Carpal Tunnel Syndrome Assessment With Ultrasonography: A Comparison Between Non-diabetic and Diabetic Patients

Abstract

ObjectiveTo investigate the diagnostic value of cross-sectional area (CSA) and wrist to forearm ratio (WFR) in patients with electro-diagnosed carpal tunnel syndrome (CTS) with or without diabetes mellitus (DM).MethodsWe retrospectively studied 256 CTS wrists and 77 healthy wrists in a single center between January 1, 2008 and January 1, 2013. The CSA and WFR were calculated for each wrist. Patients were classified into four groups according to the presence of DM and CTS: group 1, non-DM and non-CTS patients; group 2, non-DM and CTS patients; group 3, DM and non-CTS patients; and group 4, DM and CTS patients. To determine the optimal cut-off value, receiver operating characteristic (ROC) curve analysis was performed.ResultsThe CSA and WFR were significantly different among the groups (p<0.001). The ROC curve analysis of non-DM patients revealed CSA ≥10.0 mm2 and WFR ≥1.52 as the most powerful diagnostic values of CTS. The ROC curve analysis revealed CSA ≥12.5 mm2 and WFR ≥1.87 as the most powerful diagnostic values of CTS.ConclusionUltrasonographic assessment for the diagnosis of CTS requires a particular cut-off value for diabetic patients. Based on the ROC analysis results, improved accurate diagnosis is possible if WFR can be applied regardless of presence or absence of DM.

Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity

“…Although discrepancies in the accuracy of sonographic criteria of median nerve Carpal tunnel syndrome (CTS), cross sectional area distal (CSAd), cross sectional area proximally (CSAp), cross sectional area difference (ΔCSA), mean average of cross sectional area distal and proximal (CSApd), body mass index (BMI), standard deviation (SD), P value was calculated by independent t-test between two groups with 95%CI Cross sectional area distal (CSAd), cross sectional area difference (ΔCSA), mean average of cross sectional area distal and proximal (CSApd), entrapment have been reported, CSA with cutoff values of more than 9 or 10 mm 2 at the scapho-pisiform level indicating CTS [12][13][14][15] is still agreed upon as the most reliable and reproducible sonographic criterion indicating CTS [33], with sensitivity of 82% and specificity of 87% (which were almost equal to those of electrodiagnostic values) with a cutoff CSA of more than 12 mm 2 considered as excellent to diagnose CTS [11]. In the current work, the cutoff value of CSA at the level of carpal tunnel to diagnose CTS in Saudi population was 13 mm 2 with 90% sensitivity and 95% specificity which was in agreement with other studies cutoff threshold that ranged between 12 and 13 mm 2 in CTS with or without diabetes [20,34,35]. The mean CSAdp of 9.5 showed sensitivity of 82 and 95% specificity to diagnose CTS, however ΔCSA of 2.5 mm 2 was associated with 97% sensitivity and 100% specificity, with much higher sensitivity and specificity than using CSAd and mean CSAdp.…”

Role of High Resolution Ultrasound in Assessment of Abnormalities of Median Nerve in Carpal Tunnel Syndrome

“…This also came in accordance with other studies cutoff threshold that ranged between 12 and 13 mm 2 in CTS as compared with the control [24] [42] [43].…”

Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity.

“…Although discrepancies in the accuracy of sonographic criteria of median nerve entrapment have been reported, CSA is still agreed upon as the most reliable and reproducible sonographic criterion indicating CTS [32]with cutoff values of more than 9 or 10 mm 2 at the scaphoid-pisiform level having been described to indicate CTS [12][13][14][15], with sensitivity of 82% and specificity of 87% (which were almost equal to those of electrodiagnostic values) with a cutoff CSA of more than 12 mm 2 considered as excellent to diagnose CTS [11]. In the current work, the cutoff value of CSA at the level of carpal tunnel to diagnose CTS in Saudi population was 13 mm 2 with 90% sensitivity and 95% specificity which was in agreement with other studies cutoff threshold that ranged between 12-13 mm 2 in CTS with or without diabetes [20,33,34]. The mean CSAdp of 9.5 showed sensitivity of 82% and 95% specificity to diagnose CTS, however ∆CSA of 2.5 mm 2 was associated with 97% sensitivity and 100% specificity, with much higher sensitivity and specificity than using CSAd and mean CSAdp.…”