Carpal tunnel syndrome severity staging using sonographic and clinical measures

Abstract

Introduction Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures. Methods Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated. Results The severity staging model with best fit (Rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants. Discussion This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model.

Sonography of Carpal Tunnel Syndrome According to Pathophysiologic Type: Conduction Block Versus Axonal Degeneration

“…The mean cross‐sectional area values were smallest in group 1. These results are in accordance with many previous studies reporting that abnormal nerve function in various pathologic conditions is correlated with nerve cross‐sectional area enlargement . Our results are also consistent with a few previous reports describing sonographic findings and their correlations with pathophysiologic types .…”

“…These results are in accordance with many previous studies reporting that abnormal nerve function in various pathologic conditions is correlated with nerve cross-sectional area enlargement. 4,15 Our results are also consistent with a few previous reports describing sonographic findings and their correlations with pathophysiologic types. 9,10 Several studies have reported that axonal nerve lesions lead to greater nerve swelling than demyelinating lesions do.…”

“…There have been increasing reports of focal swelling and changes in the echo texture of entrapped nerves in patients with carpal tunnel syndrome and ulnar neuropathy in the last decade. Our study was especially focused on sonographic evaluation of patients with carpal tunnel syndrome according to the pathophysiologic type: conduction block or axonal degeneration.…”

Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome

“…A recent study by Roll et al used a similar multicomponent approach to develop a scoring system for grading the severity of CTS, which also incorporated the Boston Carpal Tunnel Questionnaire grade and provocative tests, as well as nerve vascularity and longitudinal irregularity, but complex US parameters were not addressed in that study. Considering observed variations in the site of median nerve enlargement and an increase in the sensitivity of the mean cross‐sectional area compared to the inlet cross‐sectional area, we propose measuring inlet and outlet cross‐sectional areas for inlet‐outlet mean cross‐sectional area calculation, as well as the forearm cross‐sectional area, because of the correlation of the wrist‐to‐forearm ratio with clinical data.…”

Medical Ultrasound in the Evaluation of the Carpal Tunnel: A Critical Review

“…Moreover, additional findings reported through MUS, such as the echogenicity of the median nerve, its mobility, or an edema of the flexor retinaculum, may also aid in the diagnosis of CTS. The sonographic findings in patients suffering from CTS include median nerve swelling, compression of the nerve, palmar migration, and thickening of the flexor retinaculum, along with changes in the characteristic features of the median nerve [8-10].…”