ASSESSMENT OF CARPAL TUNNEL SYNDROME WITH ULTRASONOGRAPHY
DOI:
https://doi.org/10.55519/JAMC-02-9892Keywords:
Carpal Tunnel Syndrome, Ultrasonography, Median Nerve Caliber, Nerve Conduction Studies, Cross-sectional Area.Abstract
Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy caused by compression of median nerve at wrist as it passes through osseofibrous canal known as carpal tunnel. Epidemiological statistics shows one in every ten people develops the disease at any stage of life. CTS mostly affect females than males with mean age of 50. Clinical features are considered to be enough for establishing the diagnosis of carpal tunnel syndrome. However, nerve conduction studies give quantitative information regarding median nerve function therefore good at predicting outcome of intervention. Ultrasound being easily available, cost effective and real time is a promising modality for diagnosis and grading carpal tunnel syndrome. Methods: This correlational study was conducted in collaboration of Neurology and Radiology Department of Pakistan Institute of Medical Sciences, Islamabad from January 2018 to January 2019. Total 50 patients with 85 wrists involved were included in the study. All patients with positive nerve conduction study were included. Patient with history of wrist trauma were not included. Detailed history and clinical features were recorded. All patients with positive result on nerve conduction studies underwent ultrasound examinations. Fifty control wrists were also included to establish the normal median nerve cross sectional area value in our study population. Results were recorded. Data was analyzed and appropriate statistical tests were applied by using SPSS v20. Results: Mean cross sectional area of median nerve for controls was 6.34±1.23. Mean cross sectional area of median nerve for mild CTS was 8.05±1.72, moderate CTS was 11.15±2.32, severe was 17.49±4.93. Strong correlation was found between (r=0.76, p-value <0.0001) between increased cross-sectional area on Ultrasonography and severity of CTS on NCS. Other finding on Ultrasonography included flattening in 4 and fluid in 10 affected wrists. Conclusion: Increased cross-sectional area on Ultrasonography and severity of carpal tunnel syndrome on nerve conduction studies are very strongly correlated.
References
Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loret C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016;15(12):1273-84.
Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K. Case-control study on individual risk factors of carpal tunnel syndrome. Exp Ther Med 2018;15(3):2761-66.
Wang L. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am 2013;24(1):67-77.
Klauser A, Abd Ellah M, Kremser C, Taljanovi M, Schmidle G, Gabl M, et al. Carpal tunnel syndrome assessment with diffusion tensor imaging: Value of fractional anisotropy and apparent diffusion coefficient. Eur Radiol 2018;28(3):1111-7.
Peer S, Gruber H, Loizides A. Sonography of carpal tunnel syndrome: why, when & how. Imaging Med 2012;4(3):287-97.
Ng AWH, Griffith J, Lee R, Tse W, Wong C. Ultrasound carpal tunnel syndrome: additional criteria for diagnosis. Clin Radiol 2018;73(2):214.e11-214.e18.
Löscher W, Bischoff C. Basics in clinical neurophysiology: Nerve conduction studies and needle electromyography in nerve entrapment syndromes. [Internet]. In GMS; 2016 [cited 2021 Aug 1]. Available from: https://books.publisso.de/en/publisso_gold/publishing/books/overview/49/40
Takata SC, Kysh L, Mack WJ, Roll SC. Sonographic reference values of median nerve cross-sectional area: a protocol for a systematic review and meta-analysis. Syst Rev 2019;8(1):2.
Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol 2010;195(3):585-94.
Mohamed F, Hassan A, Abdel-Magied R, Wageh R. Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment. Egypt Rheumatol Rehabil 2016;43(1):27-34.
Sonoo M, Menkes DL, Blande JD, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018;3:78-88.
Billakota S, Webb LD. Standard median nerve ultrasound in carpal tunnel syndrome:A retrospective review of 1,021 cases. Clin Neurophysiol Pract 2017;2:188-91.
Mani B, Sarawagi R, Cherian R. Review of the dimensions of the median nerve and carpal tunnel using sonography in asymptomatic adults. J Med Imaging Radiat Oncol 2011;55(2):126-31.
Ghasemi M, Masoumin S, Ansari B, Esfahani MF, Mousavi SM. Determination of cut-off point of cross-sectional area of median nerve at the wrist for diagnosing carpal tunnel syndrome. Iran J Neurol 2017;16(4):164-7.
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: Value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250(1):171-7.
El Miedany Y, Aty S, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests. Rheumatology (Oxford) 2004;43(7):887-95.
Kwon HK, Kang HJ, Byun CW, Yoon JS, Kang CH, Pyuna SB. Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography. J Clin Neurol 2014;10(4):348-53.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
