Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Torres‐Costoso, Ana; Martínez‐Vizcaíno, Vicente; Álvarez‐Bueno, Celia; Ferri-Morales, Asunción; Cavero‐Redondo, Iván

doi:10.1016/j.apmr.2017.08.489

Cited by 76 publications

(56 citation statements)

References 55 publications

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“…15 A recent meta-analysis showed that the overall accuracy of CSA measurement at the level of the CTI was slightly higher than that at the CTO with ORs of 31.11 (95% CI, 20.42-47.40) and 16.94 (95% CI, 7.58-37.86), respectively. 31 However, our findings showed that the CSA at the CTO was associated with CTS, with an OR of 2.5 (95% CI, 1.1-5.3)…”

Section: Discussioncontrasting

confidence: 58%

“…This may be have been due to the different locations where the CSA was measured (CTO, CTI, and middle carpal tunnel), different landmarks where measurements were taken, and critical thresholds for CSAs, which varied from 0.09 to 0.15 cm 2 . A recent meta‐analysis showed that the overall accuracy of CSA measurement at the level of the CTI was slightly higher than that at the CTO with ORs of 31.11 (95% CI, 20.42–47.40) and 16.94 (95% CI, 7.58–37.86), respectively . However, our findings showed that the CSA at the CTO was associated with CTS, with an OR of 2.5 (95% CI, 1.1–5.3)…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Gonzalez‐Suarez

Fidel

Cabrera

et al. 2019

J of Ultrasound Medicine

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Objectives To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS). Methods Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees’ work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross‐sectional area, hypervascularity, wrist‐to‐forearm ratio, wrist‐forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO). Results A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist‐forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4–15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8–8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms. Conclusions Combining US findings for the CTO wrist‐forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Gonzalez‐Suarez

Fidel

Cabrera

et al. 2019

J of Ultrasound Medicine

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“…A cross-sectional area (CSA) measurement of the medial nerve in the wrist is the most common method of ultrasound for diagnosis of CTS. In a recent meta-analysis, the most frequent CSA cutoff point for detecting CTS was 8.5-10 mm 2 at the level of the pisiform [29]. Additionally, some reports have shown that ultrasonogra-lateral condition or turn from a unilateral to bilateral neuropathy.…”

Section: Discussionmentioning

confidence: 99%

The bilaterality of idiopathic carpal tunnel syndrome among manual workers

Lewańska

2020

Int J Occup Med Environ Health

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Objectives: To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Material and Methods: Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. Results: A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. Conclusions: The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151 -61

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“…More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.Pharmaceuticals 2020, 13, 49 2 of 17 factors of CTS include, but are not limited to, female sex, obesity, diabetes, and hypothyroidism [4,5]. The diagnosis of CTS is traditionally based on electrophysiological tests; however, ultrasonographic nerve cross-sectional area measurements have also recently emerged as useful alternatives [6]. The therapeutic algorism for CTS can be based on symptom severity, findings of electrophysiological tests, and responsiveness to non-surgical therapy.…”

mentioning

confidence: 99%

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

et al. 2020

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This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.Pharmaceuticals 2020, 13, 49 2 of 17 factors of CTS include, but are not limited to, female sex, obesity, diabetes, and hypothyroidism [4,5]. The diagnosis of CTS is traditionally based on electrophysiological tests; however, ultrasonographic nerve cross-sectional area measurements have also recently emerged as useful alternatives [6]. The therapeutic algorism for CTS can be based on symptom severity, findings of electrophysiological tests, and responsiveness to non-surgical therapy. Conservative treatments for mild to moderate CTS include corticosteroid injection [7], splinting [8], and physiotherapy (like therapeutic ultrasound, exercise, and neural mobilization) [9,10]. In patients with moderate to severe symptoms and poor responsiveness to non-operative management, carpal tunnel release (CTR) is indicated [11]. However, the symptoms might persist in 3% to 20% of patients after CTR [12]. In recalcitrant cases, the physicians should consider surgical management, such as revision neuroplasty, neurolysis, and nerve reconstruction [12].Corticosteroids function as potent anti-inflammatory medications and have been widely used as the main injectate for treating CTS. A recent randomized controlled trial that recruited 234 patients with CTS demonstrated that a single corticosteroid injection was better than night splinting in terms of clinical effectiveness at six weeks post-injection [13]. The aforementioned result is consistent with that of a previous systematic review that revealed the s...

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Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Cited by 76 publications

References 55 publications

Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

The bilaterality of idiopathic carpal tunnel syndrome among manual workers

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

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