis is usually made based on history and clinical symptoms, which are confirmed using nerve conduction studies (NCS) and electromyography. More recently, ultrasound has gained more use in CTS diagnosis due to its advantages, which include patients' comfort during diagnosis, better visualization of anatomy and nerve forms directly, and cost-effectiveness. However, a literature review shows that the diagnostic accuracy of ultrasound over NCS is still in question; therefore, the present systematic review was carried out to compare the diagnostic accuracy of ultrasound to NCS and electromyography.A systematic literature search was performed on five electronic databases: PubMed, Medline, Web of Science, Embase, and Google Scholar. The search strategy limited the retrieval of literature published between 2000 and 2022. Of the 1098 articles retrieved from the electronic databases, only 12 met the inclusion criteria. A meta-analysis of outcomes from the included studies showed that the pooled sensitivity and specificity of the ultrasound were 0.80 (95% CI: 0.73, 0.88) and 0.90 (0.83, 0.96), respectively. On the other hand, combing the outcomes of electromyography and NCS resulted in sensitivity and specificity values of 0.89 (95% CI: 0.84, 0.95) and 0.77 (95% CI; 0.64, 0.90), respectively.The results show that ultrasound has comparable sensitivity and slightly higher specificity than NCS and electromyography; therefore, ultrasound can be used as an alternative diagnostic test for CTS. However, it cannot replace NCS and electromyography since more research needs to be done on doubtful and secondary cases of CTS.

The Role of Ultrasonography Compared to Nerve Conduction Velocity in Diagnosis of Median Nerve Entrapment: Review Article

“…Similar to ultrasonography, nerve conduction study and electromyography use a variety of parameters to determine whether a patient has CTS. The NCS measuring criteria include sensory amplitude, distal motor latency (DML), sensory conduction velocity (SCV), and distal sensory latency (DSL) (30) .…”

“…Electrodiagnostic procedures, including electromyography, are uncomfortable and painful for the patient. Nonetheless, the discomforts associated with electrodiagnostic testing are frequently disregarded (30) .…”

Anomalous Flexor Digitorum Superficialis Muscle Belly Associated with Carpal Tunnel Syndrome

“…Historically, nerve conduction studies were the gold standard for further workup of CTS; however, more recently neuromuscular ultrasound has been shown as a validated tool in this workup with comparable sensitivity and specificity. 10 In this uncommon demographic of patients presenting with CTS, NMUS may have a unique use in identifying underlying pathology and surgical planning.…”

Evaluation of electrophysiological examinations for the diagnosis of carpal tunnel syndrome

“…Filho(de Jesus Filho et al, 2014) conducted a cross-sectional study and reported that electrophysiological examinations had higher sensitivity than ultrasound and physical tests. Zaki(Zaki et al, 2022) reported a higher sensitivity and speci city of electromyography than that of ultrasound. Kele(Kele et al, 2003) reported a sensitivity of 90% in 77 cases.…”