Ultrasonography of Carpal Tunnel Syndrome: Clinical Significance and Limitations in Elderly Patients

Abstract

Objective Carpal tunnel syndrome (CTS) severity increases with age. Ultrasonographic measurement of the median nerve cross-sectional area (CSA) is an additional or complementary method for CTS diagnosis. The present study was aimed to investigate the diagnostic significance of median nerve CSA in various age groups of CTS patients. Methods The subjects were patients with electrophysiologically confirmed CTS and age-matched controls. Sonographic measurements of the median nerve CSA were performed. Results A total of 279 hands of 175 patients with CTS and 50 normal hands were examined. CSA was correlated with distal motor and sensory latencies of the median nerve and severity of CTS. CTS severity increased with age, particularly in patients over 80; however, their median nerve CSA was not enlarged regardless of their high severity of CTS. Conclusion Although the median nerve CSA is a useful diagnostic measurement for CTS, it should be emphasized that its diagnostic significance might be limited in aged patients. In particular, in very elderly patients, careful evaluation of CTS severity is necessary.

Carpal Tunnel Syndrome in Elderly Patients

“…It is suggested that results of NCS indicating severe disease could be related to delayed treatment owing to age-related reduced pain sensitivity because of reduced nerve membrane excitability 21) . Reportedly, the CSA of the median nerve was correlated with distal motor and sensory latencies of the median nerve and severity of CTS except in patients aged >80 years in whom CSA was not m regardless of severe CTS 13) . Our study demonstrated that Group I patients showed higher NCS grades and USG proven more severe median nerve swelling.…”

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

“…although at least 1 study showed that the CSA of the median nerve at the wrist exceeded the upper limit of normal for the majority of tested patients with severe CTS [47]. This dissociation between increased CSA and FMMW severity encountered in patients with chronically severe CTS may be particularly evident in elderly individuals [49].…”

Ultraschalldiagnostik von Kompressionsneuropathien: Karpaltunnelsyndrom

“…Nichtsdestotrotz und nicht zuletzt aufgrund individuell unterschiedlicher Nervendicken, Geschlechts- [46], Seiten- [47] und Altersunterschiede [48,49] Hobson-Webb u. Mitarb. konnten für einen Verhältniswert zwischen der Nervenquerschnittfläche auf Handgelenkhöhe und einer Schnittebene 12 cm proximal der Raszetta von ≥ 1,4 eine Sensitivität von 100 % nachweisen [36].…”