Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome

Pastare, D.; Therimadasamy, Aravindakannan; Lee, E.; Wilder-Smith, Einar

doi:10.1002/jcu.20601

Cited by 66 publications

(68 citation statements)

References 20 publications

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“…We agree with the results found by the authors and according to the trend showed in the literature, there is an increased interest on this topic [2][3][4] that demonstrates that US is able to detect median nerve damage in a very easy, non-invasive and non-expensive way.…”

supporting

confidence: 94%

Severity of carpal tunnel syndrome assessed with high frequency ultrasonography: reply to Karadağ and colleagues

Pazzaglia

Padua

2009

Rheumatol Int

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We read with great interest the article written by Karadaf and colleagues [1] entitled "Severity of carpal tunnel syndrome assessed with high frequency ultrasonography".The authors investigated the relationship between neurophysiological and ultrasound (US) evaluation in a sample of patients aVected by carpal tunnel syndrome (CTS) and they found agreement between the two measures: the increase of median nerve cross-sectional area (CSA) at the wrist reXects the damage severity as assessed by nerve conduction (NC) study.We agree with the results found by the authors and according to the trend showed in the literature, there is an increased interest on this topic [2-4] that demonstrates that US is able to detect median nerve damage in a very easy, non-invasive and non-expensive way.Another important value of US is that it provides not only a diagnosis of CTS, with a determination of CTS severity, but also able to supply morphological information about the nerve surrounding thus giving indirect data about the therapeutical approach.What is surprising in the article is that in the half patients aVected by clinical CTS, the neurophysiological examination was negative (49/99 symptomatic wrist) and these data are also followed by US evaluation. We have some comments on it.As American Academy of Neurology (ANN) previously [5] stated the diagnosis of CTS is mostly clinical with the morphofunctional test aimed in conWrming the diagnosis. Now, it is well accepted that, in order to increase the sensitivity of conventional conduction studies (sensory digit-wrist and motor wrist-thenar), segmentary and/or comparative tests should be used as stated in AAN and American Association of Electrodiagnostic Medicine recommendations [6]. When the standard tests yield normal results ("standard negative" hands), studies as follows could increase the electrodiagnostic sensitivity: 1. Segmental motor or sensory conduction tests in palmwrist segment. 2. Comparative studies (median-ulnar or median radial) 3. Segmental/comparative studies (as disto-proximal ratio)A study conducted on CTS patients showed that the sensitivity of standard tests can reach 83.5%, comparative/segmental tests can disclose abnormal Wndings in a further 11.4% of cases, providing CTS electrodiagnosis in about 7 of 10 "standard negative" cases. The overall sensitivity of protocol reaches in that way 94.9% [7]. The concordance of negativity of US with NC probably is due to the same limitation. Since the Wrst applications of US in the peripheral nerve study, reWnement has been done to improve the sensitivity and speciWcity of the evaluation. For example, the wrist-to-forearm ratio of median nerve area can be considered more sensitive than measure of median nerve area at the wrist alone, and should be used in case of mild impairment [8]. Moreover, the comparison of CSA measurements of the median nerve obtained at the level of the carpal tunnel with those obtained more proximally, at the level of the pronator quadratus muscle showed an increased accuracy of the diagnosis [9]...

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supporting

confidence: 94%

Severity of carpal tunnel syndrome assessed with high frequency ultrasonography: reply to Karadağ and colleagues

Pazzaglia

Padua

2009

Rheumatol Int

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“…Patients without clinical signs and symptoms of CTS may still have inflammation and thickening of the median nerve (only 4% of asymptomatic patients will have abnormal ultrasound examinations), but the changes have not yet caused clinical symptoms and signs [19]. Studies using EDX as the gold standard have substantial false-positive and false-negative rates [4,9,10,14,[22][23][24]. Third, the use of ROCs to determine optimal cutoff values for the diagnosis of CTS also clouds the interpretation of data.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…1,9,16,26,28) Our ROC analysis yielded a cut-off value of 9 mm 2 with 86.7% sensitivity and 88.9% specificity. Those results are similar to previous reports and comparable with sensitivities and specificities of the EDT results.…”

Section: Discussionmentioning

confidence: 80%

“…14) Anatomical variations of median nerve and other morphological changes, such as cysts, neuromas, and aberrations of muscles and nerves, at the wrist are relatively common. 1,4,8,13,16) Therefore USG can provide an anatomical profile which is important when minimal invasive surgery, such as endoscopic median nerve release, is performed. Mean normal value of median nerve CSA at the carpal tunnel inlet have varied among reports, ranging from 6.1 to 10.4 mm 2 .…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Ultrasonography in Korean Carpal Tunnel Syndrome Patients

Shim

Doh

Lee

et al. 2013

Korean J Neurotrauma

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Objective: The purpose of this study was to assess the diagnostic utility of the wrist ultrasonography (USG) in patients with and without carpal tunnel syndrome (CTS). Methods: Individuals with electrodiagnostically proven CTS patients and healthy control subjects were enrolled prospectively. USG was done 60 wrists of 48 patients with CTS and 36 wrists of 18 controls. The USG analysis included median nerve cross sectional area (CSA) at the level of carpal tunnel inlet. We also evaluated the relationship between median nerve CSA at the level of carpal tunnel inlet and severity grade of nerve conduction test in CTS patients. Results: The median nerve CSA at the level of carpal tunnel inlet was significantly larger in CTS patients (13.6 mm 2 versus 7.7 mm 2 , p＜0.0001). And there was an association between median nerve CSA and severity grade of nerve conduction studies (p=0.036). Receiver operating characteristics (ROC) analysis yielded sensitivity of 86.7% and specificity of 88.9% using a cut-off value of 9 mm 2 . But the specificity was increased to 97.2%, although sensitivity was decreased to 78.3%, when using cut-off value at 10.1 mm 2 . Conclusion: Ultrasonographic measurement of the median nerve CSA at carpal tunnel inlet was useful in diagnosis of CTS. According to ROC analysis, USG is used as a complementary test for electrodiagnostic test.

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Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome

Cited by 66 publications

References 20 publications

Severity of carpal tunnel syndrome assessed with high frequency ultrasonography: reply to Karadağ and colleagues

Severity of carpal tunnel syndrome assessed with high frequency ultrasonography: reply to Karadağ and colleagues

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

The Diagnostic Value of Ultrasonography in Korean Carpal Tunnel Syndrome Patients

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