Title: Validity of Ultrasonography in Diagnosis of Carpal Tunnel Syndrome

Authors: Dr Managalanandan. S, Dr Cinchu Santappan, Dr Mathew George, Dr Geena Benjamin

 DOI: https://dx.doi.org/10.18535/jmscr/v8i8.53

Abstract

Introduction: Carpal tunnel syndrome (CTS), a common peripheral entrapment neuropathys due to impairment of median nerve function. Diagnosis of CTS is based on clinical signs and symptoms and confirmed by electrodiagnostic studies. Ultrasound imaging is noninvasive, offers high temporal and spatial resolutions and can provide dynamic anatomical information regarding structure and kinetics.

Aims and Objectives: 1.To find the validity of using ultrasonography before and after provocative exercises for diagnosed CTS patients with nerve conduction studies. 2. To find out the cut off values of median nerve cross sectional area in our population in diagnosis of CTS and to compare it with NCS using a Receiver Operating Characteristic (ROC) curve.

Methodology: This is a study of diagnostic test tool evaluation. 29 patients diagnosed as CTS with nerve conduction studies, were taken for ultrasound before and after exercise and studied the cross sectional area of median nerve at wrist and tabulated.

Results: the cut off values of median nerve area in diagnosis of moderate and severe CTS is calculated. Predictive power of median nerve cross sectional area also is calculated.

Conclusion:  As per the present study, the mean value of cross sectional area is 0.108 (pre exercise) and 0.125 ( post exercise) is diagnostic.

References

  1. Kuo Tzung – Tai, Lee RU –Ming , Liao Yin – Yin, Lee-Ning Wei, Hsu Wei – Yen,Chen Perng – Jiann et al. - Assessment of median nerve mobility by ultrasound dynamic imaging in carpal tunnel syndrome diagnosis. 2013 Joint UFFC, EFTF and PFM symposium.
  2. Cartwright S Michael, Webb – Hobson D L, Boon J A, Alter E K, Hunt H C, Flores H V  et al - Evidence –Based Guideline: Neuromuscular Ultrasound for the diagnosis of Carpal tunnel Syndrome. American Association of neuromuscular and electrodiagnostic Medicine. Muscle Nerve 46: 287293,2012.
  3. Rosenbaum RB, Ochoa JL (1993) Carpal tunnel syndrome and other disorders of the median nerve. Butterworth- Heinemann, Boston.
  4. Mishra UK, Kalita J(1999)Clinical Neurophysiology, B.I. Churchill Livingstone Pvt limited,32-34
  5. Altinok T, Baysal O, Karkas M H , Firat K A. - Sonographic Evaluation of the Carpal Tunnel after Provocative Exercises. J Ultrasound Med 2004;23:1301 – 1306.
  6. Buchberger W, Judmaier W, Birbamer G et al. (1992) Carpal tunnel syndrome: diagnosis with high resolution sonography. AJR Am J Roentgenol 159:793–798
  7. Nakamichi KI, Tachibana S. Enlarged median nerve in idiopathic carpal tunnel syndrome. Muscle Nerve 2000; 23:1713– 1718.
  8. 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
  9. Koyuncuoglu HR, Kutluhan S, Yesildag A et al. (2005) The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol 56:365–36
  10. Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G (2006) Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol 186:1240–1245
  11. Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology 1988;167:179 -182
  12. Beekman R, Visser LH (2003) Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 27:26–3
  13. Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology 1988;167:179 -182
  14. Altinok T, Baysal O, Karakas HM et al. (2004) Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome. Clin Radiol 59:916–925
  15. Visser LH, Smidt MH, Lee ML (2008) High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 79:63–67.

Corresponding Author

Dr Mangalanandan

Associate Professor, Department of Radiodiagnosis, Pushpagiri Medical College, Thiruvalla, Kerala, India