Criteria For Carpal Tunnel Syndrome Research Articles

Diagnostic criteria and outcome measures in randomized clinical trials on carpal tunnel syndrome: a systematic review

The diagnostic criteria for carpal tunnel syndrome (CTS) lack uniformity. Moreover, because CTS is a syndrome, there is no consensus as to which signs, symptoms, clinical and complementary tests are more reproducible and accurate for use in clinical research. This heterogeneity is reflected in clinical practice. Thus, establishing effective and comparable care protocols is difficult. To identify the diagnostic criteria and outcome measures used in randomized clinical trials (RCTs) on CTS. Systematic review of randomized clinical trials carried out at the Federal University of São Paulo, São Paulo, Brazil. We searched the Cochrane Library, PubMed, and Embase databases for RCTs with surgical intervention for CTS published between 2006 and 2019. Two investigators independently extracted relevant data on diagnosis and outcomes used in these studies. We identified 582 studies and 35 were systematically reviewed. The symptoms, paresthesia in the median nerve territory, nocturnal paresthesia, and special tests were the most widely used clinical diagnostic criteria. The most frequently assessed outcomes were symptoms of paresthesia in the median nerve territory and nocturnal paresthesia. The diagnostic criteria and outcome measures used in RCTs about CTS are heterogeneous, rendering comparison of studies difficult. Most studies use unstructured clinical criteria associated with ENMG for diagnosis. The Boston Questionnaire is the most frequently used main instrument to measure outcomes. PROSPERO (CRD42020150965- https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965).

Development of an Objective Structured Clinical Examination Checklist and a Post-Education Questionnaire for Musculoskeletal Ultrasound Training Focusing on Volar Wrist and Carpal Tunnel Syndrome

Background: The objective structured clinical examination (OSCE) is used in the colleges of Korean Medicine, but few studies have validated the OSCE evaluation criteria or post-education questionnaires. Diagnostic ultrasound is used in Korean medicine treatment including acupuncture, acupotomy, and pharmacopuncture to increase the safety and efficacy of treatment. We aimed to develop and validate a OSCE checklist and questionnaire for diagnostic musculoskeletal ultrasound training.Methods: A OSCE checklist and rubric for diagnostic ultrasound training, and questionnaire was developed using literature research. Eight expert panelists verified each draft item in a single-round survey. Items with a content validity ratio (CVR) < 0.75 were excluded or modified to reflect the experts’ opinions.Results: The OSCE checklist and rubric for diagnostic ultrasound training focusing on volar wrist and carpal tunnel syndrome included: 15 items revised according to CVR and expert opinions, the pre-examination procedure, structures to be identified by ultrasound, scans with 2 diagnostic criteria for carpal tunnel syndrome, an explanation of the exam results, and the post exam procedure. The questionnaire consisted of 15 items, including the overall evaluation of training, the effect of the OSCE, and the perception of the ultrasound. All 6 self-evaluation items were not revised, as they had a CVR of ≥ 0.75.Conclusion: An ultrasound OSCE for scanning the volar wrist and diagnosing carpal tunnel syndrome was developed using 15 validated tasks, 15 survey questions about ultrasound training, and 6 questions for selfevaluation. These results may be used in the future for education in diagnostic ultrasound.

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.

S11-5. Diagnostic criteria of carpal tunnel syndrome

S11-5. Diagnostic criteria of carpal tunnel syndrome

OBLIGATORY ALTERATIONS IN THE MORPHOLOGY OF MEDIAN NERVE: A SONOGRAPHIC STUDY IN ASYMPTOMATIC INDIVIDUALS

Introduction: Median nerve is formed in axilla by contributions from medial and lateral cords of brachial plexus. It descends in the arm, forearm and then through carpal tunnel in close conjunction with flexor tendons of forearm. Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Median nerve cross sectional area (CSA) and ratio of nerve major axis to minor axis (flattening ratio) serve as potential diagnostic criteria for carpal tunnel syndrome. Median nerve cross sectional area and flattening ratio (FR) can be assessed by ultrasonography (US). Aim of the study was to assess median nerve by US and tabulate mean values for CSA and FR in asymptomatic population. This would serve to limit the cut-off values that differentiate asymptomatic nerves from neuropathic nerves. Material & Methods: Study was conducted in the Department of Anatomy, KGMU, Lucknow. Fifty randomly selected asymptomatic volunteers (undergraduate students: 30 males, 20 females) participated in the study. Sonography was performed to evaluate certain morphological dimensions of median nerve. Height, weight and wrist circumference of participants were also noted. Ultrasonography was performed using high frequency linear probe and observations were made at two pre-determined sites. Observations were recorded, tabulated and analyzed. Results: Median nerve was easily observable at both sites. It was round in shape in forearm (Fo), and flattened as it reached the carpal tunnel (Ct). Among all 50 study subjects, at both sites, flattening was more on right side (FRFoRt-1.71; FRCtRt-3.08) than on left side (FRFoLt-1.66; FRCtLt-2.78). In right forearm, nerve was flatter in females (FRFoRt-1.77) as compared to males (FRFoRt-1.68). In left forearm, median nerve was slightly rounder in females (FRFoLt-1.65) as compared to males (FRFoLt-1.67). At the distal wrist crease on right side, increased flattening was observed in females (FRCtRt-3.30) as compared to males (FRCtRt-2.94), whereas on left side, at same site flattening was more in females (males FRCtLt-2.74; females FRCtLt-2.83). Conclusion: Altered FR has both diagnostic as well as prognostic values in carpal tunnel syndrome. The database generated from the study will help in facilitating comparisons between normal, asymptomatic and pathological, asymptomatic individuals.

High frequency ultrasonography in the diagnosis of carpel tunnel syndrome

Objective To analyze the efficacy of high-frequency ultrasound in the clinical diagnosis of carpal tunnel syndrome (CTS), and to study the suitable diagnostic indicators and criteria of CTS for Chinese population. Methods High-frequency ultrasound was used to scan the median nerves of 67 CTS wrists and 67 normal wrists at the entrance, the middle and the outlet of carpal tunnels, and measured the cross-sectional area, diameter and flattening rate. Statistical analysis was used to evaluate the sensitivity, specificity, and AUC of ROC curve of the different parts of carpal tunnels. Results Compared with normal subjects, the CTS patients has larger cross-sectional area, diameter and flattening value of the median nerve in different parts of the carpal tunnel, and the differences are statistically significant (all P>0.05). Among the measured indicators, the cross-sectional area of the median nerve at the entrance of the carpal tunnel has a better AUC value and good diagnostic sensitivity and specificity. Conclusion High-frequency ultrasonography has potential clinical significance for CTS diagnosis. The cross-sectional area of the median nerve at the entrance of the carpal tunnel can be used as a CTS diagnostic indicator for Chinese population, and it has good diagnostic sensitivity and specificity. Key words: High frequency ultrasound; Carpal tunnel syndrome; Median nerve; Diagnosis

ROLE OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME

Background: Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. Recent studies have demonstrated advantages of sonographic techniques in the diagnosis of carpal tunnel syndrome (CTS). Objective: Assessing the utility of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) and grading its severity. Patients and Methods : Sixty hands in 46 patients with clinically and electro-physiologically confirmed carpal tunnel syndrome, and sixty asymptomatic hands in 34 healthy individuals as control group were included in the study and underwent high-resolution ultrasonography of the wrists. In ultrasonographic assessment the cross-sectional area (CSA) of the median nerve at the distal crease of the wrist and flattening ratio (FR) of the median nerve in the carpal tunnel as well as palmar bowing (PB) of the flexor retinaculum were measured. Ultrasonographic Data from the patients group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) curve analysis. Sensitivity and specificity of ultrasonographic measurements were evaluated. Ultrasonographic measurements were correlated with severity of CTS according to nerve conduction studies (NCS). Results: The CSA of the median nerve and PB of the flexor retinaculum were significantly larger in the CTS hands compared to the normal control hands. However, FR of the median nerve showed no significant difference between both groups. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a CSA cut-off value of 10 mm² provided a diagnostic sensitivity of 93.3 % and specificity of 98.3 % and PB cut-off value of 3.3 mm provided a diagnostic sensitivity of 90 % and specificity of 85 %. No significant differences in CSA and PB were found among patients with mild, moderate and severe carpal tunnel syndrome so that CSA and PB did not reflect the severity of the condition. Conclusion: Ultrasonography is a useful non-invasive method for the diagnosis of carpal tunnel syndrome but not assessing its severity.

O120 Sensory conduction slowing does not precede motor slowing in the development of mild carpal tunnel syndrome

Objectives To study changes in median nerve conduction across the wrist in workers exposed to short-term hand-intensive work. Methods Eleven males (mean age 35.7 years (SD: 10.2)) skinned minks during an intensive 22 days’ season. Median and ulnar nerve conduction studies were performed pre-, mid-, end-, and post-season. Age-corrected reference values were used. Results Changes from pre- to end-season were seen for mean median nerve distal motor latency (DML) (0.41 ms; CI: 0.27–0.56), antidromic sensory nerve conduction velocity (SNCV) to digit 2 (−6.3 m/s; −10.2 to −2.5) and digit 3 (−6.2 m/s; −10.6 to −1.9). Normalisation to SDs ( Z -scores) revealed that motor and sensory mean changes were of equal magnitude: DML 1.22 (0.85–1.59); SNCV(dig2) 1.31 (0.61–2.10); SNCV(dig3) 1.23 (0.47–1.99). There were no changes in ulnar nerve parameters. At end-season, five workers fulfilled criteria for carpal tunnel syndrome (CTS). At post-season 3–6 weeks after end of exposure, all parameters had reverted to pre-season levels. Discussion Our data contradict the common assumption that sensory changes precede motor changes in CTS. This assumption may erroneously rely on the use of absolute fixed borders for abnormality instead of age-corrected and normalised reference values. Conclusions Conduction slowing in the development of mild CTS follows similar courses in motor and sensory fibres. The quick recovery of mild sub-acute CTS suggests another mechanism of conduction slowing than demyelination. Significance Severity scales and guidelines for CTS examination should be reviewed. Elaborated reference values may provide new insight and improve diagnostic workup.

Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies.

The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79%; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm(2)). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86%, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3%. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The elevated pressure in the carpal tunnel causes compression of median nerve. Although the diagnostic criteria for carpal tunnel syndrome are not clear, the diagnosis is based on the patient history and physical examination and may be confirmed by electrodiagnosis with nerve conduction test or ultrasonography. Nonsurgical treatments are generally recommended for early carpal tunnel syndrome and surgical treatments are preferred for failed nonsurgical treatment, however there is controversy regarding the optimal time when the surgery should be performed. Results of surgical treatment are usually satisfactory, however there are also complications after surgical treatment. In order to achieve good results without complications, normal anatomy around the median nerve and its anatomical variations should be thoroughly understood before the operation and careful surgical technique is absolutely required.

Application of 3-Dimensional Ultrasonography in Assessing Carpal Tunnel Syndrome

The aim of study was to assess the usefulness of 3D ultrasonography (3DUS) in the diagnosis of carpal tunnel syndrome. Fifty patients with carpal tunnel syndrome confirmed by electromyography and 37 healthy control participants underwent 3DUS of the wrists. The mean times per participant for the 3DUS examination and review of the 3D volume set were recorded. The cross-sectional area at the proximal carpal tunnel and the maximum swelling point were measured. Data from patients and controls were compared for determination of statistical significance. The accuracy of the 3DUS diagnostic criteria for carpal tunnel syndrome was evaluated using receiver operating characteristic analysis, and changes in the median nerve shape, including the maximum swelling point, were assessed by review of the 3D volume data. The mean times for examination of a participant and review in each wrist were 56 seconds and 5.7 minutes, respectively. Significant differences were observed in the mean cross-sectional areas of the median nerve between patients and controls. The mean cross-sectional areas ± SD were 16.7 ± 6.7 mm(2) in patients and 8.3 ± 1.9 mm(2) in controls. Using the receiver operating characteristic curve, a cutoff value of greater than 10.5 mm(2) provided diagnostic sensitivity of 84% and specificity of 86%. In 42 of 73 wrists with carpal tunnel syndrome, the median nerve showed fusiform morphologic abnormalities and maximum swelling points. Our results show that 3DUS could markedly decrease scanning time, and measurement of the median nerve cross-sectional area combined with morphologic analysis using 3DUS is a promising supplementary method for the diagnosis of carpal tunnel syndrome.

A Holistic Evaluation of Risk Factors for Work-Related Musculoskeletal Distress Among Asymptomatic Sonographers Performing Neurosonology

A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm 2 and an anterior bulge of the retinaculum of &gt;4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and postscanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.

The Value Added by Electrodiagnostic Testing in the Diagnosis of Carpal Tunnel Syndrome

There is no clear-cut consensus on the best diagnostic criteria for carpal tunnel syndrome. The objective of this study was to compare the probability of carpal tunnel syndrome being present following electrodiagnostic testing with the probability of it being present after the diagnosis was established on the basis of a clinical evaluation alone. The study sample included patients with any peripheral nerve diagnosis who had been referred to the electrodiagnostic laboratory of an academic health-care center. The probability of carpal tunnel syndrome before electrodiagnostic testing (pretest probability) was estimated with use of the CTS-6, a validated clinical diagnostic aid that is used to estimate the probability of carpal tunnel syndrome on the basis of the presence or absence of six clinical findings recorded as part of the history or noted on physical examination. All patients then underwent a standard electrodiagnostic assessment of the median nerve by a neurologist blinded to the result of the CTS-6 evaluation. Sensory nerve conduction velocity was used to classify the result of the electrodiagnostic testing as either positive or negative for carpal tunnel syndrome with use of two different criteria (one stringent and one lax) derived from the literature. The main outcome measure was the difference between the pretest and posttest probabilities of carpal tunnel syndrome. One hundred and forty-three patients were studied. The pretest probability of carpal tunnel syndrome ranged between 0.10 and 0.99 (mean [and standard deviation], 0.81 +/- 0.22). Seventy-three percent of the patients had a pretest probability of at least 0.80. The average change in probability for these patients was -0.02 when the stringent electrodiagnostic criterion was used and -0.06 when the lax criterion was used. With either electrodiagnostic criterion, the majority of the large changes in probability were for patients for whom the pretest probability was < or =0.50. The probability of carpal tunnel syndrome was lowered after the electrodiagnostic testing in most of these cases. For the majority of patients who are considered to have carpal tunnel syndrome on the basis of their history and physical examination alone, electrodiagnostic tests do not change the probability of diagnosing this condition to an extent that is clinically relevant.

Evaluation of the neurological involvement and prevalence of the carpal tunnel syndrome in patients with type-2 diabetes mellitus

Objective: to determine the frequency of the carpal tunnel syndrome (CTS) in patients with type 2 diabetes mellitus, verify whether it is associated with diabetic neuropathy (DN) and identify ways to recognize both by examining the upper limbs. Methods: The patients were submitted to anamnesis; the complaints were verified, tactile and vibratory sensitivity was evaluated, sensitive and motor nerve conduction (SMNC) was studied and Phalen’s test (PHT) was performed. The criteria for isolated CTS diagnosis were: alterations in the SMNC, complaints of paresthesia in the median nerve area and absence of either sensitive or motor alterations in the area of the ulnar nerve and lower extremities. Results: Of the 94 patients studied, 60 presented paresthesia. The SMNC study detected alterations in 88 patients (93.6%) and it was the most sensitive test. At the test to discriminate the two most static points (D2SP) we observed alterations in 47 patients and with the Semmes-Weinstein test detected alterations in 11 patients. Alterations were detected in 72 patients (76.6%) using the bioesthesiometer and in 04 patients using the diapason. PHT was positive in 33 patients. The correlation of the results showed that neural alterations were present in 92/94 patients; 11 patients presented alterations only in the median nerve and 81 patients presented combined alterations in the ulnar and median nerves. Only 4 patients presented CTS without subjacent neuropathy. Conclusions: The most sensitive tools were the bioesthesiometer and the D2SP. The neurophysiological examination demonstrated the presence of neuropathy subjacent to CTS. Clinical and neurophysiological criteria for CTS were presented by 31.91% of the patients; 27.66% with signs of subjacent neuropathy and 4.25% without diabetic neuropathy. Clinical criteria should be preponderant over the remaining tests and the neurophysiological test in order to characterize the carpal tunnel syndrome in the diabetic patient.

Development and Validation of Diagnostic Criteria for Carpal Tunnel Syndrome

To develop clinical diagnostic criteria for carpal tunnel syndrome (CTS) that modeled the clinical diagnostic practices of experts. Fifty-seven clinical findings associated with CTS had been ranked previously in order of diagnostic importance using Delphi as a method of establishing consensus among a panel of expert clinicians. The 8 most highly ranked criteria then were placed into all possible combinations to create 256 unique case histories. Two new panels of experts rated these case histories. One panel made a binary evaluation as to whether the case history did or did not represent CTS. This allowed the development of a logistic regression model that had the probability of carpal tunnel syndrome as the dependent variable and the weighted diagnostic criteria as the independent variables. This model then was validated against the judgments of the second panel of clinicians who estimated the probability of CTS for each of the same case histories. The correlation between the probability of CTS predicted by the model and the panel of clinicians was 0.71. The most important clinical diagnostic criteria for CTS as identified from a larger pool of potential diagnostic items through a consensus approach using Delphi were weighted and found to correlate well with the judgments of a new panel of clinicians. By improving the consistency of the diagnosis of CTS these criteria should lead to more effective treatment and a better understanding of the effect of workplace exposures in the development of this condition. A methodology that emphasizes a rigorous approach to item generation and item reduction through expert consensus, followed by validation, may represent a template for establishing consensus among experts on other controversial clinical issues. Diagnostic, Level I.

Electrodiagnostic criteria for carpal tunnel syndrome in axonal polyneuropathy

Median-ulnar comparative studies (MUCSs) play an important role in the electrodiagnosis of carpal tunnel syndrome (CTS), but diagnostic criteria in patients with underlying axonal polyneuropathy have not been established. We prospectively evaluated 28 patients with axonal polyneuropathy (48 hands), blindly dichotomized into CTS cases and controls, using the lumbrical-interosseous motor (LIM), mixed palmar sensory (MPS), and digit 4 sensory (D4S) MUCS. LIM, MPS, and D4S MUCS latency differences could be calculated in 98%, 69%, and 48% of hands. Based on the maximum combination of sensitivity and specificity, diagnostic cutoffs were > or = 0.8, > or = 0.5, and > or = 0.4 ms for the LIM, MPS, and D4S studies, respectively. The LIM study was the most accurate test and the only MUCS that yielded a positive likelihood ratio greater than 10 (16.25 for a cut-off value of 1 ms) and a negative likelihood ratio less than 0.1 (0.09 for a cut-off value of 0.4 ms), resulting in meaningful differences in pretest and posttest probabilities of CTS in patients with axonal polyneuropathy. These novel MUCS electrodiagnostic criteria should facilitate more accurate electrodiagnostic confirmation of CTS in this population.

Variations in diagnostic criteria for carpal tunnel syndrome among Ontario specialists

Variations in diagnostic criteria for carpal tunnel syndrome (CTS) may result in differing reports of disease prevalence, errors in diagnosis, and variable results of treatment. The objective of this study was to determine how consistent specialists are in their ratings of the importance of clinical criteria for the diagnosis of CTS. Three hundred specialist physicians and surgeons received a questionnaire containing 57 clinical criteria for the diagnosis of CTS. A visual analog scale (VAS) was used to rate the importance of each criterion in the diagnosis of CTS. The overall consistency both across and within specialties was poor (intraclass correlation coefficient across specialties (ICC) = 0.28; ICC range within specialties 0.27-0.37). Specialists are relatively inconsistent in the importance they assign to clinical criteria for the diagnosis of CTS. This inconsistency may be an important source of variation in the reported prevalence and treatment of CTS.

The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome

AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm 2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.

Electrophysiological assessment of the carpal tunnel syndrome in hemodialysis patients: formula for predicting surgical results

AbstractNerve conduction studies performed between 1994 and 1996 on the median nerves of 204 hands of 113 patients [20 patients in hemodialysis (HD) with diabetic nephropathy, 27 without diabetes mellitus in HD for 10 years or more, 18 without diabetes mellitus in HD for less than 10 years, and 48 with diabetes mellitus not undergoing HD] were reviewed retrospectively to develop a discriminating tool that would better inform treatment selection for patients with carpal tunnel syndrome (CTS) in HD. Scatter diagrams were drawn from the results of this study, and a regression formula was obtained. Among the long-term HD patients without diabetic nephropathy, distal motor latency (DML) tended to increase without a significant concomitant reduction in motor nerve conduction velocity (MCV) in the forearm. In contrast, in HD patients with diabetic nephropathy, DML tended to increase and MCV was significantly lower despite shorter HD periods. The study showed that in HD patients, in whom the MCV (m/s) >11[9 - DML(ms)], the surgical results might be excellent or good. The formula was tested against the results of the 30 surgical cases. The sensitivity of this formula was 0.84, and the specificity was 1.00. The formula produced a predictor of surgical results when used in conjunction with other criteria for CTS in HD patients, especially those with diabetic nephropathy.

Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome.

Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case-control study. Patients with carpal tunnel syndrome and asymptomatic controls who were matched for age and sex were enrolled and underwent sonography of the wrists. Eight separate sonographic criteria were analyzed in each wrist. Data from the patient group and the control group were compared to establish optimal diagnostic criteria for carpal tunnel syndrome, using receiver operating characteristic analytic techniques. Thirty-five patients with carpal tunnel syndrome and 35 asymptomatic controls were examined. Increased cross-sectional area of the median nerve was found to be the most predictive measure of carpal tunnel syndrome, proximal to the tunnel inlet, at the tunnel inlet, and at the tunnel outlet, with significant differences between patients and controls. Using a receiver operating characteristic curve, a cut-off value >0.098 cm(2) at the tunnel inlet provided a diagnostic sensitivity of 89% and a specificity of 83%. Sonographic measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of carpal tunnel syndrome.