High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome

Visser, Leo H.; Smidt, Martijn H.; Lee, Martin L.

doi:10.1136/jnnp.2007.115337

Cited by 201 publications

(210 citation statements)

References 16 publications

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“…Eight studies used a constellation of clinical findings as the reference standard to determine the presence of CTS [1,5,12,14,[22][23][24]27]. The sensitivity and specificity reported in these studies ranged from 62% to 98% and 63% to 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

274

230

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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.

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Section: Discussionmentioning

confidence: 99%

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

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

274

230

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“…able diagnostic method [16]. Previous studies have shown significant differences in median nerve CSA measurements between idiopathic CTS patients and healthy controls [5,16]. In a study comparing idiopathic, diabetic and DPN patients with CTS and healthy controls, the CSA of the idiopathic, diabetic and DPN patients with CTS was found to be greater than that of the healthy controls.…”

Section: Dm-cts-handsmentioning

confidence: 99%

“…However, despite the evaluation of clinical symptoms in diabetic hand syndromes which develop in diabetic patients and various comparative NCS tests, the diagnosis of CTS can be difficult [4]. As ultrasonography is painless, easily available and preferred by patients, it has been defined as a non-invasive diagnostic method which can be used in CTS [3,5]. A significant correlation has been shown between the median nerves CSA measurements measured with ultrasonography and median nerve conduction abnormalities obtained with electrodiagnostic tests [6].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Boyacı

Tutoğlu²,

Boyacı³

et al. 2014

J Clin Exp Invest

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ÖZETAmaç: Diabetes mellituslu (DM) hastalarda karpal tünel sendromu (KTS) teşhisinde ultrasonografinin değerini ve diabetik KTS'li hastalarda radial ve ulnar arterlerin akım karakteristiklerini araştırmak amaçlanmıştır. Bulgular: DM-KTS grubunda, CSA-p ve CSA-d değerle-ri DM ve C gruplarına göre anlamlı olarak daha büyüktü (p<0.01). FR-p, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.01). ROC eğrisi analizinde, CSA-p ≥ 9.5 mm 2 (AUC 0.84; duyarlılık 78.3% and özgüllük 88%) ve CSA-d ≥ 9.5 mm 2 (AUC 0.78; duyarlılık 73.9% and özgüllük 84%), DM-KTS elin çok güçlü bir prediktörüdür. Doppler incelemesinde her iki radial ve ulnar arter akım volumü, pik sistolik hız, end-diyastolik hız ve rezistif indeks ölçümlerinde gruplar arası farklılık yoktu (p>0.05). Radial arter damar çapı, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.05). Sonuçlar: Diabetik KTS'li hastalarda diabetli ve sağlıklı kişilere göre median sinir CSA anlamlı olarak büyüktür. Diabetik hastalarda KTS değerlendirilmesinde, ultrasonografiyle ölçülen CSA diagnostik bir araç olabilir. YöntemlerAnahtar kelimeler: Karpal tünel sendromu, kesit alanı, median sinir, ultrasonografi ABSTRACTObjective: This study aimed to research the value of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) in patients with diabetes mellitus (DM) and to examine the flow characteristics of the radial and ulnar arteries in diabetic patients with CTS. Methods:A total of 23 diabetic hands diagnosed with CTS from electrophysiological evaluation (DM-CTS), 47 asymptomatic diabetic hands (DM) and 50 healthy hands (C) as the control group were evaluated with high resolution ultrasonography. The median nerve was measured in the crosssectional area (CSA), flattening ratio (FR) and at the level of the carpal tunnel inlet [proximal (p)] and the wrist crease [distal (d)]. The radial and ulnar arteries were evaluated with both hands in a neutral position. Results:In the DM-CTS group, the CSA-p and CSA-d values were statistically signficantly greater compared to the DM and C groups (p<0.01). The FR-p in the DM-CTS group was statistically significantly greater than that of the C groups (p<0.01). In the ROC curve analysis, CSA-p ≥ 9.5 mm 2 (AUC 0.84; sensitivity 78.3% and specificity 88%) and CSA-d ≥ 9.5 mm 2 (AUC 0.78; sensitivity 73.9% and specificity 84%) were very strong predictors of the DM-CTS hand. In the Doppler examination, no difference was determined between the groups in terms of flow volume, peak systolic velocity, enddiastolic velocity and resistive index measurements of both radial and ulnar arteries (p>0.05). The radial artery diameter was determined to be statistically significantly greater in the DM-CTS group than the C group (p<0.05). Conclusion:The median nerve CSA is significantly greater in diabetic CTS patients compared to patients with diabetes only and healthy controls. In the evaluation of CTS in diabetic patients, CSA measured with ultrasonography may be a diagnostic tool. J Clin Exp Invest 2014; 5 (2): 179-185

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“…The neurodiagnostic criteria were based on the American Academy of Neurology summary statement, which further classified the abnormalities as follows: (i) mild abnormality, that is, abnormal comparative tests or prolonged median distal sensory latency (> 3.5 ms) but normal median distal motor latency (DML); (ii) moderate abnormality, that is, prolonged median DSL and DML (> 4.2 ms); and (iii) severe abnormality, that is, absence of median sensory nerve action potential or absent compound muscle action potentials. 6 Patients were excluded if they had any recognized causes of CTS including inflammatory arthritis, diabetes mellitus, hypothyroidism, renal failure, polyneuropathy and history of significant local trauma. Other exclusion criteria included age younger than 18 years, pregnancy and previous treatments of CTS, namely injection, splinting and surgery.…”

Section: Patient Recruitmentmentioning

confidence: 99%

Local steroid injection versus wrist splinting for carpal tunnel syndrome: A randomized clinical trial

Chung

Cheng

et al. 2017

Int J of Rheum Dis

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Aim: We conducted a prospective randomized parallel clinical trial comparing the efficacy of local steroid injection and nocturnal wrist splinting in patients with carpal tunnel syndrome (CTS). Methods:The well-validated and disease-specific Boston Carpal Tunnel Questionnaire (BCTQ) was employed and its score at 4 weeks after treatment was used as the primary outcome measure. Important secondary outcomes included patient satisfaction, the change of an objective finger dexterity test and the side effects.Results: Twenty-five patients in the local steroid group and 25 patients in the wrist splinting group completed the study procedures. At 4 weeks after treatment, there was significant improvement of the BTCQ scores in both the steroid group and splinting group. There was improvement of the finger dexterity test only in the steroid group but not in the splinting group. However, there was no statistically significant difference in the changes of BTCQ scores between the two groups after treatment. Patient satisfaction score was higher in the steroid group. Patients in the steroid group took fewer painkillers after treatment. Four patients developed side effects after splinting and three after local steroid injection, which was not statistically significant. Conclusion:Although local steroid injection and nocturnal wrist splinting were equally effective in the treatment of patients with CTS, only the former improved objective hand function. Local steroid injection also resulted in better patient satisfaction and less painkiller use without causing more side effects.

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High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome

Abstract: In patients with a clinical diagnosis of CTS, the accuracy of sonography is similar to that for EMG. Sonography is probably preferable because it is painless, easily accessible and preferred by the patients.

Cited by 201 publications

References 16 publications

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

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

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Local steroid injection versus wrist splinting for carpal tunnel syndrome: A randomized clinical trial

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