Introduction. Carpal tunnel syndrome (CTS) is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS) depending on the results of nerve conduction study (NCS). Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS). Furthermore, 40 healthy volunteers (80 wrists) underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI). The cross section area (CSA) of the median nerve (MN) was obtained using HRUS at the carpal tunnel inlet by direct tracing method. Results. There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome. 1. Introduction Carpal tunnel syndrome (CTS) or compression neuropathy of the median nerve (MN) at the wrist is the most common form of peripheral entrapment neuropathy [1, 2]. It accounts for 90% of all entrapment neuropathies [3] and it is particularly prevalent in middle-aged women [4] and is recognized as one of the most important causes of the workplace morbidity [5]. The prevalence of CTS in the United Kingdom was 7–16% in 2010, while in the United States was only 5% [6]. The diagnosis of CTS involves combination of a detailed clinical history, accurate examination, and appropriate electrodiagnostic studies (EDS) [7]. High resolution ultrasound (HRUS) has emerged as a feasible, simple, relatively low-cost, rapid, accurate, and noninvasive imaging method for evaluating the MN in the carpal tunnel [1, 2, 4, 5, 8–21]. Despite that, some authors consider that the role of ultrasound scanning (US) in diagnosis of CTS is yet to be proven [22] and other stated that US appears to be of little use in the diagnosis of CTS [9]. By contrast, Wong et al. [10] proposed an algorithm involving initial US examination of patients suspected of having CTS and secondary EDS performed only when US results were negative. Furthermore, some studies stated that US could be used to grade the severity of CTS [18]. In addition to the detection of increased cross sectional area (CSA) of
References
[1]
I. Duncan, P. Sullivan, and F. Lomas, “Sonography in the diagnosis of carpal tunnel syndrome,” American Journal of Roentgenology, vol. 173, no. 3, pp. 681–684, 1999.
[2]
L. Sarría, T. Cabada, R. Cozcolluela, T. Martínez-Berganza, and S. García, “Carpal tunnel syndrome: usefulness of sonography,” European Radiology, vol. 10, no. 12, pp. 1920–1925, 2000.
[3]
S. Aroori and R. A. J. Spence, “Carpal tunnel syndrome,” Ulster Medical Journal, vol. 77, no. 1, pp. 6–17, 2008.
[4]
N. Akcar, S. ？zkan, ？. Mehmetoglu, C. Calisir, and B. Adapinar, “Value of power Doppler and gray-scale US in the diagnosis of carpal tunnel syndrome: contribution of cross-sectional area just before the tunnel inlet as compared with the cross-sectional area at the tunnel,” Korean Journal of Radiology, vol. 11, no. 6, pp. 632–639, 2010.
[5]
L. Moran, M. Perez, A. Esteban, J. Bellon, B. Arranz, and M. Del Cerro, “Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies,” Journal of Clinical Ultrasound, vol. 37, no. 3, pp. 125–131, 2009.
[6]
S. E. Luckhaupt, J. M. Dahlhamer, B. W. Ward, M. H. Sweeney, J. P. Sestito, and G. M. Calvert, “Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 national health interview survey,” American Journal of Industrial Medicine, vol. 55, no. 12, pp. 1069–1077, 2012.
[7]
D. Rempel, B. Evanoff, P. C. Amadio et al., “Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies,” American Journal of Public Health, vol. 88, no. 10, pp. 1447–1451, 1998.
[8]
A. Mohammadi, A. R. Afshar, S. Masudi, and A. Etemadi, “Comparison of high resolution ultrasonography and nerve conduction study in the diagnosis of carpal tunnel syndrome: diagnostic value of median nerve cross-sectional area,” Iranian Journal of Radiology, vol. 6, no. 3, pp. 147–152, 2009.
[9]
S. Andrea, J. Ethan, F. Ralph et al., “Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement,” Radiology, vol. 259, no. 3, pp. 123–129, 2011.
[10]
S. M. Wong, J. F. Griffith, A. C. F. Hui, S. K. Lo, M. Fu, and K. S. Wong, “Carpal tunnel syndrome: diagnostic usefulness of sonography,” Radiology, vol. 232, no. 1, pp. 93–99, 2004.
[11]
Y. M. El Miedany, S. A. Aty, and S. Ashour, “Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?” Rheumatology, vol. 43, no. 7, pp. 887–895, 2004.
[12]
W. Buchberger, G. Schon, K. Strasser, and W. Jungwirth, “High-resolution ultrasonography of the carpal tunnel,” Journal of Ultrasound in Medicine, vol. 10, no. 10, pp. 531–537, 1991.
[13]
W. Buchberger, W. Judmaier, G. Birbamer, M. Lener, and C. Schmidauer, “Carpal tunnel syndrome: diagnosis with high-resolution sonography,” American Journal of Roentgenology, vol. 159, no. 4, pp. 793–798, 1992.
[14]
M. Mondelli, G. Filippou, A. Gallo, and B. Frediani, “Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome,” Arthritis Care and Research, vol. 59, no. 3, pp. 357–366, 2008.
[15]
M. G. Hochman and J. L. Zilberfarb, “Nerves in a pinch: imaging of nerve compression syndromes,” Radiologic Clinics of North America, vol. 42, no. 1, pp. 221–245, 2004.
[16]
S. M. Wong, J. F. Griffith, A. C. F. Hui, A. Tang, and K. S. Wong, “Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome,” Arthritis and Rheumatism, vol. 46, no. 7, pp. 1914–1921, 2002.
[17]
L.-Y. Wang, C.-P. Leong, Y.-C. Huang, J.-W. Hung, S.-M. Cheung, and Y.-P. Pong, “Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome,” Chang Gung Medical Journal, vol. 31, no. 5, pp. 469–476, 2008.
[18]
Y. S. Karadag, O. Karadag, and E. Cicekli, “Severity of carpal tunnel syndrome assessed with high frequency ultrasonography,” Rheumatology International, vol. 30, no. 6, pp. 761–765, 2010.
[19]
I. K. Kele？, A. T. Kendi, G. Aydin, S. G. Z？？, and S. Orkun, “Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome,” American Journal of Physical Medicine & Rehabilitation, vol. 84, pp. 443–450, 2005.
[20]
A. S. Klauser, E. J. Halpern, T. De Zordo et al., “Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers,” Radiology, vol. 250, no. 1, pp. 171–177, 2009.
[21]
M. Keberle, M. Jenett, W. Kenn et al., “Technical advances in ultrasound and MR imaging of carpal tunnel syndrome,” European Radiology, vol. 10, no. 7, pp. 1043–1050, 2000.
[22]
S. P. Mathew, P. Jonathan, S. K. Wasim, and J. Nicholas, “Is there light at the end of the tunnel? Controversies in the diagnosis and management of carpal tunnel syndrome,” American Association For Hand Surgery, vol. 5, no. 4, pp. 354–360, 2010.
[23]
J. D. Bland, “A neurophysiological grading scale for carpal tunnel syndrome,” Muscle & Nerve, vol. 23, no. 8, pp. 1280–1283, 2000.
[24]
L. Alemán, J. D. Berná, M. Reus, F. Martínez, G. Doménech-Ratto, and M. Campos, “Reproducibility of sonographic measurements of the median nerve,” Journal of Ultrasound in Medicine, vol. 27, no. 2, pp. 193–197, 2008.
[25]
G. S. Phalen, “The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands,” Journal of Bone and Joint Surgery A, vol. 48, no. 2, pp. 211–228, 1966.
[26]
J. W. Hilburn, “General principles and use of electrodiagnostic studies in carpal and cubital tunnel syndromes: with special attention to pitfalls and interpretation,” Hand Clinics, vol. 12, no. 2, pp. 205–221, 1996.
[27]
R. A. Werner, J. W. Albers, A. Franzblau, and T. J. Armstrong, “The relationship between body mass index and the diagnosis of carpal tunnel syndrome,” Muscle and Nerve, vol. 17, no. 6, pp. 632–636, 1994.
[28]
T. Jessie, P. Maureen, and A. Kerry, “Impact of ancestry and body size on sonographic ulnar nerve dimensions,” Radiography, vol. 18, no. 2, pp. 100–104, 2012.
[29]
T. F. Elwakil, A. Elazzazi, and H. Shokeir, “Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release,” Lasers in Medical Science, vol. 22, no. 4, pp. 265–270, 2007.
[30]
A. Mallouhi, P. Pültzl, T. Trieb, H. Piza, and G. Bodner, “Predictors of carpal tunnel syndrome: accuracy of gray-scale and color doppler sonography,” American Journal of Roentgenology, vol. 186, no. 5, pp. 1240–1245, 2006.
[31]
M. Courtney and J. Townsend, Sabiston Textbook of Surgery, Saunders Elsevier, Toronto, Canada, 18th edition, 2007.
[32]
J. Pomerance and I. Fine, “Outcomes of carpal tunnel surgery with and without supervised postoperative therapy,” Journal of Hand Surgery, vol. 32, no. 8, pp. 1159–1163, 2007.
[33]
D. Lee, M. T. Van Holsbeeck, P. K. Janevski, D. L. Ganos, D. M. Ditmars, and V. B. Darian, “Diagnosis of carpal tunnel syndrome: ultrasound versus electromyography,” Radiologic Clinics of North America, vol. 37, no. 4, pp. 859–872, 1999.
