Shearwave Elastography in the Differentiation of Carpal Tunnel Syndrome Severity

Abstract

Background There is emerging evidence that ultrasound elastography may provide additional diagnostic information in peripheral neuropathies. Objective To investigate the use of ultrasound elastography to evaluate median nerve stiffness in patients with carpal tunnel syndrome (CTS), as well as the relationship between the elastographic stiffness and electrophysiological severity. Design Case control study. Setting Tertiary hospital outpatient neurophysiology clinic. Participants Twenty eight patients (47 wrists) with CTS and 25 control patients (25 wrists). Interventions None. Main Outcome Meaures Ultrasound parameters (median nerve cross‐sectional area [CSA] at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm), shearwave elastography parameter (median nerve stiffness), and electrophysiological severity of carpal tunnel syndrome. Results In patients with CTS, median nerve stiffness by ultrasound elastography was increased between the different severity groups (control 83.5 ± 24.8, EDx negative CTS 84.2 ± 46.4, mild 117.7 ± 79.3, moderate 144.0 ± 71.1, severe 196.6 ± 48.4). The control versus moderate and severe subgroup was statistically significant. Conclusions In total, this study has demonstrated that ultrasound elastography was able to discriminate the severity of CTS whereas conventional ultrasound parameters did not.

Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

“…Many studies were performed about diagnosis of CTS by ultrasound elastography; regardless of US elastography technique either strain or shear wave. These studies evoked a significant difference in median nerve mean stiffness measured by SWE between patients with CTS and controls [18,19,23,[34][35][36][37][38]. This trend was similarly observed in our study to those recorded by the former studies.…”

“…The cutoff values for median nerve CSA and wrist/forearm median nerve CSA ratio were (8.5 mm 2 and 1.3, respectively) to differentiate between patients with CTS and control group with sensitivity and specificity of 81% and 83% for CSA of median nerve, and 87% and 89%, respectively, for wrist/forearm CSA ratio. These results showed comparable results to those mentioned by Simon et al [1], Lin et al [29] and Wee et al [2,35].…”

“…There are various cutoff values that have been proposed for the diagnosis of CTS with reasonable respective sensitivity and specificity. In our study, the cutoff value of mean median nerve stiffness measured by SWE was 65.6 kPa (P value < 0.001, AUC = 0.910, sensitivity = 94.6%, specificity = 97.3%); these findings were matched with the previous results recorded by many studies, as the range of cutoff values was between 38.25-79 kPa and 3.0-3.23 m/s [18,19,[35][36][37][38], as the study by Cingoz et al [18], which involved 59 patients and 18 controls, reported that the best cutoff value of median nerve stiffness was 38.25 kPa, with 78.6% sensitivity, and 62.5% specificity.…”

“…But the demonstrated cutoff value of mean median nerve in this study was found to be lower than had been reported by Wee et al [35], which was 84 kPa. And this could be explained by the younger age of participants involved in our study compared to older patients included in a study by Wee et al [35].…”

Asymptomatic common extensor tendon pathology in patients with carpal tunnel syndrome

“…Ultrasound imaging of the median nerve followed the technique used in a previous study. 17 In brief, the same machine presets and depth described earlier were used, but focus was adjusted to the level of the median nerve. Ultrasound was performed with the patient lying supine on an examination table.…”