Purpose
The purpose of this study was to identify associations between the clinical manifestations
of carpal tunnel syndrome (CTS) and the sonographic measurements of the median nerve
in the carpal tunnel. We hypothesized that sonographic changes in the median nerve
from proximal to distal along the carpal tunnel would be associated with symptom severity
scores.
Methods
We report on 38 patients with clinical signs and symptoms of CTS in a prospective
investigation. Subjects underwent sonographic evaluation with measurement of median
nerve cross-sectional area (CSA) at 3 locations: the level of the pronator quadratus,
pisiform, and hamate. In addition, we measured dimensions of the carpal tunnel at
the levels of the pisiform (inlet) and hamate (outlet). Finally, we recorded maximal
thickness of the transverse carpal ligament (TCL). Patients underwent routine clinical
evaluation and 31 patients had electrodiagnostic examination. Patients completed the
Levine Katz Questionnaire (LKQ) to characterize severity of clinical symptoms. Each
clinician was blinded to symptom severity scores. Pearson correlation coefficients
were calculated to measure the relationship between LKQ score and sonographic measures.
Results
Median nerve CSA decreased over the course of the carpal tunnel from proximal to distal
in 30 of 38 wrists. A greater absolute change in CSA of the median nerve over the
course of the carpal tunnel between the pisiform and the hamate as well as between
the pronator quadratus and the hamate correlated with increased severity of clinical
symptoms. Increased thickening of the TCL also correlated with greater symptom severity
scores.
Conclusions
Changes in CSA of the median nerve as well as thickening of the TCL correlate with
CTS severity.
Type of study/level of evidence
Diagnostic II.
Key words
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Article Info
Publication History
Published online: September 18, 2018
Accepted:
July 25,
2018
Received:
July 24,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2019 by the American Society for Surgery of the Hand. All rights reserved.
