The Usefulness of Ultrasonography in the Diagnosis of Carpal Tunnel                     Syndrome

Pinilla, Inmaculada; Martín-Hervás, C.; Sordo, Gelsomina Del; Santiago, Susana

doi:10.1177/1753193408090396

Cited by 54 publications

(40 citation statements)

References 16 publications

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“…Although ultrasound is unable to evaluate proximal etiologies of carpal tunnel-like symptoms, it does have the ability to detect other causes of compression in the carpal tunnel such as space-occupying lesions and tenosynovitis [18,19,26]. Although some studies have confirmed the utility of ultrasound in the diagnosis of CTS, their small sample size and the heterogeneity of study design has made it difficult to draw definitive conclusions regarding the sensitivity and specificity of ultrasonographic measurement of the median nerve in the diagnosis of CTS [17,22,24]. In this meta-analysis, we determined the sensitivity and specificity of ultrasound as a diagnostic tool for CTS.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies used a constellation of clinical findings as the reference standard to determine the presence of CTS [1,5,12,14,[22][23][24]27]. The sensitivity and specificity reported in these studies ranged from 62% to 98% and 63% to 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Patients without clinical signs and symptoms of CTS may still have inflammation and thickening of the median nerve (only 4% of asymptomatic patients will have abnormal ultrasound examinations), but the changes have not yet caused clinical symptoms and signs [19]. Studies using EDX as the gold standard have substantial false-positive and false-negative rates [4,9,10,14,[22][23][24]. Third, the use of ROCs to determine optimal cutoff values for the diagnosis of CTS also clouds the interpretation of data.…”

Section: Discussionmentioning

confidence: 99%

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The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

255

219

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Background Carpal tunnel syndrome (CTS) is the most commonly diagnosed compression neuropathy of the upper extremity. Current AAOS recommendations are to obtain a confirmatory electrodiagnostic test in patients for whom surgery is being considered. Ultrasound has emerged as an alternative confirmatory test for CTS; however, its potential role is limited by lack of adequate data for sensitivity and specificity relative to electrodiagnostic testing. Questions/purposes In this meta-analysis we determined the sensitivity and specificity of ultrasound in the diagnosis of CTS. Methods A PubMed/MEDLINE search identified 323 articles for review. After applying exclusion criteria, 19 articles with a total sample size of 3131 wrists were included for meta-analysis. Three groups were created: a composite of all studies, studies using clinical diagnosis as the reference standard, and studies using electrodiagnostic testing as the reference standard. Results The composite sensitivity and specificity of ultrasound for the diagnosis of CTS, using all studies, were 77.6% (95% CI 71.6-83.6%) and 86.8% (95% CI 78.9-94.8%), respectively. Conclusions The wide variations of sensitivities and specificities reported in the literature have prevented meaningful analysis of ultrasound as either a screening or confirmatory tool in the diagnosis of CTS. The sensitivity and specificity of ultrasound in the diagnosis of CTS are 77.6% and 86.8%, respectively. Although ultrasound may not replace electrodiagnostic testing as the most sensitive and specific test for the diagnosis of CTS given the values reported in this meta-analysis, it may be a feasible alternative to electrodiagnostic testing as the first-line confirmatory test.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Fowler

Gaughan

Ilyas

2011

Clinical Orthopaedics &Amp; Related Research

255

219

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“…Cross sectional area and AP diameter of median nerve at carpal tunnel outlet. Results showed significant differences between the control and CTS group with CTS groups have larger area and diameter [23].…”

Section: Idmentioning

confidence: 88%

Hand Volume as a Diagnostic Tool in Carpal Tunnel Syndrome

Burke¹,

Bell²,

Burke³

et al. 2015

Int J Phys Med Rehabil

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Objectives: To determine whether patients with carpal tunnel syndrome have an objective swelling of their hands.Design: A prospective, cross-sectional study of consecutive patients. Setting: Two independent electromyographic laboratories.Participants: Sixty-three patients referred for electrodiagnostic work-up.Interventions: NCS/EMG testing and volumetric analysis. Limb volume was measured using the water displacement method using a volumeter. Main Outcome Measures: Differences in volume (DHV) and EMG/NCS data.Results: EMG results indicated that 24 subjects (38%) had findings consistent with CTS. Data concerning subjective swelling was available for only six of these 24 subjects. The data, which are limited by low power, indicate that there was no difference 1) between the volume of the affected hand and the unaffected hand among those with CTS; 2) between the DHV of those with CTS and those without;. 3) Patients with lower extremity complaints had significantly less DHV than those with an upper extremity complaint (p< 0.0034, excluding patients with both upper and lower extremity complaints). Conclusions:Though a patients' perception of hand swelling has previously been determined to be an indicator of CTS severity, there was no correlation found in this study between CTS and objective measures of swelling. However patients with an upper extremity complaints had a statistically larger DHV than those with a lower extremity complaint (p<0.0034), suggesting that objective swelling might be present under some unknown circumstances. As this study was limited by a low power, further investigation is warranted in this area.

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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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The Usefulness of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome

Cited by 54 publications

References 16 publications

The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis

Hand Volume as a Diagnostic Tool in Carpal Tunnel Syndrome

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

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