Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome.

Yuichi Yoshii,Peter C Amadio,Chunfeng Zhao

doi:10.3390/diagnostics10080596

Abstract

With the widespread use of high-resolution ultrasonography, ultrasonic examination has been shown to be useful as a diagnostic method for carpal tunnel syndrome. The main advantages of ultrasonography are that it is simple, quick, non-invasive, and economical. Another advantage is that tissue dynamics can be observed with real-time imaging. In recent reports, it has been shown that ultrasonic examination can provide similar diagnostic accuracy as nerve conduction study in the diagnosis of carpal tunnel syndrome. It has been expected that ultrasound demand in daily medical care will continue to increase. Ultrasonography in carpal tunnel syndrome shows an enlarged median nerve in proximal carpal tunnel, thickening of the flexor retinaculum, and edema around flexor tendons in cross-sectional images. In addition, with the introduction of new technologies such as ultrasonic elastography and speckle tracking, it has become possible to quantify dynamics and material property changes of nerves, tendons, and their surrounding structures. In this review, we describe recent advancements of carpal tunnel syndrome diagnosis based on ultrasound dynamic images, and discuss its pathology.

Highlights

Carpal tunnel syndrome (CTS) was first reported in 1854 by Paget as a posttraumatic entrapment neuropathy at the wrist joint [1]
Since this review focused on the recent advancement in ultrasound diagnosis of CTS, extra keywords’ search of “elastography” or “dynamic assessment” or “motion assessment” and “carpal tunnel syndrome” were performed and related articles were included for the Sections 3–5
It is well accepted currently that static ultrasound measurement of median nerve cross-sectional area is helpful in the diagnostic evaluation of CTS patients as the initial diagnostic test and may, in some cases, at least, eliminate the need for EP testing

Summary

Introduction

Carpal tunnel syndrome (CTS) was first reported in 1854 by Paget as a posttraumatic entrapment neuropathy at the wrist joint [1]. The diagnosis of carpal tunnel syndrome is established by the history, clinical symptoms, and physical examination. Recent technological advances in ultrasonography have improved its image quality as well as affordability, leading to an increased adaptation of ultrasound evaluation of nerve entrapment syndromes. For inclusion in this review, a PubMed search was conducted using keywords “carpal tunnel syndrome” and “ultrasonography” or “ultrasound”. The articles excluded were those that did not address ultrasound diagnosis of CTS from the titles. Since this review focused on the recent advancement in ultrasound diagnosis of CTS, extra keywords’ search of “elastography” or “dynamic assessment” or “motion assessment” and “carpal tunnel syndrome” were performed and related articles were included for the Sections 3–5

Static Cross-Sectional Ultrasound for CTS Assessment

Ultrasound Elastography for CTS Assessment

Future

Future Perspectives

Findings

Conclusions