Carpal Tunnel Syndrome Grading Research Articles

Diagnostic efficacy of high-frequency Grey-scale ultrasonography and Sono-elastography in grading the severity of carpal tunnel syndrome in comparison to nerve conduction studies.

To correlate the cross-sectional area (CSA) and elasticity of the median nerve (MN) measured at carpal tunnel inlet between healthy controls and various degrees of carpal tunnel syndrome (CTS) graded as per nerve conduction studies (NCS). A total of 53 patients (with 81 wrists) presenting with clinical symptoms characteristic of CTS, having their diagnosis confirmed and severity graded by NCS, and 48 healthy controls (with 96 wrists) were included in the study. All the study participants underwent wrist ultrasound which included initial Grey-scale USG followed by strain and shear wave elastography. The CSA and elasticity (in terms of strain ratio and shear modulus) of MN were measured at the carpal tunnel inlet. Statistical analysis was performed using the Mann-Whitney U test to compare between the two groups and for subgroup analysis of cases. The diagnostic performance of each variable was evaluated using the receiver operating characteristic curves. The mean CSA was 9.20 ± 1.64, 11.48 ± 1.05, 14.83 ± 1.19 and 19.87 ± 2.68 mm2, the mean shear modulus was 17.93 ± 2.81, 23.59 ± 2.63, 32.99 ± 4.14 and 54.26 ± 9.24kPa and the mean strain ratio was 5.26 ± 0.68, 5.56 ± 0.70, 7.03 ± 0.47 and 8.81 ± 0.94 in control, mild, moderate and severe grades of CTS, respectively (p < 0.001). The combined utility of Grey-scale USG and Elastography may serve as a painless and cost-effective alternative to NCS in grading the severity of CTS.

Value of MUNE versus compound muscle action potential in assessing motor unit loss in patients with carpal tunnel syndrome

BackgroundThe most prevalent nerve entrapment disorder, known as carpal tunnel syndrome (CTS), is brought on by wrist-based median nerve compression. Focal demyelination progresses to axonal dysfunction as the condition worsens. In order to detect motor unit (MU) loos, this study compares two motor unit number estimation (MUNE) techniques with compound muscle action potential (CMAP) amplitude. The CMAP amplitude and MUNE of the median nerve in 137 hands of 70 neurophysiologically approved CTS patients, aged 40.27 ± 10.06 years were examined. Another 90 hands from 56 healthy volunteers who are age- and gender-matched serve the control group.ResultsIn contrast to 192.5 and 248.5 in controls, the median nerve values of incremental and adapted multipoint stimulation (aMPS) MUNE in CTS patients were, respectively, 111 and 133 (p < 0.0001). Patients with severe CTS compared to those with mild CTS using both methods had significantly lower MUNE. MUNE values are the same regardless of gender or hand dominance. In comparison to MUNE methods (cutoff values of 106.5 and 203, respectively), CMAP amplitude had a sensitivity and specificity of more than 60% in detecting MU loss (cutoff value of 6.85 mV). The CTS grading had no effect on the CMAP amplitude. MUNE values had positive with CMAP amplitude and negative with CTS grading and Phalen test positivity.ConclusionsWhen identifying motor nerve involvement in CTS patients, the MUNE technique is more accurate than a standard motor nerve conduction study (NCS). It was emphasized that MUNE evaluation in determining MU loss in the early stages of CTS may be helpful in diagnosis and treatment. There was no correlation between handedness and the number of MUs as determined by MUNE techniques. Both methods almost equally identify MU loss and have the same sensitivity and specificity.

Association of upper extremity anthropometry and subcutaneus adipose tissue with carpal tunnel syndrome

<p>Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders.</p>. <p>Our study included 150 patients who were diagnosed with CTS clinically and electrophysiologically and 165 healthy controls. The biceps and triceps skinfold thickness, the diameters of the wrist and metacarpal joints, and the upper arm circumferences over the belly of the biceps muscle were measured by using skinfold caliper and measuring cylinder. All data were analyzed by using the Statistics Open For All package (SofaStats) programme. To detect the role of anthropometric indexes, we used multivariable multinomial logistic regression models.&nbsp;</p>. <p>We revealed that BMI, biceps and triceps adipose tissue thicknesses were higher in females and also in patients with CTS. There was a positive correlation between electrophysiological grades of CTS and BMI with logistic regression analyzes. The mean Wrist circumference/Metacarpo&shy;ph&shy;arengeal Circumference ratio and biceps circumference were higher in moderate CTS groups. Metacarpofarengeal circumference was smaller in mild and moderate CTS cases compared to healthy ones.</p>. <p>We suggest that the differen&shy;ces between the anatomical bone structure and local adiposity between the genders may play an important role in the occurrence of CTS. Moreover, the structures of proximal muscle groups and distal metacarpal joints may contribute both to the development and severity of CTS.</p>.

Ultrasound-guided interventions in primary carpal tunnel syndrome: perineural injection to thread carpal tunnel release.

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and electrophysiological study are complementary in the diagnosis and grading of CTS in appropriate clinical settings. The initial management of patients with CTS is conservative with medical therapy and splinting. However, surgical interventions are indicated in patients in whom medical management has failed. With evolution of the concept of safe zone on ultrasonography and identification of the sonoanatomical landmarks of carpal tunnel in greater detail, Ultrasonography-guided interventions are safer and preferred over surgical management in CTS. The primary ultrasonography-guided interventions include perineural injection, perineural hydrodissection and ultrasonography-guided release of transverse carpal ligament. This review article presents the principles of ultrasonography-guided perineural injection, perineural hydrodissection in CTS, the merits and demerits of injectant used in perineural injection/ hydrodissection, and percutaneous ultrasonography-guided thread release of transverse carpal ligament utilizing the concept of safe zone of the ultrasonography-guided interventions for CTS.

Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome.

This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.

ARTIFICIAL INTELLIGENCE BASED RATING OF CARPAL TUNNEL SYNDROME EFFICACY IN CLINICAL DIAGNOSIS

Objective: The most common entrapment neuropathy seen by the clinician is Carpal tunnel syndrome (CTS). CTS is graded as mild, moderate, and severe according to the results obtained on electroneuromyography (ENMG) by clinicians. We aimed to show the effectiveness of the use of artificial intelligence in clinical diagnosis in the grading of CTS.&#x0D; Methods: In our study, the data of 315 people with a pre-diagnosis of CTS were used and classified into four classes based on AI as CTS grade. Machine Learning (ML) algorithms Ensemble, Support Vector Machine (SVM), K-Nearest Neighbor (KNN), and Decision Tree (Tree) algorithms were used in classification processes. 10% Hold-out validation was used and the learning rate was determined as 0.1. As a result of the classification, accuracy, precision, sensitivity, specificity, and F1-score performance values were obtained. &#x0D; Results: SVM made the best estimation and KNN made the worst estimation in the 0 class. The best estimate in class 1 belongs to the Support Vector Machine. Ensemble and Tree made the best guesses in the 2nd and 3rd grades. In our study, the best algorithm with an overall success rate is SVM with 93.55%. &#x0D; Conclusions: The results showed that ML algorithm models consistently provided better predictive results and would assist physicians in determining the medical treatment modality of CTS. Artificial intelligence (AI) techniques are reliable methods that assist clinicians to deliver quality healthcare.

Significance of Early Diagnostic of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. The conservative treatment remains the first therapeutic choice in the treatment of mild and moderate CTS. The aim of this paper was to examine the average age of female patients with CTS diagnosed by EMNG, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the nerve when the CTS diagnosis is confirmed for the first time. The retrospective examination included 187 female patients, aged from 27 to 79, with complains on unilateral CTS. All patients underwent EMNG for confirmation of CTS and the degree of damage to median nerve. Statistical analysis was performed by methods of descriptive statistics, Kruskal-Wallis test, and the Student t-test. The value of p 0.05 was considered statistically significant. The average age of the female examinees was 54.53 years. The bilateral CTS was confirmed in 67.9 %, most often of a moderate degree and more often on the right hand. No statistically significant difference was found in grades of CTS between the analysed age groups of patients that had the bilateral CTS (p = 0.206), nor there was a difference in years of life between the patients with unilateral and bilateral CTS (p = 0.638). Bilaterality of CTS, as well as the degree of the damage are not connected with age. The patients report timely for the first examination and diagnostics of CTS when there is still a possibility of the conservative treatment.

Shear wave elastography is a valuable tool for diagnosing and grading carpal tunnel syndrome.

To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37m/s and 19.4 ± 5.8kPa) than in controls (1.91 ± 0.24m/s and 11.1 ± 3.0kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39m/s and 22.4 ± 7.1kPa) than in the mild CTS group(2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6kPa, with 87% and 82% sensitivity and specificity. MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.

The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome in Bangladeshi Population

Introduction: The CTS is one of the clinical syndromes, it was experienced by the patients from numbness, tingling, burning and or pain associated with localized compression of the median nerve at the wrist. Median nerve with the carpel tunnel (CTS) is localized and it was compressed in median nerve, resulting in mechanical compression and local ischemia has been associated with age and sex matched control. Objective: To assess The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome in Bangladesh Population. Methods: A prospective study was conducted at Department of Neurology, Uttara Adhunik Medical College Hospital (UAMCH), Uttara, and Dhaka, Bangladesh from January to December 2021. A total 100 case were prospectively observed for the period of six months 50 patients’ with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined. Based on clinical assessment, the study patients were divided into 03 groups with mild CTS, moderate CTS and severe CTS respectively as per Mackinnsons classification. The relationship between the clinical severity grade and various nerve conduction study parameters were correlated. The study was correlated with age and gender matched control intervention and we extrapolate the any significant correlation between the clinical grades and various attributes of study traits. All the traits were carefully assessed by using logistic regression analysis and Fisher F- test statistics. Results: Out of 50 patients with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined. The Left hand was involved in 11patients; right hand in 19 patients &amp; 20 patients had involvement of both hands. Numbness and tingling of hand and first three fingers was the most common presenting symptom. Phalens test was positive 30 (60.0%) of our patients. 7(14.0%) pts had hypothyroidism, 10(20%) patients showed raised DM and 4(8.0%) patients showed lipid profile abnormalities. Both male and female sex ratio was 1:3. All cases were considered for the study. The distal motor latency was significantly correlated with different age group of the population and CMAP and conduction velocity not shows any significant relation with clinical severity of CTS. Since, the median sensory latency and nerve conduction velocity seen in study population and well apprehension with clinical different grading of CTS. Conclusion: Summing of the results concludes that, the sensory conduction appears to be more sensitive (95%) AUC 0.89 and significantly correlated when compared to motor conduction attributes, the correlation besides with clinical severity of CTS apart from gender and age matched cases.

HP55 : Association of Neurophysiological grading of Carpal tunnel syndrome with sleep quality and depression

The aim of this study was to investigate the association of nerve conduction study parameters with the sleep quality and depression in a clinically suspicious Carpal Tunnel Syndrome. Introduction: Carpal tunnel syndrome (CTS) is a frequent condition in which sleep and humor are disturbed. These disturbances can be related to neurophysiological grading. Methods: It’s a transversal study collecting data of patients with CTS clinical symptoms consulting for nerve conduction study (NCS). According to Padua’s classification, hands were divided into three groups: G1 (normal NCS), G2 (minimal and mild) and G3 (moderate, severe and extreme). Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI) were used and compared to NCS parameters. Kruskall-wallis and post-hoc tests were applied. Results: 88 hands were collected. According to PSQI, G1 (N=16), G2 (N=19) and G3 (N=53) had sleep disturbances with a significant increase in G3 (G1: 5,56 ± 0,81; G2: 6,26 ± 1,32; G3: 6,71 ± 1,29; p=0.003). According to BDI, three groups had a mild depression and no significant difference was between them (G1: 11,56 ± 2,18; G2: 12,36 ± 1,94; G3: 12,15 ± 2,81), however, G2 had the highest score. PSQI was significantly correlated with NCS parameters (p<0.05) when BDI wasn’t correlated with any one of them in all the sample. Conclusion: The neurophysiological grading of CTS showed that more severe stages with sensory and motor implications had significantly worst quality of sleep. While depression wasn’t related to a CTS grade nor NCS parameters, even if less severe stages were more depressive.

Does Patient Sex Affect Ultrasound Cutoff Values for Severity Grading of Carpal Tunnel Syndrome?

A growing body of evidence supports ultrasound (US) as an alternative first-line confirmatory test for carpal tunnel syndrome (CTS). Recent studies have demonstrated a correlation of US cross-sectional area with electrodiagnostic (EDX)-determined severity; however, it is unclear whether patient sex affects the cutoff values used for determining severity. The purpose of this study was to determine if patient sex affects US graded severity when using EDX as the reference standard. A cohort of 367 women and 46 men, aged 18-90 years, from 1 orthopedic hand surgeon's practice underwent EDX and US. Distal motor latency and distal sensory latency of the median nerve were recorded. Severity was classified using a modified Bland severity scale. The US measurements of the cross-sectional area of the median nerve at the wrist crease were acquired by a fellowship-trained hand surgeon. Separate receiver operator characteristic curve analyses of the male and female groups were performed for US cutoff values. The cutoff value in both the female (F) and male (M) patients was 11 mm2 for mild (area under the curve= 0.76 F; 0.78 M), 12 mm2 for moderate (area under the curve= 0.75 F; 0.73 M), and 13 mm2 for severe (area under the curve= 0.75 F; 0.71 M) CTS. The sensitivity of the cutoffs for mild, moderate, and severe CTS in the female and male groups was 49% and 56%, 44% and 50%, and 49% and 44%, respectively. The specificity of the cutoffs for mild, moderate, and severe CTS in the female and male groups was 75% and 79%, 74% and 82%, and 83% and 78%, respectively. Patient sex does not appear to have a significant impact on the determination of CTS severity graded using US cutoff values. Ultrasound can be used to grade the severity of CTS with a 75% to 85% specificity but low sensitivity. A cutoff value of 13 mm2 can be used to classify CTS as severe. Prognostic II.

Assessing Diagnostic and Severity Grading Accuracy of Ultrasound Measurements for Carpal Tunnel Syndrome Compared to Electrodiagnostics

The combined sensory index (CSI) is the most sensitive electrodiagnostic criteria for carpal tunnel syndrome (CTS), and the CSI and Bland criteria have been shown to predict surgical treatment outcomes. The proposed ultrasound measurements have not been assessed against the CSI for diagnostic accuracy and grading of CTS severity. To investigate the use of ultrasound evaluations for both diagnosis and assessment of severity grading of CTS in comparison to electrodiagnostic assessment. All patients underwent an electrodiagnostic evaluation using the CSI and Bland severity grading. Each patient underwent an ultrasound evaluation including cross-sectional area (CSA), the change in CSA from the forearm to the tunnel (∆CSA), and the wrist-forearm ratio (WFR). These measurements were assessed for diagnostic and severity grading accuracy using the CSI as the gold standard. Tertiary academic center. All patients referred for electrodiagnostic evaluation for CTS were eligible for the study. Only those with idiopathic CTS were included and those with prior CTS treatment were also excluded. Ninety-five patients were included in the study. Not applicable. The primary study outcome measure was concordance between CSI diagnosis and severity categories and the ultrasound measurements. Both outcomes were also assessed using Bland criteria. Optimal cut-points for diagnosis of CTS were found to be CSA ≥12 mm2 , ∆CSA ≥4 mm2 , WFR ≥1.4. Using these cut-points, C-statistics comparing diagnosis of CTS using ultrasound measurements versus using the CSI ranged from 0.893-0.966. When looking at CSI severity grading compared to ∆CSA, however, the C-statistics were 0.640-0.661 with substantial overlap between severity groups. Although ultrasound measurements had high diagnostic accuracy for CTS based on the CSI criteria, ultrasound measurements were unable to adequately distinguish between CSI severity groups among patients with CTS.

Ultrasound Assessment of Carpal Tunnel Syndrome in Comparison with Nerve Conduction Study: A Case-control Study

Introduction: Carpal Tunnel Syndrome (CTS) is the entrapment neuropathy which is diagnosed based on the clinical history, examinations and the electrophysiological findings. The Cross- sectional Area (CSA) measurement of the median nerve has emerged as an alternative to Nerve Conduction Studies (NCS) for diagnosis of CTS. This study was done to correlate NCS and Ultrasonography (USG) in clinically diagnosed CTS patients. Aim: To evaluate the diagnostic value of Cross-sectional Area (CSA) of median nerve at carpal tunnel inlet in patients with clinically and NCS confirmed Carpal Tunnel Syndrome (CTS) and to assess severity of the syndrome by NCS and its correlation with USG results. Materials and Methods: This was a hospital based, case-control study done on a total of 109 patients of CTS and analysed during the period from June 2017 to June 2019. Total 203 hands of the patients with abnormal NCS formed case group while 101 hands from healthy volunteers constituted the control group. All the patients underwent neurological evaluation by Boston Carpal Tunnel Questionnaire (BCTQ) and were divided into mild, moderate and severe according to the score. An electromyography machine was used to perform electrophysiological studies of both the limbs in all subjects. CTS was diagnosed electro-diagnostically based on the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and were classified as mild (Grades 1 and 2), moderate (Grades 3 and 4), and severe (Grades 5 and 6) grades using Bland’s electrophysiological grading scale. USG was performed for all the subjects and all the data of various investigations was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 software. Chi-square test and Mann Whitney U-test were used as test of significance for qualitative data. Results: The mean age of subjects was 44.38±9.561 years. Strongly significant association was observed in BCTQ symptom, functional and total scores with NCS severity grading (p-value &lt;0.001). Moderately significant association was found between BCTQ symptom and total scores with USG severity grading (p-value&lt;0.02). Tunnel grade and NCS grade were found significantly correlated (p-value &lt;0.001). The mean CSA cut-off value of 8.5 mm² at the inlet of carpal tunnel had a good sensitivity 86.21%, specificity 83.17%, Positive Predictive Value (PPV) 91.1% and Negative Predictive Value (NPV) 75%. Conclusion: The diagnostic accuracy of USG assessment and NCS was found to be correlated comparably and complement each other in all grades of CTS. USG, can be considered a preferable screening tool by the patients of CTS due to its painless nature and easy accessibility. It requires minimal time and many a times detects those structural abnormalities which have great therapeutic implications. In mild CTS cases, USG should always be combined with NCS for proper diagnosis as USG might give negative result.

Diagnosis and grading of carpal tunnel syndrome with quantitative ultrasound: Is it possible?

The recent diagnostic tools for carpal tunnel syndrome (CTS) include nerve conduction studies (NCS) and ultrasound (US). Quantitative US (QUS) can be used for demonstrating muscle changes according to denervation. The aim of this study was to evaluate if QUS can diagnose and grade the severity of CTS. In this single blinded cross-sectional study, female patients diagnosed with CTS and age-matched healthy female subjects were included in the study. Median and ulnar nerve conduction studies (NCS) were performed for CTS diagnosis. Median and ulnar nerve cross-sectional area (CSA) was measured, and the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles were longitudinally and transversally visualised. Axial images were analysed for echo intensity (EI) via computer-assisted, grayscale analysis. Intra-rater and inter-rater reliability analysis was performed. The Boston questionnaire was used for the evaluation of symptom severity and functional status. Forty-two patients (42 hands) and 32 controls were included. In the CTS group, 17 patients had mild, 13 patients had moderate, and 12 patients had severe CTS. CSA of the median nerve and APB echo intensity was significantly higher in patients with CTS. However, according to the CTS grade, no significant difference was detected for APB EI. The intraclass correlation coefficient (ICC) was calculated as 0.928 for intra-rater reliability and 0.768 for inter-rater reliability. QUS evaluation is helpful for the diagnosis of CTS, but not for grading. Further studies are needed with a larger population including both genders.

The diagnostic accuracy of high-resolution ultrasound in screening for carpal tunnel syndrome and grading its severity is moderated by age

ObjectiveTo assess the effect of age on the accuracy of high-resolution ultrasound (HRUS) in the diagnosis and grading of carpal tunnel syndrome (CTS). MethodsPatients with symptoms and signs of CTS (N = 527 wrists) were evaluated using electrodiagnostic studies (EDx) for CTS diagnosis and grading. Median nerve cross-sectional areas at carpal tunnel inlet (CSA) and at forearm level were measured by HRUS and the ratio of these values was calculated (WFR). Healthy controls underwent identical testing (N = 122 wrists). HRUS accuracy was assessed against the EDx standard by Receiver Operator Characteristic (ROC) curve analysis. ResultsIn patients >65 y with moderate and severe CTS, disease-related increases in CSA and WFR were negatively correlated with increasing age. Subjects were grouped by age into younger (<65 y) and older (≥65 y). The c-statistics for CSA and WFR respectively were: For CTS diagnosis, younger group: 0.94 and 0.96 (excellent); older group: 0.85 and 0.86 (satisfactory). For CTS grading, younger group: differentiating mild CTS from controls: 0.90 and 0.92 (excellent); mild from moderate: 0.79 and 0.74 (satisfactory); moderate from severe: 0.82 and 0.78 (satisfactory). For CTS grading, older group: differentiating mild CTS from controls: 0.83 and 0.83 (satisfactory); mild from moderate: 0.53 and 0.61 (poor); moderate from severe: 0.65 and 0.53 (poor). ConclusionsFor subjects aged <65 y, HRUS accuracy is excellent in CTS diagnosis and satisfactory in grading. For older subjects, accuracy is satisfactory in diagnosis but not in grading. SignificanceHRUS for CTS has diagnostic limitations selectively in older individuals.

Body, wrist, and hand anthropometric measurements as risk factors for carpal tunnel syndrome

AimThe aim of this study was to identify cut-off values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS).Patients and methodsThis study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cut-off values, sensitivity, and specificity were calculated separately for each measured parameter.ResultsThere were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS.ConclusionThe cut-off values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS.

S38. Boston questionnaire and neurophysiological findings in carpal tunnel syndrome in Sri Lanka

Although the common clinical presentation of carpal tunnel syndrome (CTS) is the presence of numbness or pain in the hand, many attempts have been made to develop a score based on clinical findings. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) is a standardised, patient-based outcome measure of symptom severity and functional status. It has been widely used in different populations. The objective of this study was to find out BCTQ findings among Sri Lankan patients suspected with CTS and correlate the findings with neurophysiological parameters. In a group of 147 patients suspected of carpal tunnel syndrome (CTS) based on the presence of numbness or pain in the hand, BCTQ was administered as an interview-based questionnaire format and the nerve conduction tests were performed on the median and ulnar nerves using a Natus EMG machine at the Neurophysiological Unit of the Teaching Hospital, Peradeniya, Sri Lanka. Neurophysiological grading was done according to the scale described by Bland in 2000. Mean age was 49.4 ± 11.9 years. BCTQ symptom and functional scores showed no correlation with the severity of CTS grading. In BCTQ, questions on numbness (r = 0.3, P < 0.001), numbness at night (r = 0.3, P < 0.05) and numbness causing waking up (r = 0.2, P < 0.05) were significantly correlated with the severity of CTS grading. Mean symptom and functional scores were comparable with a previous Indian study which showed a lower score than that was reported for the western CTS patients. In 19.7% of patients neurophysiological findings were normal. Neurophysiological severity in CTS could be predicted by the scores related to numbness in BCTQ.

Reply to Considerations About "Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography".

Reply to Considerations About "Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography".

P227 Carpal tunnel syndrome grading using high-resolution ultrasonography

Introduction Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the wrist. The diagnosis of CTS has been a concern for physicians for a long time. The aim of this study is to evaluate the use of the median nerve (MN) cross-sectional area (CSA) in the wrist compared with the CSA in the forearm to grade the severity of carpal tunnel syndrome in Egyptian patients. Methods The cross sectional areas of the median nerve in the wrist and forearm were measured in 72 wrists that were diagnosed with carpal tunnel syndrome via nerve conduction studies (NCS) and 80 healthy wrists. The CTS group was subdivided into 3 subgroups (mild, moderate and severe CTS). The ratio of the cross sectional area of the median nerve in the wrist to that in the forearm (WFR) was used to calculate cutoff values for carpal tunnel syndrome grading. Results There were positive correlations between the CSAs of the MN in the wrist and MN conduction latency. At a WFR of 1.7, the high resolution ultrasonography (HRUS) showed 96.1% accuracy in the detection of carpal tunnel syndrome. Conclusion As the disease severity increased, the CSA in the wrist showed significant increase among all groups so HRUS could be used for carpal tunnel grading.

Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the wrist. The diagnosis of CTS has been a concern for physicians for a long time. The aim of this study is to evaluate the use of the median nerve (MN) cross-sectional area (CSA) in the wrist compared with the CSA in the forearm to grade the severity of CTS in Egyptian patients. The CSAs of the MN in the wrist and forearm were measured in 72 wrists that were diagnosed with CTS via nerve conduction studies and 80 healthy wrists. The CTS group was subdivided into three subgroups (mild, moderate, and severe CTS). The ratio of the CSA of the MN in the wrist to that in the forearm was used to calculate cutoff values for CTS grading. There were positive correlations between the CSAs of the MN in the wrist and MN conduction latency. At a wrist-forearm ratio of 1.7, the high-resolution ultrasonography showed 96.1% accuracy in the detection of CTS. High-resolution ultrasonography can be used in CTS grading.