Meta-Analysis on the Performance of Sonography for the Diagnosis of Carpal Tunnel Syndrome

Descatha, Alexis; Huard, Laure; Aubert, François; Barbato, B.; Gorand, O.; Chastang, Jean-François

doi:10.1016/j.semarthrit.2011.11.006

Cited by 47 publications

(40 citation statements)

References 50 publications

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“…19 Wong et al 4 proposed an algorithm in which sonography was the initial study for patients suspected of having carpal tunnel syndrome, with electrodiagnostic tests performed only if the sonographic results were nonconfirmatory. The results of a meta-analysis by Descatha et al 20 suggested that sonography would be an efficient complement to nerve conduction studies for diagnosing carpal tunnel syndrome. In addition to its use in making an initial diagnosis of carpal tunnel syndrome, the practical applications for sonographic evaluation of the median nerve also include follow-up evaluation after conservative treatment and surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome

Junck

Escobedo

Lipa

et al. 2015

J of Ultrasound Medicine

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Objectives The aim of this study was to determine the intra- and inter-rater reliability of sonographic measurements of the median nerve cross-sectional area in individuals with carpal tunnel syndrome and healthy control participants. Methods The median nerve cross-sectional area was evaluated by sonography in 18 participants with carpal tunnel syndrome (18 upper extremities) and 9 control participants (18 upper extremities) at 2 visits 1 week apart. Two examiners, both blinded to the presence or absence of carpal tunnel syndrome, captured independent sonograms of the median nerve at the levels of the carpal tunnel inlet, pronator quadratus, and mid-forearm. The cross-sectional area was later measured by each examiner independently. Each also traced images that were captured by the other examiner. Results Both the intra- and inter-rater reliability rates were highest for images taken at the carpal tunnel inlet (radiologist, r = 0.86; sonographer, r = 0.87; inter-rater, r = 0.95; all P < .0001), whereas they was lowest for the pronator quadratus (r = 0.49, 0.29, and 0.72, respectively; all P < .0001). At the mid-forearm, the intra-rater reliability was lower for both the radiologist and sonographer, whereas the inter-rater reliability was relatively high (r = 0.54, 0.55, and 0.81; all P < .0001). Tracing of captured images by different examiners showed high concordance for the median cross-sectional area at the carpal tunnel inlet (r = 0.96–0.98; P < .0001). Conclusions The highest intra- and inter-rater reliability was found at the carpal tunnel inlet. The results also demonstrate that tracing of the median nerve cross-sectional area from captured images by different examiners does not contribute significantly to measurement variability.

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Section: Discussionmentioning

confidence: 99%

Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome

Junck

Escobedo

Lipa

et al. 2015

J of Ultrasound Medicine

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“…Recent meta-analyses have noted that the sensitivity and specificity for diagnosing CTS using sonographic CSA range from 78% to 87%, 2,31,32 compared with 88% sensitivity and 93% specificity for nerve conduction studies. 33 Although these data indicate that gray-scale sonographic evaluations may be useful in initial screening, ultrasonography may not be an exclusive alternative to electrodiagnostic testing for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Carpal tunnel syndrome severity staging using sonographic and clinical measures

et al. 2015

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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.

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“…However, these tests have not been shown to be more accurate than EDS in high-quality studies. 36,37 The department does not cover these services.…”

Section: Other Diagnostic Testsmentioning

confidence: 99%