Abstract
BackgroundTo compare the value of ultrasonography for diagnosing carpal tunnel syndrome (CTS) in patients with and without diabetes mellitus (DM).MethodsEighty non-DM and 40 DM patients with electromyography-confirmed CTS were assessed and underwent high-resolution ultrasonography of the wrists. Cross-sectional area (CSA) and flattening ratio (FR) of the median nerve were measured at the carpal tunnel outlet (D) and wrist crease (W).ResultsThe 80 non-DM and 40 DM patients had 81 and 59 CTS-hands, respectively. The CSA_D and CSA_W were significantly larger in the CTS-hands and DM-CTS-hands compared to the normal control (p < 0.001). However, there is no difference of CSA_D and CSA_W between DM and non-DM CTS patients. Receiver operating characteristics [ROC] curve analysis revealed that CSA_W ≥13 mm2 was the most powerful predictor of CTS in DM (area under curve [AUC] = 0.72; sensitivity 72.9%, specificity 61.9%) and non-DM (AUC = 0.72; sensitivity 78.5%, specificity 53.2%) patients. The CSA positively correlated with the distal motor latency of the median compound motor action potential (CMAP), distal sensory latency of the median sensory nerve action potential (SNAP), and latency of the median F wave, but negatively correlated with the amplitude of the median CMAP, amplitude of the median SNAP, and sensory NCV of the median nerve. Stepwise logistic regression revealed that CSA_W (OR 1.21, 95% CI 1.07-1.38; p = 0.003) was independently associated with CTS in DM patients and any 1 mm2 increase in CSA_W increased the rate of CTS by 28%.ConclusionsThe CSA of the median nerve at the outlet and wrist crease are significantly larger in CTS hands in both DM and non-DM patients compared to normal hands. The CSA of the median nerve by ultrasonography may be a diagnostic tool for evaluating CTS in DM and non-DM patients.
Highlights
To compare the value of ultrasonography for diagnosing carpal tunnel syndrome (CTS) in patients with and without diabetes mellitus (DM)
Body mass index (BMI), and wrist circumference were significantly higher in the DM patients than in the nonDM patients and controls (p < 0.05)
Wrist crease is a predictive factor for CTS in DM patients and any increase of 1 mm2 in the cross-sectional area (CSA) at the wrist crease increases the predictive rate by 28%
Summary
To compare the value of ultrasonography for diagnosing carpal tunnel syndrome (CTS) in patients with and without diabetes mellitus (DM). Most investigators agree that CSA measurement of the median nerve at the pisiform bone is a valid and reliable test for diagnosing CTS [8]. Diabetes mellitus (DM) is a risk factor for CTS [9], reports about median nerve CSA measurements between CTS patients with and without DM are scant. The aim of this study was to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM CTS patients. This study was made to elucidate the diagnostic value of ultrasonography and correlate the diagnostic accuracy of ultrasonography with electrodiagnostic results in both DM and non-DM CTS patients
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