Abstract
ObjectivesTo investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).MethodsProspective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.ResultsShort-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.ConclusionsUltrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.
Highlights
Carpal Tunnel Syndrome (CTS) is the most frequent peripheral nerve entrapment syndrome, potentially leading to long-term pain and disability
Regression analysis revealed that the cross-sectional area (CSA), measured at the carpal tunnel inlet, predicted short-term clinical improvement according to Boston Questionnaire (BQ) in CTS patients undergoing carpal tunnel surgery, but not in patients treated conservatively
Ultrasound imaging with measurement of the cross-sectional area (CSA) and Power Doppler (PD) signals in the median nerve is a valuable tool for the diagnosis of CTS,[3] but it would be interesting to know whether sonographic findings might predict the clinical outcome of CTS patients
Summary
Carpal Tunnel Syndrome (CTS) is the most frequent peripheral nerve entrapment syndrome, potentially leading to long-term pain and disability. A few studies have investigated the prognostic value of CSA in the setting of established CTS undergoing carpal tunnel release (CTR). These studies, are limited by small sample size, selection bias and short-term follow-up. The results of these studies are contradictory: One study by Naranjo et al including 112 wrists found that patients with a large CSA at baseline had a better outcome after carpal tunnel surgery than those with a smaller CSA.[4] In contrast, Mondelli et al conducted a study of 67 patients and concluded that a smaller CSA was linked to a higher chance of patient satisfaction after CTR, as measured by the Levine/Boston Questionnaire (BQ).[5] In another study, the baseline CSA was not a significant predictor of the clinical outcome after carpal tunnel release. The baseline CSA was not a significant predictor of the clinical outcome after carpal tunnel release. [6,7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
