The Use of Neuromuscular Ultrasound and NCS/EMG Testing in the Differential Diagnosis of Carpal Tunnel Syndrome and Radiculopathy

Abstract

ABSTRACTBackground and Purpose: The Neuromuscular ultrasound and Nerve conduction studies/Electromyography (NCS/EMG) are valuable diagnostic tools that examine and diagnose several nerve problems. The purpose of this case report is to describe a diagnostic electrophysiologic evaluation that differentiates between carpal tunnel syndrome (CTS) and radiculopathy in very mild or early stage cases. Case Description: The patient was a 30-year-old woman who sustained a tingling sensation in the second and third digits of her left hand, radiating pain in her left upper extremity and occasional neck pain. The patient cannot determine whether her radiating pain starts from the neck to her hand or starts from her hand up to the neck. Physical examination was not conclusive. Neuromuscular ultrasound and NCS/EMG were used to assess the median nerve at the carpal tunnel and the C6-7 nerve roots. A proof of the median nerve injury at the wrist was confirmed. The patient was treated with a night wrist splint. Outcomes: The patient’s symptoms were diminished after the use of the night splint for a period of approximately 4 weeks. A follow-up electrodiagnostic evaluation reveals improvement compared to the previous data with no electrophysiologic evidence of a current nerve injury status. Discussion: Neuromuscular ultrasound and NCS/EMG combined techniques helped in the differential diagnosis between CTS and C6-7 nerve roots radiculopathy. In this case, physical examination could not give an immediate conclusive answer.