Ultrasonographic diagnosis of carpal tunnel syndrome: introducing a new approach.

Abstract

CTS, the most common nerve entrapment syndrome of the upper limb, is being diagnosed by clinical criteria, in most cases supported by the electrodiagnosis method, which appears limits regarding its sensitivity and specificity and suggests an intervening and expensive technique. The purpose of this study was to contribute to establishing U/S examination as a method with at least of the same accuracy with electrodiagnosis. A sample of 60 healthy individuals and 30 patients suffering from CTS was scanned. The diagnosis was conducted by both clinical and electrodiagnostic criteria, or by clinical criteria supported by postsurgical outcome. In order to improve the accuracy of measurements, the anteroposterior to transverse diameter of the median nerve inside the canal and in its entrance was scanned and compared, by sonography. The examination conducted three times for each dimension, and the mean value per individual was calculated. The mean ratios for the 60 healthy wrists was found to range within the interval 0.49-0.88 (presenting a mean value of 0.66), and the corresponding for the 30 suffering from CTS wrists was within the interval 1.12-1.59 (with a mean value of 1.39). The statistical analysis of the examination results clearly demonstrates that the interval of ratios over the value 1.07 can be considered completely safe to diagnose that someone is suffering from CTS. In correspondence, a U/S measurement of ratios in the area up to 0.79 is completely safe to opine that this wrist refers to a healthy individual. The intermediate range of ratios 0.79-1.0 suggests a grey zone, which, by the rational of this study, does not include discrete CTS or healthy cases. This "gap" may describe subclinical or mild cases of CTS which were not been taken under consideration and for which there is no rational to interfere surgically. In the everyday's practice clinical point of view, the grey zone cases are considered healthy.