Carpal tunnel syndrome: Ultrasound, neurophysiology, clinical and patient-oriented assessment

Padua, Luca; Pazzaglia, Costanza; Caliandro, Pietro; Granata, Giuseppe; Foschini, M.; Briani, Chiara; Martinoli, Carlo

doi:10.1016/j.clinph.2008.05.004

Cited by 111 publications

(105 citation statements)

References 30 publications

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“…Although ultrasound is unable to evaluate proximal etiologies of carpal tunnel-like symptoms, it does have the ability to detect other causes of compression in the carpal tunnel such as space-occupying lesions and tenosynovitis [18,19,26]. Although some studies have confirmed the utility of ultrasound in the diagnosis of CTS, their small sample size and the heterogeneity of study design has made it difficult to draw definitive conclusions regarding the sensitivity and specificity of ultrasonographic measurement of the median nerve in the diagnosis of CTS [17,22,24]. In this meta-analysis, we determined the sensitivity and specificity of ultrasound as a diagnostic tool for CTS.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies used a constellation of clinical findings as the reference standard to determine the presence of CTS [1,5,12,14,[22][23][24]27]. The sensitivity and specificity reported in these studies ranged from 62% to 98% and 63% to 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Patients without clinical signs and symptoms of CTS may still have inflammation and thickening of the median nerve (only 4% of asymptomatic patients will have abnormal ultrasound examinations), but the changes have not yet caused clinical symptoms and signs [19]. Studies using EDX as the gold standard have substantial false-positive and false-negative rates [4,9,10,14,[22][23][24]. Third, the use of ROCs to determine optimal cutoff values for the diagnosis of CTS also clouds the interpretation of data.…”

Section: Discussionmentioning

confidence: 99%

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The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

255

220

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Background Carpal tunnel syndrome (CTS) is the most commonly diagnosed compression neuropathy of the upper extremity. Current AAOS recommendations are to obtain a confirmatory electrodiagnostic test in patients for whom surgery is being considered. Ultrasound has emerged as an alternative confirmatory test for CTS; however, its potential role is limited by lack of adequate data for sensitivity and specificity relative to electrodiagnostic testing. Questions/purposes In this meta-analysis we determined the sensitivity and specificity of ultrasound in the diagnosis of CTS. Methods A PubMed/MEDLINE search identified 323 articles for review. After applying exclusion criteria, 19 articles with a total sample size of 3131 wrists were included for meta-analysis. Three groups were created: a composite of all studies, studies using clinical diagnosis as the reference standard, and studies using electrodiagnostic testing as the reference standard. Results The composite sensitivity and specificity of ultrasound for the diagnosis of CTS, using all studies, were 77.6% (95% CI 71.6-83.6%) and 86.8% (95% CI 78.9-94.8%), respectively. Conclusions The wide variations of sensitivities and specificities reported in the literature have prevented meaningful analysis of ultrasound as either a screening or confirmatory tool in the diagnosis of CTS. The sensitivity and specificity of ultrasound in the diagnosis of CTS are 77.6% and 86.8%, respectively. Although ultrasound may not replace electrodiagnostic testing as the most sensitive and specific test for the diagnosis of CTS given the values reported in this meta-analysis, it may be a feasible alternative to electrodiagnostic testing as the first-line confirmatory test.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

255

220

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“…5,6,16,17 In addition to contributing to the diagnostic workup of patients with suspected CTS, sonographic examination allows noninvasive detection of aberrations. 4,9,10 In our investigation, however, electrodiagnostic studies seemed to be more sensitive in picking up preoperative deficits-our patients with motor deficits had statistically significantly longer preoperative dmL (10.5 ± 2.8 msec vs 6.5 ± 2.3 msec; p = 0.021 in multivariate analysis), but not greater CSA (p = 0.124) or circumference (p = 0.252).…”

Section: Discussionmentioning

confidence: 99%

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

Tas

Staub²,

Dombert³

et al. 2015

FOC

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OBJECT Carpal tunnel syndrome causes increased cross-sectional area (CSA) of the median nerve, which can be assessed by high-definition ultrasonography. It is unclear today, however, whether high-definition ultrasonography may play a role in the postoperative period. This prospective study aimed to determine the natural history of the morphology of the median nerve at the carpal tunnel after surgical decompression assessed by high-definition ultrasonography. METHODS Between October and December 2014, patients with suspected carpal tunnel syndrome who were referred to the authors’ center for peripheral neurosurgery were prospectively enrolled and underwent pre- and postoperative (3 months) high-definition ultrasonography, electrophysiology, and clinical testing. RESULTS Eighty-one patients were enrolled in the study, and 100% were clinically better at the 3-month follow-up. The mean CSA decreased from 14.7 ± 4.9 mm2 to 12.4 ± 3.4 mm2 (mean ± SD, p < 0.0001). The mean distal motor latency decreased from 6.6 ± 2.4 msec to 4.8 ± 1.0 msec (mean ± SD, p < 0.0001). Ninety-eight percent of patients who were available for electrodiagnostic follow-up showed an improvement of the distal motor latency; only 80% had a reduction in the CSA. CONCLUSIONS The authors present the second-largest series of patients with sonographic follow-up after surgical decompression of the carpal tunnel reported in the literature so far. This study, which showed a decrease in size of the median nerve after surgical decompression, suggests that the preoperative increase in median nerve CSA at the carpal tunnel may be due to compression and that enlargement of the median nerve is (partially) reversible.

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“…One meta-analysis of papers that reported the sensitivity and specificity of ultra sonography from clinical or nerve conduction studies showed that ultrasonography has a sensitivity of 77.6% and a specificity of 86.8% for diagnosis of carpal tunnel syndrome (CTS) 38 . Interestingly, abnormalities in ultrasonographic images have a linear correlation with hand function (for example, fine finger movement) -the larger the nerve cross-sectional area, the greater the impairment -but not with the severity of the symptoms (such as paraesthesias and dysaesthesias) 39 . Nevertheless, evidence-based guidelines state that the median nerve cross-sectional area at the wrist is of value in combination with nerve conduction studies, and can be used as a diagnostic test 36 .…”

Section: Entrapment Neuropathiesmentioning

confidence: 99%

New technologies for the assessment of neuropathies

et al. 2017

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Peripheral neuropathies are among the most common neurological disorders 1 . In routine clinical practice, diagnosis of peripheral neuropathies is typically based on clinical assessment, nerve conduction studies and needle electromyography, which can determine whether symptoms are caused by primary axonal damage or demyelinating damage. This distinction is often relevant to therapeutic choices and to prognosis, as axonal damage typically reflects an inflammatory (for example, vasculitic) or degenerative (for example, hereditary or idiopathic) process that correlates with disability, whereas demyelinating damage can reflect a hereditary neuro pathy, but more often reflects an acquired immunemediated neuropathy. Besides metabolic, inflammatory or primary degenerative neuropathies, peripheral nerves can also be damaged by compression from adjacent tissue structures, such as tendons, cysts or haematomas. In this case, proper identification of the site, nature and degree of the lesion might be challenging, but is relevant to treatment and prognosis. Moreover, some patients present with symptoms that suggest damage to small nerve fibres, which nerve conduction studies cannot be used to detect.In the past 15 years, several techniques have become available to investigate focal and diffuse peripheral neuropathies, and their reliability has widened the spectrum of diagnostic tools for clinicians and improved assessment of neuropathies. In this Review, we provide an overview of these new and emerging technologies. We first discuss peripheral nerve imaging with MRI and ultrasonography, which can provide information about the precise localization of neuro pathies and the pathological processes involved in large-fibre neuropathies, and can complement clinical and electrophysiological evaluation. We then consider techniques that can provide diagnostic information when the pathological process is restricted to small nerve fibres and is consequently not detectable with nerve conduction studies or neuroimaging. These include skin biopsy, which is established in clinical practice, and the emerging techniques of corneal confocal microscopy, laser-evoked potentials and heat-related and pain-related evoked potentials, and microneurography.Nerve imaging technology Advances in imaging techniques have made it possible to gain great insight into nerve pathology with magnetic resonance and ultrasound. Each approach offers distinct advantages, and can provide different information about damage to large myelinated fibres. Abstract | Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean th...

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Carpal tunnel syndrome: Ultrasound, neurophysiology, clinical and patient-oriented assessment

Cited by 111 publications

References 30 publications

The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

New technologies for the assessment of neuropathies

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