Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity

Kutlar, Nihal; Bayrak, Ayşe; Bayrak, İlkay Koray; Canbaz, Sevgi; Türker, Hande

doi:10.1080/01616412.2016.1275455

Cited by 40 publications

(68 citation statements)

References 21 publications

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“…That there is a hyperemic response of injured nerves has also been confirmed independently by morphometric analysis, identifying endoneurial microvascular dilatation early after injury . More recently, hyperemia has been detected in human median nerves entrapped at the carpal tunnel …”

Section: Nbf and Nerve Injurymentioning

confidence: 72%

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Local blood flow in peripheral nerves and their ganglia: Resurrecting key ideas around its measurement and significance

Zochodne

2018

Muscle and Nerve

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Over 3 decades ago, seminal work by Phillip Low and colleagues established exquisite physiology around the measurement of nerve blood flow (NBF). Although not widely explored recently, its connection to the clinic has awaited human methodology. While human studies have not achieved a convincing level of rigour, newer imaging technologies are offering early information. The peripheral nerve trunk has parallel blood flow compartments that include epineurial flow dominated by arteriovenous shunts and downstream endoneurial blood flow (EBF). NBF and EBF have lower values than central nervous system blood flow, lack autoregulation yet have sympathetic and peptidergic neurovascular control. Contrary to expectation, injury to nerves is often associated with rises in NBF rather than ischemia, a finding of biological interest corroborated by human studies. Despite its potential importance, quantitative human measurements of EBF and NBF are not yet available. However, with development, careful NBF analysis may present new insights into nerve disorders. Muscle Nerve 57: 884-895, 2018.

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Section: Nbf and Nerve Injurymentioning

confidence: 72%

“…Later advanced cases had declines. In contrast, Kutlar et al identified a significant correlation between CTS severity and median nerve hypervascularization. Joy et al used apparent rises in median NBF for the diagnosis of CTS and noted a linear relationship between flow values they obtained with other measures of CTS.…”

Section: Human Studies Of Nbfmentioning

confidence: 86%

Local blood flow in peripheral nerves and their ganglia: Resurrecting key ideas around its measurement and significance

Zochodne

2018

Muscle and Nerve

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“…Studies on the diagnostic accuracy of US in detecting CTS have centered mainly on the CSA of the median nerve, measured either at the CTI or CTO. There are studies that have examined different US parameters but did not conduct a regression analysis to determine whether combined measurements are more diagnostically discriminatory . Using stepwise multiple logistic regression models, this study demonstrated that the wrist‐forearm difference coupled with evidence of hypervascularity at the CTO were predictive parameters for CTS with high sensitivity (98.1%).…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, venous outflow is blocked in early stages of CTS, which may result in blood accumulation and increased pressure in the area of entrapment. This will reduce the signal detected by Doppler US; however, there may be compensatory dilatation of peripheral veins, resulting in a net signal increase . Studies by Kutlar et al and Ooi et al showed that hypervascularity with a cutoff of 0.0020 cm 2 and the presence of at least a single neovessel of greater than 1 mm in length in the sagittal plane had sensitivity of 93.4% and 69%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…This will reduce the signal detected by Doppler US; however, there may be compensatory dilatation of peripheral veins, resulting in a net signal increase. 33 Studies by Kutlar et al 33 and Ooi et al 26 showed that hypervascularity with a cutoff of 0.0020 cm 2 and the presence of at least a single neovessel of greater than 1 mm in length in the sagittal plane had sensitivity of 93.4% and 69%, respectively. Our study used an approach similar to that of Ooi et al 26 ; however, whereas they applied dichotomous scoring (0 and 1), our study used the grades proposed by El Miedany et al 27…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Gonzalez‐Suarez

Fidel

Cabrera

et al. 2019

J of Ultrasound Medicine

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Objectives To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS). Methods Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees’ work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross‐sectional area, hypervascularity, wrist‐to‐forearm ratio, wrist‐forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO). Results A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist‐forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4–15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8–8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms. Conclusions Combining US findings for the CTO wrist‐forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.

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Ultrasound parameters to identify and diagnose carpal tunnel syndrome. A review of the literature

Linehan

Childs

Quinton

et al. 2020

Australas J Ultrason Med

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Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut‐off values. Currently, an effective parameter and cut‐off value are still debated. The aim of this review is to determine if these parameters have sufficient rigour to allow their use in clinical practice. Twenty‐one studies using sonographic parameters to identify carpal tunnel syndrome in comparison with electrodiagnostic testing (EDx) were selected for review. Methodological differences were found between studies in the use of EDx criteria, scanning and recruitment protocols, with participant biometrics often not reported. Parameters including the cross‐sectional area of the median nerve at the level of the pisiform bone in addition to the wrist‐to‐forearm difference demonstrated high diagnostic utility for set cut‐off values. Doppler techniques and mobility are promising, and further research is required to understand the effectiveness of these techniques.

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Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity

Abstract: Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.

Cited by 40 publications

References 21 publications

Local blood flow in peripheral nerves and their ganglia: Resurrecting key ideas around its measurement and significance

Local blood flow in peripheral nerves and their ganglia: Resurrecting key ideas around its measurement and significance

Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Ultrasound parameters to identify and diagnose carpal tunnel syndrome. A review of the literature

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