J Korean Neurosurg Soc.  2014 Feb;55(2):78-82. 10.3340/jkns.2014.55.2.78.

Value of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome: Correlation with Electrophysiological Abnormalities and Clinical Severity

• Kim MK
• Jeon HJ
• Park SH
• Park DS
• Nam HS

• KMID: 2191049
• DOI: http://doi.org/10.3340/jkns.2014.55.2.78

Abstract

OBJECTIVE
To investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity.
METHODS
Two-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity.
RESULTS
The mean CSA was 13.7+/-4.2 mm2 in symptomatic hands and 7.9+/-1.3 mm2 in asymptomatic hands. The mean FR was 4.2+/-1.0 in symptomatic hands and 3.4+/-0.4 in asymptomatic hands. The mean PB was 3.5+/-0.5 mm in symptomatic hands and 2.6+/-0.3 mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of 10 mm2 for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively.
CONCLUSION
Ultrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.

Keyword

Carpal tunnel syndrome; Ultrasonography; Diagnosis; Severity

MeSH Terms

Carpal Tunnel Syndrome*
Diagnosis*
Hand
Humans
Median Nerve
Reference Values
Sensitivity and Specificity
Ultrasonography*

Figure

• 

  Fig. 1 Transverse sonographic section of an enlarged median nerve (indicated by arrow) at the level of the pisiform bone in a subject with CTS. The cross-sectional area (CSA) of the median nerve (direct method within the oval dotted line) (A). The flattening ratio (FR) is defined as the ratio of the nerve's transverse axis to the antero-posterior axis (B). The palmar bowing (PB) of the flexor retinaculum is displacement of the retinaculum from the attachments of a ligament connecting the pisiform bone with the scaphoid bone (C). S: scaphoid bone, P: pisiform bone.

• 

  Fig. 2 ROC curve of ultrasonographic measurements. ROC: receiver operating characteristic, CSA: cross sectional area, FR: flattening ratio, PB: palmar bowing.

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