The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis.
BACKGROUND
Carpal tunnel syndrome (CTS) is the most commonly diagnosed compression neuropathy of the upper extremity. Current AAOS recommendations are to obtain a confirmatory electrodiagnostic test in patients for whom surgery is being considered. Ultrasound has emerged as an alternative confirmatory test for CTS; however, its potential role is limited by lack of adequate data for sensitivity and specificity relative to electrodiagnostic testing.


OBJECTIVE
In this meta-analysis we determined the sensitivity and specificity of ultrasound in the diagnosis of CTS.


METHODS
A PubMed/MEDLINE search identified 323 articles for review. After applying exclusion criteria, 19 articles with a total sample size of 3131 wrists were included for meta-analysis. Three groups were created: a composite of all studies, studies using clinical diagnosis as the reference standard, and studies using electrodiagnostic testing as the reference standard.


RESULTS
The composite sensitivity and specificity of ultrasound for the diagnosis of CTS, using all studies, were 77.6% (95% CI 71.6-83.6%) and 86.8% (95% CI 78.9-94.8%), respectively.


CONCLUSIONS
The wide variations of sensitivities and specificities reported in the literature have prevented meaningful analysis of ultrasound as either a screening or confirmatory tool in the diagnosis of CTS. The sensitivity and specificity of ultrasound in the diagnosis of CTS are 77.6% and 86.8%, respectively. Although ultrasound may not replace electrodiagnostic testing as the most sensitive and specific test for the diagnosis of CTS given the values reported in this meta-analysis, it may be a feasible alternative to electrodiagnostic testing as the first-line confirmatory test.


METHODS
Level III, systematic review of Level III studies. See Guidelines for Authors for a complete description of levels of evidence.
Fowler
John R
JR
Department of Orthopaedics, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, USA, fowler@temple.edu.
Gaughan
John P
JP
Ilyas
Asif M
AM
D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging*; D004568:Electrodiagnosis; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography