The controversy of the normal values of ultrasonography in carpal tunnel syndrome: diagnostic accuracy of wrist-dependent CSA revisited

Kleermaeker, Floriaan G. C. M. De; Meulstee, J.; Verhagen, W. I. M.

doi:10.1007/s10072-019-03756-z

Cited by 12 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diagnostic accuracy of US in CTS patients depends on the upper limit of normal of the measured CSA of the median nerve at the carpal tunnel inlet. We previously showed, by performing multivariable linear regression, that wrist circumference is the most important independent predicting factor for CSA (15), accounting for 37% of the variation in this parameter (19). We also showed an equation for the ULN of the CSA with a relatively low sensitivity but a very high specificity.…”

Section: Discussionmentioning

confidence: 72%

“…We previously showed a strong correlation between wrist circumference and CSA of the median nerve at the carpal tunnel inlet in subjects without signs or symptoms of carpal tunnel syndrome (15). Furthermore, we developed an equation for the ULN of the CSA which has a relatively low sensitivity (53.4%) but a very high specificity (95%) (19). It is the low sensitivity that hampers the clinical applicability of this equation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Augmented Diagnostic Accuracy of Ultrasonography for Diagnosing Carpal Tunnel Syndrome Using an Optimised Wrist Circumference-Dependent Cross-Sectional Area Equation

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction: In diagnosing carpal tunnel syndrome (CTS) there is no consensus about the upper limit of normal (ULN) of the cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet. A previous study showed wrist circumference is the most important independent predictor for the ULN. In this study we optimised a wrist circumference-dependent ULN equation for optimal diagnostic accuracy and compared it to the generally used fixed ULN of 11 mm 2. Methods: CSA and wrist circumference were measured in a prospective cohort of 253 patients (clinically defined CTS) and 96 healthy controls. An equation for the ULN for CSA was developed by means of univariable regression analysis. We calculated z-scores for all patients and healthy controls, and analysed these scores in a ROC curve and a decision plot. Sensitivity and specificity were determined and compared to fixed ULN values. Results: We found augmented diagnostic accuracy of our newly developed equation y = 0.88 * x −4.0, where y = the ULN of the CSA and x = wrist circumference. This equation has a corresponding sensitivity and specificity of 75% compared to a sensitivity of 70% while using a fixed cutoff value of 11 mm 2 (p = 0.015). Conclusion: Optimising the regression equation for wrist circumference-dependent ULN cross-sectional area of the median nerve at the wrist inlet might improve diagnostic accuracy of ultrasonography in patients with carpal tunnel syndrome and seems to be more accurate than using fixed cutoff values.

show abstract

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Augmented Diagnostic Accuracy of Ultrasonography for Diagnosing Carpal Tunnel Syndrome Using an Optimised Wrist Circumference-Dependent Cross-Sectional Area Equation

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thirty-one articles reported measurement of CSA by the method of direct tracing method, out of which 26 articles 5 , 6 , 21 – 25 , 27 – 30 , 32 , 36 – 47 traced CSA without the hyperechogenic rim of the epineurium of the median nerve. The echogenic rim of the epineurium is reported but did not provide any image of ultrasound trace for interpretation 34 .…”

Section: Resultsmentioning

confidence: 99%

A systematic review: normative reference values of the median nerve cross-sectional area using ultrasonography in healthy individuals

Chandrasekaran

Prakash

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Median nerve cross-sectional area (CSA) was used for screening and diagnosis of neuropathy, but few studies have suggested reference range. Hence, this systematic review was performed to evaluate a normative values of median nerve CSA at various landmarks of upper limb based on ultrasonography. PubMed and Web of science were used to search relevant articles from 2000 to 2020. Forty-one eligible articles (2504 nerves) were included to access median nerve CSA at different landmarks (mid-arm, elbow, mid-forearm, carpal tunnel (CT) inlet and CT outlet). Data was also stratified based on age, sex, ethnicity, geographical location, and method of measurement. Random effects model was used to calculate pooled weighted mean (95% confidence interval (CI), [upper bound, lower bound]) at mid-arm, elbow, mid-forearm, CT inlet and outlet which found to be 8.81 mm2, CI [8.10, 9.52]; 8.57 mm2 [8.00, 9.14]; 7.07 mm2 [6.41, 7.73]; 8.74 mm2 [8.45, 9.03] and 9.02 mm2 [8.08, 9.95] respectively. Median nerve CSA varies with age, geographical location, and sex at all landmarks. A low (I2 < 25%) to considerable heterogeneity (I2 > 75%) was observed, indicating the variation among the included studies. These findings show that median nerve CSA is varying not only along its course but also in other sub-variables.

show abstract

“…Borire reported that the ultrasound can detect the syndrome in borderline or even false negative cases diagnosed by electrodiagnostic studies [ 10 ]. On the other hand, De Kleermaeker detected low sensitivity for the ultrasound, so that it cannot replace electrodiagnostic studies for diagnosis of CTS [ 11 ]. Some researchers have employed plain X-ray as a noninvasive way for the evaluation of CTS patients.…”

Section: Discussionmentioning

confidence: 99%

Carpal Dimensions by Plain Wrist Radiography in Patients with Severe Carpal Tunnel Syndrome

Saeed-Banadaky

Rahimian

Sobhan

2022

Advances in Medicine

View full text Add to dashboard Cite

In this study, we evaluated the diagnostic value of carpal dimensions in wrist plain radiography for the screening of carpal tunnel syndrome (CTS). This is a case-control diagnostic probe in which patients with severe CTS documented by electrodiagnostic study and healthy subjects as controls were enrolled. In the posteroanterior view of the wrist plain radiography in both groups, we defined and measured the carpal ratio, and the results were analyzed deploying statistical software. In this study, 119 participants, including 50 patients and 69 healthy subjects, were recruited. According to the ROC chart, the cutoff points, positive and negative predictive values, and the diagnostic accuracy for the cutoff points were calculated.

show abstract

The controversy of the normal values of ultrasonography in carpal tunnel syndrome: diagnostic accuracy of wrist-dependent CSA revisited

Cited by 12 publications

References 25 publications

Augmented Diagnostic Accuracy of Ultrasonography for Diagnosing Carpal Tunnel Syndrome Using an Optimised Wrist Circumference-Dependent Cross-Sectional Area Equation

Augmented Diagnostic Accuracy of Ultrasonography for Diagnosing Carpal Tunnel Syndrome Using an Optimised Wrist Circumference-Dependent Cross-Sectional Area Equation

A systematic review: normative reference values of the median nerve cross-sectional area using ultrasonography in healthy individuals

Carpal Dimensions by Plain Wrist Radiography in Patients with Severe Carpal Tunnel Syndrome

Contact Info

Product

Resources

About