Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome

Mondelli, Mauro; Filippou, Georgios; Gallo, Adriana; Frediani, Bruno

doi:10.1002/art.23317

Cited by 137 publications

(145 citation statements)

References 51 publications

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“…A comparative study of US (measuring the cross-sectional area of the median nerve at different levels) and NCS [28] found similar rates of abnormalities detected for both methods (64.7% for US vs. 67% for NCS). However, the sensitivity of diagnosis increased to 76.5% when both US and NCS were considered together.…”

Section: Discussionmentioning

confidence: 99%

A Review of Nerve Conduction Studies in Cases of Suspected Compression Neuropathies of the Upper Limb

Neligan¹,

O’Sullivan

Mullins³

et al. 2009

Eur Neurol

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Introduction: Entrapment neuropathies, particularly those affecting upper limbs, are common reasons for referral for nerve conduction studies (NCS). However, concordance between clinical findings and NCS findings, especially in patients being considered for intervention including decompressive surgery, has not been assessed. Methods: We conducted a retrospective study using records from a tertiary referral centre’s neurophysiology database. We aimed to establish the proportions of agreement between the suspected clinical diagnosis as defined by the referring clinician and NCS findings in the setting of an upper limb entrapment neuropathy. Results: Of the 571 referrals for NCS, suspected bilateral carpal tunnel syndrome was the commonest reason for referral (30.5%). In total, there was 51.5% concordance between suspected clinical diagnosis and NCS findings. Patients with NCS evidence of an entrapment neuropathy (n = 437) were more likely to be older compared to those with normal studies (54.0 ± 15.6 years vs. 45.9 ± 13.4 years, p < 0.001). Those with normal NCS findings were more likely to be female (72%, p = 0.001). An alternative or additional diagnosis was found in 14%. Conclusion: This study raises concerns regarding the appropriateness of referral for decompressive surgery based on clinical diagnosis alone as many have an additional or alternative diagnosis as suggested by NCS findings.

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Section: Discussionmentioning

confidence: 99%

A Review of Nerve Conduction Studies in Cases of Suspected Compression Neuropathies of the Upper Limb

Neligan¹,

O’Sullivan

Mullins³

et al. 2009

Eur Neurol

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“…Ultrasonographic diagnosis can be widely utilized because the measurements are reproducible [23]. Currently, the diagnostic value of ultrasonography has been reported in a number of studies [24,25,26,27] and accepted in clinical practice. In this study, we measured the electrophysiologic parameters such as DML, SCV, and SNAP and ultrasound evaluation parameters such as anteroposterior diameter and cross-sectional area of the median nerve at the level of the hamate bone and pisiform, and the thicknesses of TCL on the cross-section at the level of hamate bone was also measured preoperatively and 1 month postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Guo

Xiong²,

Zhao³

et al. 2017

Eur Neurol

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Background: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS). Methods: Between May 2014 and June 2016, 52 patients (56 wrists) with CTS were included in this study. Among these patients, 28 wrists were treated with ultrasound-guided corticosteroid injection plus needle release of the TCL (group A) and 28 wrists were treated with a single ultrasound-guided corticosteroids injection (group B). The following parameters were assessed and compared including postoperative results of procedure based on relief of symptoms, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of median nerve), and ultrasound parameters (anteroposterior diameter and cross-sectional area of the median nerve at the levels of pisiform and hamate bone, and the thicknesses of TCL on the cross-section at the level of hamate bone). Results: The overall excellent and good rate regarding the postoperative results of procedure based on the relief of symptoms at 1 month postoperatively was 82.1% in group A and 46.4% in group B (p = 0.004). There was significant difference in the above electrophysiological and ultrasound parameters between the preoperative and postoperative values in both groups (all p < 0.05). Furthermore, a significant difference was also observed in the postoperative values of the above-mentioned electrophysiological and ultrasound parameters in the 2 groups (all p < 0.05). Conclusions: Both approaches had treatment benefit in CTS. Ultrasound-guided corticosteroid injection in combination with needle release of the TCL is superior to the single ultrasound-guided corticosteroids injection.

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“…14 Various ultrasound studies on carpal tunnel syndrome have given a wide range of dimensions of non-bifid median nerve area in the proximal tunnel (at the scaphoid-pisiform level), varying from 8.5 to 15.0 mm 2 with sensitivities and specificities ranging from 67%-94% and 57%-97% respectively. [15][16][17] It is evident that several investigators have attempted to determine the most appropriate median nerve CSA cut-off value, however there still remains a lack of consensus.…”

Section: -11mentioning

confidence: 99%

Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

2016

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INTRODUCTIONThe sensory and motor innervation of the upper limb is via three nerves originating from the brachial plexus -the ulnar, radial and median nerves. Ultrasound (US) of the forearm can effectively reveal structural abnormalities and variants of the median nerve. Bifid median nerve, defined as high division of the median nerve proximal to the carpal tunnel, is a variation of nerve anatomy first described by Lanz in 1977 and has an incidence of 2.8%. 1,2The forearm and hand are supplied by radial and ulnar arteries, however the median artery (accompanying the median nerve) normally regresses in the early embryonic period.3 Persistence of the median artery, demonstrated effectively by colour doppler, is commonly associated with bifid median nerve. 4 The median nerve is supplied by epineural, interfascicular, and intrafascicular vascular plexuses that link to one another and form a free vascular network. Vascular compromise involving the median nerve in ABSTRACT Background: Patients with high division of the median nerve proximal to carpal tunnel, or bifid median nerve, may present with carpal tunnel syndrome (CTS). Ultrasound (US) measurements indicative of CTS in this subset of patients differ from those in patients with non-bifid median nerve. The objectives were to evaluate the parameter ∆CSA [difference between the maximum cross-sectional area of bifid median nerve within carpal tunnel (CSAc) and outside tunnel (CSAp)] in the diagnosis of CTS, to compare sensitivity and specificity of ∆CSA with nerve conduction velocity studies (NCS), and to compare the cross-sectional area (CSAc, CSAp & ∆CSA) of bifid median nerve in CTS patients with that in asymptomatic controls. Methods: 20 wrists with bifid median nerves and symptoms suggestive of CTS were included in the study group. Nerve conduction velocity studies (NCS) were performed in all cases. 4 wrists of asymptomatic age-matched subjects had bifid median nerves and normal NCS and were included in the control group. High resolution ultrasonography was performed for all wrists and findings documented. Statistical Analysis: Receiver Operating Characteristics curves were used to obtain the level of significance (p-value) and assessment of correlation between ∆CSA and NCS findings. Results: There was significant correlation between ∆CSA and NCS. A cut-off value of 2.3mm 2 gave the best calculated sensitivity (76.9 %) and specificity (100%). Conclusions: CSA criteria for diagnosing CTS in patients with bifid median nerves are different from those in patients with non-bifid median nerve. ∆CSA is a sensitive and specific parameter for confirming the diagnosis of CTS in patients with bifid median nerve with sensitivity approaching that of NCS.

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Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome

Abstract: Conclusion. In mild cases of CTS, US did not detect more anomalies than NCV and vice versa, and no anomalies were detected with either diagnostic instrument in 23.5% of mild cases.

Cited by 137 publications

References 51 publications

A Review of Nerve Conduction Studies in Cases of Suspected Compression Neuropathies of the Upper Limb

A Review of Nerve Conduction Studies in Cases of Suspected Compression Neuropathies of the Upper Limb

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

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