The Diagnostic Value of Ultrasonography in Korean Carpal Tunnel Syndrome Patients

Jae-Hyun Shim; Jae-won Doh; Kyeong-Seok Lee; Jai-Joon Shim; Seok-Mann Yoon; Hack-Gun Bae

doi:10.13004/kjnt.2013.9.1.1

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

Clinical Article

Korean J Nutr 2013;9(1):1-5.

Published online: 20 April 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.1.1

The Diagnostic Value of Ultrasonography in Korean Carpal Tunnel Syndrome Patients

Jae-Hyun Shim, MD, Jae-won Doh, MD, PhD, Kyeong-Seok Lee, MD, PhD, Jai-Joon Shim, MD, Seok-Mann Yoon, MD, PhD, Hack-Gun Bae, MD, PhD

Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea

Address for correspondence: Jae-won Doh, MD, PhD Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-721, Korea Tel: +82-41-570-3651, Fax: +82-41-572-9297 E-mail: jwdohns@naver.com

Received 12 September 2012 Revised 28 October 2012 Accepted 3 November 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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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Keywords: Carpal tunnel syndrome, Ultrasonography, Electrodiagnosis

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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).

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FIGURE 2.

Box plot showing median nerve cross-sectional area (CSA) according to severity of nerve conduction study, and control subjects.

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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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