Asymptomatic common extensor tendon pathology in patients with carpal tunnel syndrome

Abstract

Introduction/Aims: Carpal tunnel syndrome (CTS) and lateral epicondylitis are both highly prevalent conditions. Our objective was to determine the prevalence of B-mode ultrasound abnormalities of the common extensor tendon (CET) in patients with CTS and establish the relationship between CET stiffness, as measured by shear wave elastography (SWE) and CTS severity.Methods: Patients without symptoms or signs of lateral epicondylitis were recruited from referrals to a neurophysiology laboratory for possible CTS. These patients were examined for clinical features of CTS before undergoing electrodiagnostic testing followed by an ultrasound examination, consisting of B-mode, power Doppler, and SWE.Results: Thirty-nine limbs with clinically diagnosed CTS and 20 control limbs were included. Of the CTS limbs, 61.5% had sonographically abnormal CET compared with 35% of the controls. The mean CET sonographic abnormality score was higher in CTS patients compared with controls (P = .006). CTS patients with sonographically abnormal CET had more severe CTS by electrophysiological criteria. The mean CET stiffness in CTS patients was lower than in controls (P = .033).Discussion: Sonographic abnormalities of the CET are common in CTS patients with no clinical evidence of lateral epicondylitis and may relate to common pathogenetic mechanisms. These findings suggest that isolated ultrasound abnormalities in the CET are not diagnostically useful in patients presenting with upper limb pain unless there are clinical features of lateral epicondylitis.

Pairwise association of upper extremity musculoskeletal conditions: large population investigation from PERSIAN cohort study

“…The intricate relationships within the UEMSCs network extend to the structural and biomechanical dimensions. Wee TC et al provide insights into shared pathophysiology, as common extensor tendon (CET) sonographic abnormalities in CTS patients without clinical symptoms of LE suggest a potential association [ 26 ]. Moreover, the biomechanical implications of prolonged non-neutral wrist posture, as observed in lateral epicondylitis (LE), raise questions about the potential bidirectional influence between CTS and other orthopedic conditions [ 12 ].…”

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

“…However, EDx provides well-established grading of severity, which is not satisfactorily stratified on imaging studies. 52 As such, imaging remains complementary to the core clinical and EDx assessments of CTS and is recommended in patients with atypical upper limb sensory syndromes, 53 typical syndromes with negative EDx, 54 and unilateral CTS affecting the non-dominant hand. 55,56 Imaging is the first choice diagnostic modality in patients intolerant of EDx studies.…”

Anatomy and Sonographic Examination for Lateral Epicondylitis

“…In this sense, clinical and sonographic findings must be considered as unique assessment of the patient with lateral elbow pain. 2,24 Lastly, wide sonographic tracking of the lateral elbow from the proximal to distal (and/or vice versa) should always be performed before focusing on the lateral complex proper, that is, to identify pathological changes also in "atypical" locations (Video 1, Supplemental Digital Content 1, http://links.lww.com/PHM/B778). 25…”