Carpal tunnel syndrome: diagnostic usefulness of sonography.
OBJECTIVE
To prospectively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome (CTS) in patients clinically suspected of having the disease in one or both hands.


METHODS
A prospective cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study. One hundred twenty patients (98 women, 22 men; mean age, 49 years; range, 19-83 years) underwent sonography within 1 week after electrodiagnostic study. Radiologist was blinded to electrodiagnostic study results. Seventy-five patients had bilateral symptoms; 23 patients, right-hand symptoms; and 22 patients, left-hand symptoms (total, 195 symptomatic hands). Cross-sectional area of median nerve was measured at three levels: immediately proximal to carpal tunnel inlet, at carpal tunnel inlet, and at carpal tunnel outlet. Flexor retinaculum was used as a landmark to margins of carpal tunnel. Optimal threshold levels (determined with classification and regression tree analysis) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease. Sensitivity, specificity, and false-positive and false-negative rates were derived on the basis of final diagnosis, which was determined with clinical history and electrodiagnostic study results as reference standard.


RESULTS
For right hands, sonography had sensitivity of 94% (66 of 70); specificity, 65% (17 of 26); false-positive rate, 12% (nine of 75); and false-negative rate, 19% (four of 21) (cutoff, 0.09 cm(2) proximal to tunnel inlet and 0.12 cm(2) at tunnel outlet). For left hands, sensitivity was 83% (53 of 64); specificity, 73% (24 of 33); false-positive rate, 15% (nine of 62); and false-negative rate, 31% (11 of 35) (cutoff, 0.10 cm(2) proximal to tunnel inlet).


CONCLUSIONS
Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should be considered as initial test of choice for patients suspected of having CTS.
Wong
Shiu Man
SM
Department of Medicine, Prince of Wales Hospital, Shatin, Hong Kong. jsmwong@hkstar.com
Griffith
James F
JF
Hui
Andrew C F
AC
Lo
Sing Kai
SK
Fu
Michael
M
Wong
Ka Sing
KS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002348:Carpal Bones / Q000000981:diagnostic imaging; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009431:Neural Conduction; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013710:Tendons / Q000000981:diagnostic imaging; D014459:Ulnar Nerve / Q000503:physiopathology; D014463:Ultrasonography