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Sonographic Findings Associated With Carpal Tunnel Syndrome

Published:September 18, 2018DOI:https://doi.org/10.1016/j.jhsa.2018.07.015

      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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      References

        • Graham B.
        • Regehr G.
        • Naglie G.
        • Wright J.G.
        Development and validation of diagnostic criteria for carpal tunnel syndrome.
        J Hand Surg Am. 2006; 31 (919.e9–919.e7)
        • American Academy of Orthopeadic Surgeons
        Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guidelines.
        (Available at:)
        • Rivlin M.
        • Kachooei A.R.
        • Wang M.L.
        • Ilyas A.M.
        Electrodiagnostics grade and carpal tunnel release outcomes: a prospective analysis.
        J Hand Surg Am. 2018; 43: 425-431
        • Braun R.M.
        • Jackson W.J.
        Electrical studies as a prognostic factor in the surgical treatment of carpal tunnel syndrome.
        J Hand Surg Am. 1994; 19: 893-900
        • Buchberger W.
        • Judmaier W.
        • Birbamer G.
        • Lener M.
        • Schmidauer C.
        Carpal tunnel syndrome: diagnosis with high-resolution sonography.
        AJR Am J Roentgenol. 1992; 159: 793-798
        • Aksekili M.A.
        • Biçici V.
        • Işik Ç.
        • et al.
        Comparison of early postoperative period electrophysiological and clinical findings following carpal tunnel syndrome: is EMG necessary?.
        Int J Clin Exp Med. 2015; 8: 10011-10015
        • Finsen V.
        • Russwurm H.
        Neurophysiology not required before surgery for typical carpal tunnel syndrome.
        J Hand Surg Br. 2011; 26: 61-64
        • Levine D.W.
        • Simmons B.P.
        • Koris M.J.
        • et al.
        A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.
        J Bone Joint Surg Am. 1993; 75: 1585-1592
        • You H.
        • Simmons Z.
        • Freivalds A.
        • Kothari M.J.
        • Naidu S.H.
        Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome.
        Muscle Nerve. 1999; 22: 497-501
        • D'Arcy C.A.
        • McGee S.
        The rational clinical examination. Does this patient have carpal tunnel syndrome?.
        JAMA. 2000; 283: 3110-3117
        • Nakamichi K.
        • Tachibana S.
        Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy.
        Muscle Nerve. 2002; 26: 798-803
        • Fowler J.R.
        • Munsch M.
        • Tosti R.
        • Hagberg W.C.
        • Imbriglia J.E.
        Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard.
        J Bone Joint Surg Am. 2014; 96: e148
        • Fowler J.R.
        • Hirsch D.
        • Kruse K.
        The reliability of ultrasound measurements of the median nerve at the carpal tunnel inlet.
        J Hand Surg Am. 2015; 40: 1992-1995
        • Naranjo A.
        • Ojeda S.
        • Arana V.
        • et al.
        Usefulness of clinical findings, nerve conduction studies and ultrasonography to predict response to surgical release in idiopathic carpal tunnel syndrome.
        Clin Exp Rheumatol. 2009; 27: 786-793
        • Naranjo A.
        • Ojeda S.
        • Mendoza D.
        • Francisco F.
        • Quevedo J.C.
        • Erausquin C.
        What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?.
        Clin Exp Rheumatol. 2007; 25: 853-859
        • Mondelli M.
        • Filippou G.
        • Gallo A.
        • Frediani B.
        Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome.
        Arthritis Rheum. 2008; 59: 357-366
        • Manni M.
        • Bisaccia M.
        • Rinonapoli G.
        • et al.
        Reliability, feasibility and value of ecography in clinical-functional results in patients affected by carpal tunnel syndrome: is there a correlation?.
        Acta Inform Med. 2017; 25: 44-48
        • Kim M.S.
        • Yoon S.Y.
        • Lee S.O.
        • Lee Y.G.
        The abnormal ultrasonographic findings of carpal tunnel in carpal tunnel syndrome.
        J Korean Acad Rehabil Med. 2003; 27: 735-739
        • Fowler J.R.
        • Gaughan J.P.
        • Ilyas A.M.
        The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis.
        Clin Orthop Relat Res. 2011; 469: 1089-1094
        • Nakamichi K.I.
        • Tachibana S.
        Enlarged median nerve in idiopathic carpal tunnel syndrome.
        Muscle Nerve. 2000; 23: 1713-1718
        • Buchberger W.
        Radiologic imaging of the carpal tunnel.
        Eur J Radiol. 1997; 25: 112-117
        • Kamolz L.P.
        • Beck H.
        • Haslik W.
        • et al.
        Carpal tunnel syndrome: a question of hand and wrist configurations?.
        J Hand Surg Br. 2004; 29: 321-324
        • Neal N.C.
        • McManners J.
        • Stirling G.A.
        Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome.
        J Hand Surg Br. 1987; 12: 229-232
        • Nakamichi K.
        • Tachibana S.
        Histology of the transverse carpal ligament and flexor tenosynovium in idiopathic carpal tunnel syndrome.
        J Hand Surg Am. 1998; 23: 1015-1024
        • Naranjo A.
        • Ojeda S.
        • Rua-Figueroa I.
        • Garcia-Duque O.
        • Fernandez-Palacios J.
        • Carmona L.
        Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgery.
        Scand J Rheumatol. 2010; 39: 409-412
        • Mohammadi A.
        • Ghasemi-Rad M.
        • Mladkova-Suchy N.
        • Ansari S.
        Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings.
        AJR Am J Roentgenol. 2012; 198: W181-W184
        • Werner R.A.
        • Andary M.
        Carpal tunnel syndrome: pathophysiology and clinical neurophysiology.
        Clin Neurophysiol. 2002; 113: 1373-1381
        • Meys V.
        • Thissen S.
        • Rozeman S.
        • Beekman R.
        Prognostic factors in carpal tunnel syndrome treated with a corticosteroid injection.
        Muscle Nerve. 2011; 44: 763-768
        • Graham B.
        The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.
        J Bone Joint Surg Am. 2008; 90: 2587-2593
        • de Carvalho Leite J.C.
        • Jerosch-Herold C.
        • Song F.
        A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire.
        BMC Musculoskelet Disord. 2006; 7: 78
        • Wiesler E.R.
        • Chloros G.D.
        • Cartwright M.S.
        • Smith B.P.
        • Rushing J.
        • Walker F.O.
        The use of diagnostic ultrasound in carpal tunnel syndrome.
        J Hand Surg Am. 2006; 31: 726-732
        • Rempel D.
        • Evanoff B.
        • Amadio P.C.
        • et al.
        Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.
        Am J Public Health. 1998; 88: 1447-1451
        • Lee C.H.
        • Kim T.K.
        • Yoon E.S.
        • Dhong E.S.
        Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome.
        Ann Plast Surg. 2005; 54: 20-23
        • Fowler J.R.
        • Cipolli W.
        • Hanson T.
        A comparison of three diagnostic tests for carpal tunnel syndrome using latent class analysis.
        J Bone Joint Surg Am. 2015; 97: 1958-1961
        • Stevens J.C.
        • Beard C.M.
        • O'Fallon W.M.
        • Kurland L.T.
        Conditions associated with carpal tunnel syndrome.
        Mayo Clin Proc. 1992; 67: 541-548