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Abstract
BackgroundMedian nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.MethodsArticles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.DiscussionA comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.Systematic review registrationPROSPERO 2016 CRD42016037286
Highlights
Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome
Despite the promising and supportive data for the use of sonography in the evaluation of median nerve pathology, (2019) 8:2 three significant concerns remain pervasive across research and clinical literature
To advance the precision of screening, prevention, and diagnosis for the evaluation of median nerve pathology, it is essential to have a robust set of common reference values for the CSA of the median nerve that can be used in research and clinical practice
Summary
This review protocol adheres to the requirements of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) [24], and the final report will be developed to meet the requirements of the PRISMA guidelines [25]. Once the data is ready for synthesis, a rerun of the full search and study selection process will be conducted to identify and include recently published and non-published studies that meet the inclusion criteria of the review. Consensus meetings among the team are being held when any reviewer is unable to make a decision regarding inclusion for an article At this step, results from the gray literature (e.g., conference abstracts, study protocols) are being compared to other published literature to identify possible full publication of study findings. Data abstracted from the studies will include demographic information (e.g., age, sex, race/ethnicity, handedness) of the healthy, asymptomatic participants; a description of the participant inclusion and exclusion criteria;’ study sample size; study and author location (e.g., country or nation); anatomic location(s) of median nerve measurement; and the mean and variance measures of median nerve CSA
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