Carpal tunnel syndrome in advanced age: A sonographic and electrodiagnostic study

Abstract

Introduction: After noting inconsistent sonographic median nerve cross‐sectional area (CSA) enlargement at the wrist in very elderly patients with carpal tunnel syndrome (CTS), we systematically reviewed ultrasound, electrodiagnostic, and clinical data collected over a 12‐month period in patients from 2 age groups: 80–95 years and 40–65 years old. Methods: Clinical and electrodiagnostic CTS severity, sensitivity of ultrasound CSA (against both electrodiagnostic and clinical reference standards), and correlations between ultrasound CSA and clinical and electrodiagnostic severity were compared in both groups. Results: In very elderly patients, despite a higher prevalence of severe CTS, nerve ultrasound was less sensitive than in the younger group (54% vs. 87%, using clinical reference standard), and did not correlate with clinical (r = 0.28, P = 0.10) or electrodiagnostic (r = 0.09, P = 0.60) severity. Discussion: Median nerve ultrasound CSA at the wrist is not a sensitive marker of CTS in very elderly populations. In this work we detail and discuss potential pathophysiological underpinnings of this unexpected finding. Muscle Nerve, 2019

Shearwave Elastography in the Differentiation of Carpal Tunnel Syndrome Severity

“…In this study, nerve stiffness was increased in older CTS patients. Some authors have speculated recently that CTS in the elderly may be a separate entity 23,24 . Median nerve CSA may be a less sensitive indicator for CTS in older patients as older CTS patients tend to have smaller CSA.…”

Is carpal tunnel syndrome in the elderly a separate entity? Evidence from median nerve ultrasound

“…The most optimistic studies have suggested that 100% sensitivity can be achieved by examining the wrist to forearm ratio of median nerve cross sectional area . In this issue Mulroy and Pelosi . point out that one explanation for the wide variety of findings may be variation in the ages of the populations studied …”

“…In this issue Mulroy and Pelosi . point out that one explanation for the wide variety of findings may be variation in the ages of the populations studied …”

“…In total, we included 1,140 subjects. Dividing these into 4 age groups of 18–39 years (group 1; n = 177), 40–65 years (group 2; n = 637), 66–79 years (group 3; n = 221), and 80–97 years (group 4; n = 105) allowed us to carry out similar analyses to those of Mulroy and Pelosi, and Moschovos et al Our neurophysiological CTS grading from 0 (normal) to 6 (extremely severe) is as previously described, and we included only 1 hand per patient in the analysis to avoid nonindependence of data from 2 hands in the same patient.…”

“…3 point out that one explanation for the wide variety of findings may be variation in the ages of the populations studied. 3 In a group of 59 younger patients (40-65 years), they found that CSA was a highly sensitive test, 97% using EDX as the reference standard and 87% against a clinical diagnosis. However, in an older group of 33 patients (80-95 years), they found that the CSA performed less well, achieving only 61% sensitivity versus EDX and 54% versus a clinical diagnosis.…”