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Does measuring the median nerve at the carpal tunnel outlet improve ultrasound CTS diagnosis?

Abstract：

INTRODUCTION:Nerve conduction is often regarded as more sensitive than ultrasonography (US) for diagnosing carpal tunnel syndrome (CTS). The diagnostic value of US derives from median nerve enlargement occurring at both ends of the carpal tunnel resulting in a dumbbell-like swelling from carpal tunnel pressure. An important reason for the inferior sensitivity of US may be because measurements are restricted to the carpal tunnel inlet. We investigate the value of including median nerve enlargement at the carpal tunnel outlet for diagnosing CTS. METHODS:Retrospective cohort study of nerve conduction verified CTS, determining sensitivity, specificity, and positive and negative predictive values of carpal tunnel inlet and outlet median nerve cross sectional area as determined by US for the diagnosis of CTS. Nerve conduction graded CTS severity. RESULTS:127 hands from 77 patients with CTS and 35 control healthy hands were assessed. US sensitivity for diagnosing CTS increased from 65% to 84% by including outlet enlargement of the median nerve. Specificity changed from 94% to 86%, positive predictive value from 98% to 96% and the negative predictive value from 43% to 60%. 25 hands out of the 127 from CTS patients showed enlargement restricted to the outlet and mainly occurred in moderate CTS. CONCLUSION:In our population, the use of carpal tunnel outlet median nerve enlargement in addition to inlet median nerve size increases sensitivity for diagnosing CTS by 19%.

journal_name

J Neurol Sci

journal_title

Journal of the neurological sciences

authors

Paliwal PR,Therimadasamy AK,Chan YC,Wilder-Smith EP

doi

10.1016/j.jns.2014.01.018

subject

Has Abstract

pub_date

2014-04-15 00:00:00

pages

47-51

issue

1-2

eissn

0022-510X

issn

1878-5883

pii

S0022-510X(14)00042-2

journal_volume

339

pub_type

杂志文章

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