Role of ultrasound and electro-diagnostic studies in the diagnosis of carpal tunnel syndrome: A comparative study

Abstract

BACKGROUND: The current gold standard for the diagnosis of Carpal tunnel syndrome (CTS) is a topic of debate. Nerve conduction studies (NCS) traditionally have been used as the confirmatory test; however, ultrasound (USG) has garnered interest as an alternative diagnostic test for CTS. Ultrasound measurement of the cross sectional area of the median nerve at the carpal tunnel has been proposed as an alternative for confirmation of CTS.

AIM: The aim of the study was to compare the sensitivity and specificity between Ultrasound and Electro-diagnostic Studies in the diagnosis of Carpal Tunnel Syndrome with reference to a validated clinical diagnostic tool i.e. CTS- 6; that combines findings from the history and physical examination.

MATERIALS AND METHODS: 40 (20 Cases and 20 controls) adult patients and adolescents of both sexes with complain of pain and paraesthesia in upper limb were included in this cross sectional study. All patients were evaluated using CTS-6 clinical diagnostic tool. Those patients with CTS score≥12 were considered as positive diagnosis for Carpal Tunnel Syndrome (cases) (Main group). Those patients with CTS Score<12 were taken as Controls. Ultrasound and Electro-diagnostic Studies were performed by individuals blinded to the results of the CTS-6 and ultrasound examination.

RESULTS: We found that USG have sensitivity of 90%, specificity of 85%, and positive predictive value of 85.71% and negative predictive value of 89.47%. Whereas NCS have sensitivity of 85%, specificity of 80%, positive predictive value of 80.95% and negative predictive value of 84.21%.

CONCLUSION: Using CTS-6 clinical tool as a standard reference, the sensitivity and specificity of USG is more than that of NCS.

Keywords

carpal tunnel syndrome / ultrasound / electro-diagnostic studies

References

[1] Keith MW, Masear V, Chung KC, et al. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;(10):2478–2479. doi: 10.2106/JBJS.I.00643

[2] Keith M.W., Masear V., Chung K.C. et al. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on diagnosis of carpal tunnel syndrome // J. Bone Joint. Surg. Am. 2009. No. 10. P. 2478–2479. doi: 10.2106/JBJS.I.00643

[3] Solomon L, Warwick D, Nayagam S. Apley’s concise system of orthopaedics and fractures. 3rd edition. NY: Oxford University Press; 2005.

[4] Solomon L., Warwick D., Nayagam S. Apley’s concise system of orthopaedics and fractures. 3rd ed. NY: Oxford University Press, 2005.

[5] Zyluk A, Kosovets L. An assessment of the sympathetic function within the hand in patients with carpal tunnel syndrome. J Hand Surg Eur Vol. 2010;(5):402–408. doi: 10.1177/1753193409361292

[6] Zyluk A., Kosovets L. An assessment of the sympathetic function within the hand in patients with carpal tunnel syndrome // J. Hand. Surg. Eur. Vol. 2010. No. 5. P. 402–408. doi: 10.1177/1753193409361292

[7] Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil. 1997;76(6):451–457. doi: 10.1097/00002060-199711000-00004

[8] Kuhlman K.A., Hennessey W.J. Sensitivity and specificity of carpal tunnel syndrome signs // Am. J. Phys. Med. Rehabil. 1997. Vol. 76. No. 6. P. 451–457. doi: 10.1097/00002060-199711000-00004

[9] Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo JC, 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(6):853–859.

[10] 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. Vol. 25. No. 6. P. 853–859.

[11] Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br. 2005;30(4):361–364. doi: 10.1016/j.jhsb.2005.04.007

[12] Amirfeyz R., Gozzard C., Leslie I.J. Hand elevation test for assessment of carpal tunnel syndrome // J. Hand. Surg. Br. 2005. Vol. 30. No. 4. P. 361–364. doi: 10.1016/j.jhsb.2005.04.007

[13] De Krom MC, Knipschild PG, Kester AD, Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. Lancet. 1990;335(8686):393–395. doi: 10.1016/0140-6736(90)90218-t

[14] De Krom M.C., Knipschild P.G., Kester A.D., Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome // Lancet. 1990. Vol. 335. No. 8686. P. 393–395. doi: 10.1016/0140-6736(90)90218-t

[15] Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113(9):1373–1381. doi: 10.1016/s1388-2457(02)00169-4

[16] Werner R.A., Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology // Clin. Neurophysiol. 2002. Vol. 113. No. 9. P. 1373–1381. doi: 10.1016/s1388-2457(02)00169-4

[17] Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90(12):2587–2593. doi: 10.2106/JBJS.G.01362

[18] Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome // J. Bone Joint Surg. Am. 2008. Vol. 90. No. 12. P. 2587–2593. doi: 10.2106/JBJS.G.01362

[19] Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–158. doi: 10.1001/jama.282.2.153

[20] Atroshi I., Gummesson C., Johnsson R., Ornstein E., Ranstam J., Rosén I. Prevalence of carpal tunnel syndrome in a general population // JAMA. 1999. Vol. 282. No. 2. P. 153–158. doi: 10.1001/jama.282.2.153

[21] Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disorders. 2003;4:9. doi: 10.1186/1471-2474-4-9

[22] Atroshi I., Gummesson C., Johnsson R., Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome // BMC Musculoskelet Disorders. 2003. Vol. 4. P. 9. doi: 10.1186/1471-2474-4-9

[23] Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006;31(6):919–924.

[24] Graham B., Regehr G., Naglie G., Wright J.G. Development and validation of diagnostic criteria for carpal tunnel syndrome // J. Hand Surg. Am. 2006. Vol. 31. No. 6. P. 919–924.

[25] Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am. 2008;33(1):65–71. doi: 10.1016/j.jhsa.2007.10.014

[26] Kwon B.C., Jung K.I., Baek G.H. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome // J. Hand Surg. Am. 2008. Vol. 33. No. 1. P. 65–71. doi: 10.1016/j.jhsa.2007.10.014

[27] Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011;469(4):1089–1094. doi: 10.1007/s11999-010-1637-5

[28] 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. Vol. 469. No. 4. P. 1089–1094. doi: 10.1007/s11999-010-1637-5

[29] Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol. 1997;25(2):112–127. doi: 10.1016/s0720-048x(97)00038-7

[30] Buchberger W. Radiologic imaging of the carpal tunnel // Eur. J. Radiol. 1997. Vol. 25. No. 2. P. 112–117. doi: 10.1016/s0720-048x(97)00038-7

[31] Sarría L, Cabada T, Cozcolluela R, Martínez-Berganza T, García S. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol. 2000;10(12):1920–1925. doi: 10.1007/s003300000502

[32] Sarría L., Cabada T., Cozcolluela R., Martínez-Berganza T., García S. Carpal tunnel syndrome: usefulness of sonography // Eur. Radiol. 2000. Vol. 10. No. 12. P. 1920–1925. doi: 10.1007/s003300000502

[33] Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum. 2002;46(7):1914–1921. doi: 10.1002/art.10385

[34] Wong S.M., Griffith J.F., Hui A.C., Tang A., Wong K.S. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome // Arthritis. Rheum. 2002. Vol. 46. No. 7. P. 1914–1921. doi: 10.1002/art.10385

[35] Wang LY, Leong CP, Huang YC, et al. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J. 2008;31(5):469–476.

[36] Wang L.Y., Leong C.P., Huang Y.C. et al. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome // Chang Gung Med. J. 2008. Vol. 31. No. 5. P. 469–476.

[37] Wong SM, Griffith JF, Hui AC, et al. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology. 200;232(1):93–99. doi: 10.1148/radiol.2321030071

[38] Wong S.M., Griffith J.F., Hui A.C. et al. Carpal tunnel syndrome: diagnostic usefulness of sonography // Radiology. 2004. Vol. 232. No. 1. P. 93–99. doi: 10.1148/radiol.2321030071

[39] Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999;173(3):681–684. doi: 10.2214/ajr.173.3.10470903

[40] Duncan I., Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome // AJR Am. J. Roentgenol. 1999. Vol. 173. No. 3. P. 681–684. doi: 10.2214/ajr.173.3.10470903

[41] El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology (Oxford). 2004;43(7):887–895. doi: 10.1093/rheumatology/keh190

[42] El Miedany Y.M., Aty S.A., Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? // Rheumatology (Oxford). 2004. Vol. 43. No. 7. P. 887–895. doi: 10.1093/rheumatology/keh190

[43] Yesildag A, Kutluhan S, Sengul N, et al The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004;59(10):910–915. doi: 10.1016/j.crad.2004.03.020

[44] Yesildag A., Kutluhan S., Sengul N. et al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome // Clin. Radiol. 2004. Vol. 59. No. 10. P. 910–915. doi: 10.1016/j.crad.2004.03.020

[45] Ashraf AR, Jali R, Moghtaderi AR, Yazdani AH. The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome. Electromyogr Clin Neurophysiol. 2009;49(1):3–8.

[46] Ashraf A.R., Jali R., Moghtaderi A.R., Yazdani A.H. The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome // Electromyogr. Clin. Neurophysiol. 2009. Vol. 49. No. 1. P. 3–8.

[47] Fowler JR, Munsch M, Tosti R, et al. 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(17):e148. doi: 10.2106/JBJS.M.01250

[48] Fowler J.R., Munsch M., Tosti R. et al. 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. Vol. 96 No. 17. P. e148. doi: 10.2106/JBJS.M.01250

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Tungoe B.N., Chopra R.K., Agarwal Y., Jaiman A.