Journal List > Korean J Neurotrauma > v.9(1) > 1058907

Shim, Doh, Lee, Shim, Yoon, and Bae: The Diagnostic Value of Ultrasonography in Korean Carpal Tunnel Syndrome Patients

Abstract

Objective

The purpose of this study was to assess the diagnostic utility of the wrist ultrasonography (USG) in patients with and without carpal tunnel syndrome (CTS).

Methods

Individuals with electrodiagnostically proven CTS patients and healthy control subjects were enrolled prospectively. USG was done 60 wrists of 48 patients with CTS and 36 wrists of 18 controls. The USG analysis included median nerve cross sectional area (CSA) at the level of carpal tunnel inlet. We also evaluated the relationship between median nerve CSA at the level of carpal tunnel inlet and severity grade of nerve conduction test in CTS patients.

Results

The median nerve CSA at the level of carpal tunnel inlet was significantly larger in CTS patients (13.6 mm2 versus 7.7 mm2, p<0.0001). And there was an association between median nerve CSA and severity grade of nerve conduction studies (p=0.036). Receiver operating characteristics (ROC) analysis yielded sensitivity of 86.7% and specificity of 88.9% using a cut-off value of 9 mm2. But the specificity was increased to 97.2%, although sensitivity was decreased to 78.3%, when using cut-off value at 10.1 mm2.

Conclusion

Ultrasonographic measurement of the median nerve CSA at carpal tunnel inlet was useful in diagnosis of CTS. According to ROC analysis, USG is used as a complementary test for electrodiagnostic test.

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FIGURE 1.
Receiver operating characteristics curve for ultrasonographic assessments of median nerve cross-sectional area at carpal tunnel inlet. The area under the curve is 0.935 (95% confidence interval, 0.86–0.98; p<0.0001).
kjn-9-1f1.tif
FIGURE 2.
Box plot showing median nerve cross-sectional area (CSA) according to severity of nerve conduction study, and control subjects.
kjn-9-1f2.tif
TABLE 1.
Electrophysiological carpal tunnel syndrome grading scheme according to the classification reported by Stevens23)
  DSL (ms) Samp (µV) DML (ms) Mamp (mV)
Mild >3.5 <20
Moderate Abnormal median sensoory latencies as above >4.2 <5
Severe Abnormal median motor/sensory latencies as above, with absent SNAP or thenar CMAP abnormal spontaneous activity on needle examination

DSL: distal sensory latency, Samp: sensory amplitude, DML: distal motor latency, Mamp: motor amplitude, SNAP: sensory nerve action potential, CMAP: compound motor action potential

TABLE 2.
Summary of carpal tunnel syndrome patients and healthy control subjects
  Patients (n=48) Controls (n=18) p
Mean age±SD (years) 58.5±12.1 54.3±12.9 0.114
Female gender 43 (89.5%) 10 (55.6%) 0.357
Number of wrists (right/left) 60 (29/31) 36 (18/18)  
Median duration of symptoms (months) 12.1 N/A  
Clinically severe grade (wrists) 18 (30.0%) N/A  
Atrophy of APBM 31 (51.7%) N/A  
Electrodiagnostic grade   N/A  
 Mild 06 (10.0%)    
 Moderate 28 (46.7%)    
 Severe 26 (43.3%)    

the numbers in parenthesis denote the counts of right/left wrists. APBM: abductor pollicis brevis muscle

TABLE 3.
Median nerve CSA according to NCS grade
NCS grade Median nerve CSA (mm2) p
Mild 09.4±2.4  
Moderate 13.3±4.2 0.036
Severe 14.9±5.4  

statistically significant was obtained through one-way analysis of variance test (p<0.05). NCS: nerve conduction test, CSA: cross sectional area

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