Electrosonodiagnosis in Carpal Tunnel Syndrome: A Proposed Diagnostic Algorithm Based on an Analytic Literature Review

Abstract

An algorithm has been developed and presented, and illustrated as a flow chart, based on findings reported in the relevant reviewed literature in which PN-USI is proposed as a painless and rapidly performed screening test for FMMW to be completed before subjecting a patient to a systematic EDx testing process.

Palmaris Longus Tendinopathy Diagnosed With Ultrasound: A Case Report

“…The ultrasound examination quickly identified a sonographically abnormal palmaris longus tendon which correlated well with her pain. Although additional nerve conduction study (NCS) such as assessing the contralateral arm and/or the combined sensory (Robinson index) may have been helpful, ultrasound has been found to be very sensitive for ruling out carpal tunnel syndrome in middle‐aged adults, and in this case allowed us to both identify the underlying pathology and further rule out mild median nerve pathology.…”

Re: Electrosonodiagnosis in Carpal Tunnel Syndrome: A Proposed Diagnostic Algorithm Based on an Analytic Literature Review

“…We read this article with great interest because carpal tunnel syndrome (CTS) is so prevalent in our physiatry practices, we use electrodiagnosis (EDX) regularly, and some of us use diagnostic ultrasound. We are concerned, however, about the development and application of a screening ultrasound protocol, especially as implemented with the proposed algorithm in Figure 1 [1].…”

“…Algorithm part 1 ( Figure 1) [1] suggests not to perform EDX if peripheral nerve ultrasound imaging (PN-USI) of the median nerve is negative, but then where does the patient or physician go with the unexplained symptoms? There is still a need to perform the EDX to exclude or confirm other nerve pathology as the etiology of patient complaints, so what has the "screening" test accomplished?…”

“…Regarding Algorithm part 2 (Figure 2) [1], we were perplexed by the initial recommendation to perform radial and ulnar sensory studies to the exclusion of a median sensory study. The primary problem that is being investigated is median nerve compression at the wrist, so it seems counterintuitive to avoid starting with median motor and sensory studies.…”

Reply

“…The undersigned authors very much appreciate the opportunity to respond to the letter to the editor submitted by Sucher et al regarding our paper [1]. It is clear that Sucher et al are not enthusiastic about the concept of screening for focal median mononeuropathy at the wrist (FMMW) in patients with clinical symptoms and signs consistent with the clinical diagnosis of carpal tunnel syndrome (CTS) using anything other than electrodiagnostic (EDx) testing.…”