Comprehensive Assessment of Ultrasound's Role in Carpal Tunnel Syndrome in Reference to Electromyography.

Yaman M Alahmad,Alaa Al-Taie,Mohamad Alhuda Mohamad Alahmad,Fatima Al-Khafaji

doi:10.7759/cureus.20798

Abstract

Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy related to entrapment syndrome. An increase in the median nerve cross-sectional area (CSA) is visualized using ultrasound (US) imaging for CTS patients. This study aims to correlate, for the first time in the state of Qatar, the findings of US imaging and electromyography (EMG) in patients with CTS for diagnostic and classification purposes. First, US CSA was numerically obtained from patients' records. Second, EMG findings were gathered as normal, mild, moderate, and severe CTS. After that, we performed a different statistical approach than those used in the literature, using one-way analysis of variance (ANOVA) and post hoc tests for the final analysis. In summary, we found that the US seems unable to differentiate some normal from mild CTS cases; however, it appears to be excellent at differentiating moderate from severe CTS cases.

Highlights

Ultrasonography (US) is a continuously advancing radiological modality that uses sound waves and acoustic phenomena of body tissues to display an image of internal structures
The carpal tunnel syndrome (CTS) classification using the median nerve cross-sectional area (CSA) reported by the US when compared to EMG was as follows (95% confidence interval of the mean (CI)): normal: 8.7-10.8 mm2, mild CTS: 10.6-16.5 mm2, moderate CTS: 15.4-18.1 mm2, severe CTS: 19.1-23.1 mm2
We found that CTS classification using the median nerve CSA reported by the US when compared to EMG was as follows: normal: 8.7-10.8 mm2, mild CTS: 10.6-16.5 mm2, moderate CTS: 15.4-18.1 mm2, severe CTS: 19.123.1 mm2

Summary

Introduction

Ultrasonography (US) is a continuously advancing radiological modality that uses sound waves and acoustic phenomena of body tissues to display an image of internal structures. Its ionizing radiation-free mechanism of action, non-invasiveness, low cost, and time-effectiveness have made it one of the most desired diagnostic tools for clinicians in daily practice This has led to exponential growth in exploring its diagnostic profile in various medical conditions, including carpal tunnel syndrome (CTS). CTS, the most common mononeuropathy, refers to the clinical features related to the compression of the median nerve at either wrist within the carpal tunnels. Electrodiagnostic studies, nerve conduction studies (NCS), and electromyography (EMG) are currently the gold standard for CTS evaluation. These studies carry a critical role in decisions regarding surgical intervention based on the severity of median nerve compression. An increase in the median nerve cross-sectional area (CSA) is seen using US imaging for CTS patients. Establishing relevant outcomes may contribute to the generalizability and external validity of previously published studies

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