Carpal Tunnel Syndrome Group Research Articles

The Application of Ultrasound Image-Based Radiomics in the Diagnosis of Mild Carpal Tunnel Syndrome.

The ultrasound diagnosis of mild carpal tunnel syndrome (CTS) is challenging. Radiomics can identify image information that the human eye cannot recognize. The purpose of our study was to explore the value of ultrasound image-based radiomics in the diagnosis of mild CTS. This retrospective study included 126 wrists in the CTS group and 88 wrists in the control group. The radiomics features were extracted from the cross-sectional ultrasound images at the entrance of median nerve carpal tunnel, and the modeling was based on robust features. Two radiologists with different experiences diagnosed CTS according to two guidelines. The area under receiver (AUC) operating characteristic curve, sensitivity, specificity, and accuracy were used to evaluate the diagnostic efficacy of the two radiologists and the radiomics model. According to guideline one, the AUC values of the two radiologists for CTS were 0.72 and 0.67, respectively; according to guideline two, the AUC were 0.73 and 0.68, respectively. The radiomics model achieved the best accuracy when 16 important robust features were selected. The AUC values of training set and test set were 0.92 and 0.90, respectively. The radiomics label based on ultrasound images had excellent diagnostic efficacy for mild CTS. It is expected to help radiologists to identify early CTS patients as soon as possible, especially for inexperienced doctors.

Impaired median nerve mobility in patients with carpal tunnel syndrome: a systematic review and meta-analysis.

This systematic review and meta-analysis investigated the mobility of the median nerve (MN) in carpal tunnel syndrome (CTS) patients compared to healthy people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed and the electronic databases including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to April 2022. All published observational studies comparing the excursion of MN between participants with and without CTS were included. The quality of research was assessed by the Newcastle-Ottawa Scale tool. The primary outcome was the excursion of the MN under dynamic examination, representing nerve mobility quantified by the standardized mean difference (SMD) for random effect meta-analysis. Fourteen studies were included in the qualitative review, and twelve entered the meta-analysis involving a total of 375 CTS patients and 296 healthy controls. The forest plot revealed that the mobility of the MN significantly decreased in the CTS group compared to the non-CTS control (SMD = -1.47, 95% CI: -1.91, -1.03, p < 0.001, heterogeneity 82%). In subgroup analysis, both transverse and longitudinal methods for nerve excursion showed less nerve mobility in CTS than in non-CTS. This meta-analysis showed that the patients with CTS exhibited less mobility of the MN than those without CTS, suggesting MN mobility as a potential CTS marker. • The patients with CTS revealed less mobility of the median nerve than those without CTS. • The mobility of the median nerve could be regarded as a potential CTS marker.

Ultrasound-based radiomics in the diagnosis of carpal tunnel syndrome: The influence of regions of interest delineation method on mode.

In the recent years, artificial intelligence (AI) algorithms have been used to accurately diagnose musculoskeletal diseases. However, it is not known whether the particular regions of interest (ROI) delineation method would affect the performance of the AI algorithm. The purpose of this study was to investigate the influence of ROI delineation methods on model performance and observer consistency. In this retrospective analysis, ultrasound (US) measures of median nerves affected with carpal tunnel syndrome (CTS) were compared to median nerves in a control group without CTS. Two methods were used for delineation of the ROI: (1) the ROI along the hyperechoic medial edge of the median nerve but not including the epineurium (MN) (ROI1); and (2) the ROI including the hyperechoic epineurium (ROI2), respectively. The intra group correlation coefficient (ICC) was used to compare the observer consistency of ROI features (i.e. the corresponding radiomics parameters). Parameters α1 and α2 were obtained based on the ICC of ROI1 features and ROI2 features. The ROC analysis was used to determine the area under the curve (AUC) and evaluate the performance of the radiologists and network. In addition, four indices, namely sensitivity, specificity, positive prediction and negative prediction were analyzed too. A total of 136 wrists of 77 CTS group and 136 wrists of 74 control group were included in the study. Control group was matched to CTS group according to the age and sex. The observer consistency of ROI features delineated by the two schemes was different, and the consistency of ROI1 features was higher (α1˃α2). The intra-observer consistency was higher than the inter-observer consistency regardless of the scheme, and the intra-observer consistency was higher when chose scheme one. The performances of models based on the two ROI features were different, although the AUC of each model was greater than 0.8.The model performed better when the MN epineurium was included in the ROI. Among five artificial intelligence algorithms, the Forest models (model1 achieved an AUC of 0.921 in training datasets and 0.830 in testing datasets; model2 achieved an AUC of 0.967 in training datasets and 0.872 in testing datasets.) obtained the highest performance, followed by the support vector machine (SVM) models and the Logistic models. The performances of the models were significantly better than the inexperienced radiologist (Dr. B. Z. achieved an AUC of 0.702). Different ROI delineation methods may affect the performance of the model and the consistency of observers. Model performance was better when the ROI contained the MN epineurium, and observer consistency was higher when the ROI was delineated along the hyperechoic medial border of the MN.

The Diagnostic Value of the Median Nerve Sonography in Chronic Phase Carpal Tunnel Syndrome Cases in Indonesia

Background. Ultrasound evaluation on the median nerve in carpal tunnel syndrome (CTS) patients by measuring cross-sectional area (CSA) is widely known. However, studies have shown that CSA of the median nerve could vary in different demographical factors. Therefore, the cut-off CSA value for CTS in the Indonesian population could be significantly different. Purpose. To compare mean CSA of the median nerve between normal and CTS populations and establish a cut-off point of CSA to diagnose CTS. Materials and Methods. A comparative cross-sectional study was conducted involving 40 people divided equally into CTS and normal groups. Normal and CTS subjects are determined by Electrodiagnostic study (EDx) using EMG and Nerve Conduction Study (NCS). The CSA measurement was performed at the level of the carpal tunnel inlet. Results. The mean CSA value at the level of tunnel inlet of the normal group was 8.3 ± 1.4 mm2 and for the CTS group is 15.4 ± 4.4 mm2. The receiver operating characteristics (ROC) analysis showed 10.6 mm2 as the cut-off point with 95% sensitivity and 95% specificity (P&lt;0.001). Conclusion. The median nerve CSA at the tunnel inlet is significantly larger in the CTS population and the cut-off point can be recommended in detecting CTS in the Indonesian population.

A new diagnostic morphological parameter for the Carpal tunnel syndrome: The palmaris longus tendon cross-sectional area.

Carpal tunnel syndrome (CTS) is correlated with increased intracarpal canal pressure (ICP). The effect of palmaris longus tendon (PLT) loading on ICP is documented in previous researches. PLT loading induces the greatest absolute increase in ICP. Therefore, to analyze the connection between the PLT and CTS, we newly made the measurement of the PLT cross-sectional area (PLTCSA). We assumed that PLTCSA is a reliable diagnostic parameter in the CTS. PLTCSA measurement data were acquired from 21 patients with CTS, and from 21 normal subjects who underwent wrist magnetic resonance imaging (W-MRI). We measured the PLTCSA at the level of pisiform on W-MRI. The PLTCSA was measured on the outlining of PLT. The two different cutoff values in the analysis were determined using receiver operating characteristic (ROC) analysis. The mean PLTCSA was 2.34 ± 0.82 mm2 in the normal group and 3.97 ± 1.18 mm2 in the CTS group. ROC curve analysis concluded that the best cutoff point for the PLTCSA was 2.81 mm2, with 76.2% sensitivity, 71.4% specificity, and area under the curve of 0.88 (95% CI, 0.78‐0.98). PLTCSA is a sensitive, new, objective morphological parameter for evaluating CTS.

High-Dimensional Analysis of Finger Motion and Screening of Cervical Myelopathy With a Noncontact Sensor: Diagnostic Case-Control Study.

Cervical myelopathy (CM) causes several symptoms such as clumsiness of the hands and often requires surgery. Screening and early diagnosis of CM are important because some patients are unaware of their early symptoms and consult a surgeon only after their condition has become severe. The 10-second hand grip and release test is commonly used to check for the presence of CM. The test is simple but would be more useful for screening if it could objectively evaluate the changes in movement specific to CM. A previous study analyzed finger movements in the 10-second hand grip and release test using the Leap Motion, a noncontact sensor, and a system was developed that can diagnose CM with high sensitivity and specificity using machine learning. However, the previous study had limitations in that the system recorded few parameters and did not differentiate CM from other hand disorders. This study aims to develop a system that can diagnose CM with higher sensitivity and specificity, and distinguish CM from carpal tunnel syndrome (CTS), a common hand disorder. We then validated the system with a modified Leap Motion that can record the joints of each finger. In total, 31, 27, and 29 participants were recruited into the CM, CTS, and control groups, respectively. We developed a system using Leap Motion that recorded 229 parameters of finger movements while participants gripped and released their fingers as rapidly as possible. A support vector machine was used for machine learning to develop the binary classification model and calculated the sensitivity, specificity, and area under the curve (AUC). We developed two models, one to diagnose CM among the CM and control groups (CM/control model), and the other to diagnose CM among the CM and non-CM groups (CM/non-CM model). The CM/control model indexes were as follows: sensitivity 74.2%, specificity 89.7%, and AUC 0.82. The CM/non-CM model indexes were as follows: sensitivity 71%, specificity 72.87%, and AUC 0.74. We developed a screening system capable of diagnosing CM with higher sensitivity and specificity. This system can differentiate patients with CM from patients with CTS as well as healthy patients and has the potential to screen for CM in a variety of patients.

Evaluation of strain echocardiography and atrial electromechanical delay in patients with idiopathic carpal tunnel syndrome

Aim: Carpal tunnel syndrome (CTS) could be an early marker for amyloidosis before developing of overt symptoms of cardiac amyloidosis (CA). CA characterized with left ventricular (LV) diastolic dysfunction and impairment of LV deformation-based parameters. There is limited data about echocardiographic parameters such as strain value of LV, diastolic parameters and atrial EMD in patients with idiopathic CTS. In this study, we investigated LV strain values, diastolic parameters of LV and atrial EMD in patients with idiopathic CTS. Then, we compared these parameters in CTS patients to control group. Material and Method: Thirty-four patients with idiopathic CTS and twenty-four aged and sex matched volunteers were enrolled to study. Patients with known amyloidosis, heart failure, diabetes mellitus and secondary etiologic states for CTS such as trauma or rheumatologic disease were excluded from the study. ECG and echocardiographic examination of each patient were performed and recorded by cardiology specialist. Conventional and strain imaging echocardiography were performed. Atrial electromechanical delays (EMD) were measured. Results: Baseline characteristics features were not different in groups. Mitral inflow velocities (mitral E and A wave), mitral E wave deceleration time, tissue Doppler velocities (lateral annular E’ and A wave), E/A and E/E’ ratios were similar in two groups. Septal basal strain values increased in CTS group (-21.3±4.83% vs -25.7±2.96%, p&amp;lt;0.001). Septal apical to base ratio (SAB) and relative apical sparing (RELAPS) were increased in CTS group compared to control group (0.94±0.43 vs 0.66±0.12, 0.90±0.31 vs 0.73±0.08, p=0.004, p=0.013, respectively). PA lateral, PA septal, inter-atrial EMD and intra-atrial EMD were significantly higher in CTS group compared to control group (78.2±12.3 ms vs 70.6±9.9 ms, 64.1±8.42 ms vs 58.3±10.1 ms, 25.8±9.09 ms vs 20.7±5.31 ms, 11.68±5.11 ms vs 8.46±3.02 ms, p=0.015, p=0.023, p=0.009 and p=.008, respectively). Conclusion: In CTS group, mean basal strain decreased compared to control group. SAB and RELAPS which associate with CA, decreased in CTS group. Atrial EMD prolonged in CTS group. These changes may associate with increased risk of CA and AF in patients with CTS.

Coexistence of Migraine and Carpal Tunnel Syndrome

Aim: Migraine and carpal tunnel syndrome (CTS) are two common health problems that have some common features and are frequently encountered in society. Is it possible for these two tables, which have so much in common, to coexist? If so, is this association meaningful? The study was designed in order to find answers to these questions.&#x0D; Method: This study was performed with a total of 345 subject as 178 patients having carpal tunnel syndrome (CTS) and 167 migraine patients. The first group was composed of those diagnosed with CTS based on the nerve conduction measurements in the electrophysiology laboratory. These patients were classified according to the international headache classification criteria and those with and without migraine were determined in the light of the data in the questionnaire. The second group, called as migraine group, comprised of those admitted to the neurology outpatient clinic and diagnosed with migraine. The study was designed as a cross-sectional and comparative study.&#x0D; Results: Of the 345 patients who remained in the study after exclusion criteria, 178 were in the CTS group and 167 were in the migraine group. Although approximately 80,3% of those with CTS had migraine, only 12,6% of those diagnosed with migraine had CTS.&#x0D; Conclusion and Suggestions: We consider that migraine headaches may create a predisposition to contract CTS in the future. Additional studies are needed to support this view.

The Effectiveness of Plasma Rich in Growth Factors (PRGF) in the Treatment of Nerve Compression Syndromes of the Upper Extremity: A Retrospective Observational Clinical Study.

Background: Nerve compression syndromes of the upper extremity are a common cause of neuropathic pain and functional impairment. Recently, platelet-rich plasma (PRP) infiltrations have emerged as an effective biological approach to the treatment of this type of injury. The objectives of this retrospective observational study were to assess clinical improvement in patients with median and ulnar nerve entrapment syndrome after undergoing biologically-assisted nerve release surgery with plasma-rich-in-growth-factors (PRGF) technology. Methods: Participants (n = 39) with moderate-to-severe nerve compression syndrome of the upper limb diagnosed by both electromyography and clinical examination, and who were treated with PRGF, were identified from the center’s medical records. The evaluation was based on patient-reported outcomes. Pre- and post-treatment differences in the Visual analog scale (VAS), the Boston carpal tunnel questionnaire (BCTQ), and the Quick-DASH score were assessed. Results: Three study groups were conducted: patients with carpal tunnel syndrome (n = 16), with recurrent carpal tunnel syndrome (n = 8), and with ulnar nerve entrapment (n = 15). The median follow-up was 12 months (interquartile range (IQR), 9–16). In comparison to pre-treatment values, all three study groups obtained statistically significant improvements for the three analyzed scales at the end of the follow-up, with p < 0.001 for all scales in the carpal tunnel syndrome and ulnar nerve entrapment groups and p < 0.01 for all scales in the recurrent carpal tunnel syndrome group. There were no serious adverse effects in the analyzed patients. Conclusion: PRGF-assisted open surgical nerve release treatment (intraneural and perineural liquid PRGF infiltrations and nerve wrapping with PRGF membrane) exerts long-term beneficial effects on pain reduction and functional improvement in the nerve and nerve–muscle unit in patients with upper extremity compression syndromes.

Is the left/right judgment task performance altered in unilateral carpal tunnel syndrome: And associated with symptom severity?

BackgroundLeft/right judgment task performance (LRJT) is impaired in severe neuropathic pain conditions. However, comparison of LRJT performance in patients with carpal tunnel syndrome (CTS) with a control group with similar cognitive functions has not been investigated. ObjectiveThe aim of the study was to compare the LRJT performance of CTS patients with healthy controls and the unaffected side. MethodsSeventy-five CTS patients with dominant, right-hand involvement and 75 control subjects were included in the study. The Recognize® tablet application was used for LRJT performance. Tactile acuity (Two-point discrimination) and handgrip strength; pain severity (Visual Analog Scale) and neuropathic component of pain (Pain Detect Questionnaire); symptom severity and functional impact of CTS (Boston CTS Assessment Test) were evaluated. Mixed-design ANOVAs and correlation analyses were used for data analysis. DesignCross-sectional study. ResultsAnalysis of variance showed that there was no significant effect of side (affected versus unaffected) or group (CTS versus control group) on recognition accuracy or time. Significant group*site interactions were found for the two-point discrimination F (1,148) = 6.388, p = 0.013; and for handgrip strength F (1,148) = 17.552, p < 0.01. A statistically significant negative correlation was found between recognition accuracy and symptom duration and a significant positive correlation was found between recognition accuracy and handgrip strength in CTS patients (r = −0.267, p = 0.020; r = 0.290, p = 0.012). ConclusionCTS patients recognize the affected side as accurately and quickly as the unaffected side and control group. Further research is needed to clarify the relationship between LRJT performance in the severely affected CTS group. ClinicalTrials.gov registration numberNCT04967144 ClinicalTrials.gov registration date19 July 2021

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.

Long-Term Outcome of Electrodiagnostic Values and Symptom Improvement After Carpal Tunnel Release: A Retrospective Cohort Study

The aim of this study was to evaluate electrodiagnostic studies and clinical outcomes after carpal tunnel release surgery in moderate and severe cases of carpal tunnel syndrome (CTS). Seventy-two patients with moderate or severe CTS who underwent carpal tunnel release surgery (46 unilateral; 26 bilateral; total, 98 surgeries) between 2009 and 2014 were included in the study. The cases were divided into 2 groups according to electrodiagnostic results: those with moderate CTS and those with severe CTS. Michigan Hand Outcomes Questionnaire scores and electrodiagnostic data (sensory nerve action potentials and compound muscle action potentials) were recorded before surgery and in postoperative follow-up studies obtained at 3 months, 1 year, and 5 years. There were 56 surgeries in the moderate CTS group and 42 surgeries in the severe CTS group. Sensory nerve action potentials and compound muscle action potentials were significantly lower in the severe CTS group when compared to the moderate CTS group at all follow-up times. There was a significant difference in Michigan Hand Outcomes Questionnaire scores between the groups before surgery, but no significant differences at the final follow-up. It was found that the values of all parameters (sensory nerve action potentials, compound muscle action potentials, and Michigan Hand Outcomes Questionnaire score) demonstrated significant improvements with time in both the severe and the moderate CTS groups. Carpal tunnel release surgery improves symptoms, regardless of the preoperative severity. Postoperative electrodiagnostic study results of patients with moderate CTS improve to a greater degree than those of patients with severe CTS, but all remain abnormal. Prognosis IIb.

Diagnostic Value of Ultrasound for Detecting Carpal Tunnel Syndrome in Patients With Rheumatoid Arthritis: A Three-Arm Cross-Sectional Study

Objective: This study was conducted to assess the diagnostic value of sonography in detecting carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and to compare the results with a normal control group. Materials and Methods: In this three-arm cross-sectional study, the sonographically measured median nerve cross-sectional area (MNCSA) was compared in three groups: RA patients with CTS, RA patients without CTS, and normal subjects (no RA, no CTS). A nerve conduction study (NCS) was performed for all enrolled participants, across the three study arms. Results: In this study, 38 RA patients (17 in CTS group and 21 in no CTS group) and 19 healthy subjects were recruited. The MNCSAs were 11.86 (±1.87) mm2 in RA patients with CTS, 10.16 (±1.71) mm2 in RA patients without CTS, and 9.42 (±1.46) mm² in healthy control patients. The accuracy of sonography in detecting CTS was 0.79 (95% confidence interval, 0.67–0.91), with a sensitivity and specificity of 88% and 57%, respectively. The MNCSA in CTS group was significantly higher than the control group ( P = .02). Conclusion: In this cohort, the sonographic measurement of MNCSA was an accurate and sensitive method for the diagnosis of CTS, especially in its early stages. In addition, in this cohort, RA without CTS did not increase the MNCSA.

Diagnostic Utility of Superb Microvascular Imaging and Power Doppler Ultrasonography for Visualizing Enriched Microvascular Flow in Patients With Carpal Tunnel Syndrome.

Recent studies suggest that blood flow changes in the median nerve may help confirm a diagnosis of carpal tunnel syndrome (CTS). Herein, we examined the utility of superb microvascular imaging (SMI), a new ultrasonographic (US) technique for visualizing microvascular flow, for detecting blood flow differences between CTS patients and healthy controls. We performed a retrospective analysis of 28 hands with suspected CTS. Patients received both nerve conduction and US examinations. Ten healthy volunteers were enrolled as the control group. The nerve compression ratio and the blood flow signal area were quantified using color Doppler US (CDUS), power Doppler US (PDUS), and SMI. Correlation analyses between the blood flow signal area, the compound muscle action potential of the thenar muscle, and the nerve compression ratio were performed. As a result, the mean nerve compression ratio was found to be significantly higher in the CTS group. There were no differences in the blood flow signal area between the groups using CDUS, while PDUS and SMI showed higher blood flow signals in the CTS group. The blood flow signal area measured by SMI had stronger correlations with the compound muscle action potential amplitude and the nerve compression ratio than those for PDUS. The diagnostic utility of SMI was equivalent to PDUS, but superior to conventional CDUS. Nevertheless, the blood flow signal by SMI was more strongly correlated with the electrophysiological severity and compression ratio than for PDUS. Use of SMI in future studies may help clarify the underlying mechanisms of blood flow changes in CTS.

Clinical Value Analysis of High-Frequency Ultrasound Combined with Carpal Dorsiflexion Electrophysiological Detection in the Diagnosis of Early Carpal Tunnel Syndrome.

Objective To investigate the clinical value of ultrasound combined with electrophysiological examination in the diagnosis of early carpal tunnel syndrome, we aimed to provide a new EMG (electromyography) method for detecting early carpal tunnel syndrome by exploring the wrist back stretch position and electrophysiological examination. Methods For the 82-lateral wrist (case group) of 62 patients with clinical symptoms or confirmed carpal tunnel syndrome and 40 normal healthy patients, neuroelectrophysiological measurements were performed using a Keypoint6.0 EMG evoked potentiometer, measuring each group twice: conventional position (before compression) and dorsal wrist extension position. The measures for each measurement included DSL, DML, and CAMP. Measure sensory conduction first and then measure motor conduction. The measurements were analyzed in a comprehensive comparative analysis. Combined ultrasound examination, the positive rate of combined ultrasound examination and electrophysiological examination was compared, respectively. Results In the carpal tunnel syndrome (CTS) group, the anterior and posterior median nerve DSL was (4.27 ± 0.73) ms and (4.82 ± 0.65) ms, and SNAP was (13.32 ± 13.68) UV and (12.19 ± 11.04) UV; the median nerve (wrist-bunions) DML was (5.29 ± 1.26) ms and (5.54 ± 1.29) ms, and CMAP was (6.44 ± 2.40) mV and (6.21 ± 2.46) mV. Mid-median DSL and DM in the CTS group L were significantly longer than before compression; median nerve SNAP and CMAP were significantly reduced compared with before compression. Conclusion Electrophysiological testing at the dorsal carpal extension position has high diagnostic value in the diagnosis of mild carpal tunnel syndrome. It helps to improve the diagnostic rate of early carpal tunnel syndrome, while providing a more accurate and effective EMG detection of early carpal tunnel syndrome, and combination examination of neuroelectrophysiology and ultrasound can improve the diagnosis rate of compression peripheral nerve diseases and clarify the site, nature, and scope of compression lesions, which is worthy of clinical application.

Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study

Confirmation of carpal tunnel syndrome (CTS) diagnosis with sonographic measurement of the median nerve cross sectional area (MN-CSA) is increasing in popularity. We aimed to analyse the ultrasonography (USG) values of MN-CSA in pregnant women with and without CTS symptoms. MN-CSAs of third trimester pregnant women were measured with USG and they were asked about the presence of CTS symptoms. Symptomatic participants were assigned to the CTS group and remaining participants were assigned to the Control group. The groups were compared according to MN-CSA. Twenty-five participants were grouped in CTS group and the remaining 64 participants were grouped in Control group. The MN-CSA was higher in the CTS group (9.44 ± 2.68) than in the Control group (7.20 ± 1.99), p = .00004. Obstetricians can use USG measurement of MN-CSA to confirm CTS diagnosis and consequently can offer conservative management, which is the widely accepted treatment modality in this cohort. Impact statement What is already known on this subject? CTS is the most common mononeuropathy of pregnancy, with up to 62% prevalence rates. The American Association of Neuromuscular & Electrodiagnostic Medicine practice guideline for the diagnosis of CTS recommends sonographic measurement of median nerve swelling at the carpal tunnel inlet as an accurate diagnostic test (Level A). What do the results of this study add? We found that a simple sonographic measurement of median nerve cross sectional area (MN-CSA) at the wrist appears to be a convenient method to confirm clinical CTS diagnosis in pregnant women. This study offers to use USG to confirm clinical CTS diagnosis in third trimester pregnant women before delivery. What are the implications of these findings for clinical practice and/or further research? This study will help to raise awareness of obstetricians about CTS during pregnancy. USG can be an effective first-line confirmatory test for CTS diagnosis in the pregnant population, but further research is necessary to determine a clear cut-off value for MN-CSA. We advise obstetricians to use sonographic measurement of MN-CSA in pregnant women with typical CTS symptoms, which will increase uniformity for consensus development. Obstetricians can offer advice for conservative management of CTS during pregnancy, which is the widely accepted treatment in this cohort.

Difference and ratio of the cross-sectional area of median nerve at the carpal tunnel and the pronator quadratus muscle in diagnosing carpal tunnel syndrome: a cross-sectional study.

BackgroundAt present, the most commonly used diagnostic method of carpal tunnel syndrome (CTS) is based on clinical manifestations and electrophysiology, but the electrophysiology is not cheap, invasive, and lacks the presentation of peripheral nerve conditions, which is exactly the advantage of ultrasound (US). The purpose of this study was to evaluate the accuracy and effectiveness of US in the diagnosis of CTS by calculating the cross-sectional area (CSA) at the carpal tunnel and proximally at the level of the pronator quadratus muscle., and to find an appropriate index that can be used to achieve the diagnosis in a more cost-effective manner.MethodsForty-three wrists from 35 symptomatic CTS patients and 23 wrists from 18 asymptomatic volunteers were evaluated. Diagnosis in the CTS group was based on the American Academy of Neurology clinical diagnostic criteria. The ultrasonic probe was placed at the carpal tunnel and the distal 1/3 of the pronator muscle respectively, and the carpal tunnel cross-sectional area (CSAC) and the proximal cross-sectional area (CSAP) was calculated, with a further calculation of their difference (ΔCSA) and ratio (R-CSA).ResultsThere was a significant difference between the 2 groups regarding mean ± standard deviation (SD) of CSAC, CSAP, ΔCSA, and R-CSA (P<0.01). The cutoff value of 12.14 mm2 for CSAC had a sensitivity and specificity of 90.7% and 100%, respectively; the cutoff value of 1.235 mm2 for R-CSA had a sensitivity and specificity of 97.67% and 95.65%, respectively; and the cutoff value of 2.035 mm2 for ΔCSA had a sensitivity and specificity of 100% and 100%, respectively. Therefore, US was found to be an effective method for the diagnosis of CTS. Receiver operating characteristic curve (ROC) analysis of all patients showed area under the curve (AUC) was 0.9778 for CSAC, 0.9949 for R-CSA and 1.000 for ΔCSA.ConclusionsUS can provide reference values for the diagnosis of CTS. CSAC, ΔCSA, and R-CSA can be used for CTS diagnosis and evaluation. The ROC curve analysis showed that among the 3 values, ΔCSA was the most useful in the diagnosis of patients with CTS. ΔCSA is considered a valid diagnostic value for CTS, as its threshold of 2.04 mm2 showed the highest sensitivity and specificity.

Cross-sectional Area Ratio of Median-to-Ulnar and Median-to-Superficial Radial Nerve at the Wrist for Diagnosis of Carpal Tunnel Syndrome.

ABSTRACTObjectives:This study aimed to evaluate the diagnostic properties for carpal tunnel syndrome (CTS) of the median-to-ulnar cross-sectional area ratio (MUR) and the median-to-superficial radial cross-sectional area ratio (MRR).Methods:A case–control study was conducted. A physiatrist, blinded to the CTS status of the subjects, assessed the cross-sectional area of the median nerve (CSA-m), MUR, and MRR at the distal wrist crease for the CTS and control groups. The relationship of CSA-m, MUR, and MRR with CTS severity was tested using Spearman’s correlation. The overall diagnostic accuracy was determined using the area under the receiver operating characteristic curve (AUC). The cut-off values to diagnose CTS were chosen to achieve similar values for sensitivity and specificity.Results:There were 32 hands in the CTS group and 33 hands in the control group. The correlations of CSA-m, MUR, and MRR with CTS severity were 0.66, 0.56, and 0.34, respectively. The AUCs of CSA-m, MUR, and MRR were 0.86 (95%CI: 0.77–0.95), 0.79 (0.69–0.90), and 0.69 (0.56–0.82), respectively. The cut-off values of CSA-m, MUR, and MRR were 12 mm2 (sensitivity, 81.3%; specificity, 81.8%), 2.6 (sensitivity, 68.8%; specificity, 69.7%), and 10 (sensitivity, 65.6%; specificity, 63.6%), respectively.Conclusions: MUR and MRR had acceptable diagnostic abilities but did not show superiority over CSA-m for CTS diagnosis.

Utility of shear wave elastography and high-definition color for diagnosing carpal tunnel syndrome

ObjectiveThe diagnostic values of measuring median nerve (MN) stiffness and vascularity with shear wave elastography (SWE) and high-definition (HD) color were investigated in carpal tunnel syndrome (CTS). MethodsSeventy patients (123 wrists) with CTS and thirty-five healthy volunteers (70 wrists) were enrolled. Based on nerve conduction studies (NCS), the patients were subdivided into NCS-negative, mild-to-moderate, and severe CTS groups. MN and abductor pollicis brevis (APB) SWE and MN HD color were performed on a longitudinal plane. ResultsThe mild-to-moderate and severe CTS groups showed increased MN stiffness at the wrist and MN stiffness ratio (wrist-to forearm) compared with the control (p < 0.001). The NCS-negative CTS group showed increased MN stiffness at the wrist (p = 0.022) and MN stiffness ratio (p = 0.032) compared with the control. The severe CTS group showed increased MN stiffness at the wrist compared with the mild-to-moderate CTS group (p = 0.034). The cutoff-values in diagnosing NCS-confirmed CTS were 50.12 kPa for MN stiffness at the wrist, 1.91 for MN stiffness ratio, and grade 1 for HD color. ConclusionsSWE and HD color are good supportive tools in diagnosing and assessing severity in CTS. SignificanceSWE and HD color demonstrated that MN in CTS was associated with increased stiffness and hypervascularity.

Ring finger sensory latency difference in the diagnosis and treatment of carpal tunnel syndrome

ObjectiveTo explore the sensitivity of median and ulnar nerve sensory latency differences in diagnosing carpal tunnel syndrome (CTS) at different severities.MethodsCTS patients were divided into three groups based on disease severity (mild, moderate, and severe). Distal latency of sensory nerve action potential (SNAP) for the median and ulnar nerves was recorded. The sensitivity of SNAP distal latency to CTS and its correlation with CTS severity were analyzed.ResultsSignificant differences were found in the median nerve sensory action potential distal latency (MSDL) and in the median and ulnar sensory latency difference to ring finger (MUD) but not in the ulnar nerve sensory action potential distal latency (USDL) between CTS and control. The sensitivity and specificity were 92.2 and 99.4% with an MSDL cutoff value of 2.40 ms, respectively, and were both 100% with a MUD cutoff value of 0.33 ms. There was no significant difference in USDL among the CTS and control groups. Significant differences were found in MSDL and MUD among the CTS severities and between mild and moderate CTS, but not between mild and severe CTS or between moderate and severe CTS. Correlations with CTS severity were observed for MSDL and MUD but not for USDL.ConclusionThe ulnar nerve of the CTS patients was not damaged. A smaller MSDL reflected median nerve damage, which can be used for the early diagnosis of CTS. MUD correlated with CTS severity with a higher sensitivity than MSDL, which can provide therapeutic insight without pain to patients.