Does measuring the median nerve at the carpal tunnel outlet improve ultrasound CTS diagnosis?
BACKGROUND
Nerve conduction is often regarded as more sensitive than ultrasonography (US) for diagnosing carpal tunnel syndrome (CTS). The diagnostic value of US derives from median nerve enlargement occurring at both ends of the carpal tunnel resulting in a dumbbell-like swelling from carpal tunnel pressure. An important reason for the inferior sensitivity of US may be because measurements are restricted to the carpal tunnel inlet. We investigate the value of including median nerve enlargement at the carpal tunnel outlet for diagnosing CTS.


METHODS
Retrospective cohort study of nerve conduction verified CTS, determining sensitivity, specificity, and positive and negative predictive values of carpal tunnel inlet and outlet median nerve cross sectional area as determined by US for the diagnosis of CTS. Nerve conduction graded CTS severity.


RESULTS
127 hands from 77 patients with CTS and 35 control healthy hands were assessed. US sensitivity for diagnosing CTS increased from 65% to 84% by including outlet enlargement of the median nerve. Specificity changed from 94% to 86%, positive predictive value from 98% to 96% and the negative predictive value from 43% to 60%. 25 hands out of the 127 from CTS patients showed enlargement restricted to the outlet and mainly occurred in moderate CTS.


CONCLUSIONS
In our population, the use of carpal tunnel outlet median nerve enlargement in addition to inlet median nerve size increases sensitivity for diagnosing CTS by 19%.
Department of Medicine, Division of Neurology, National University Hospital, Singapore.
P R
PR
Paliwal
Neurodiagnostic Laboratory, National University Hospital, Singapore.
A K
AK
Therimadasamy
National University Hospital, Singapore.
Y C
YC
Chan
Yong Loo Lin School of Medicine, National University, Singapore. Electronic address: mdcwse@nus.edu.sg.
E P
EP
Wilder-Smith
D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015331:Cohort Studies; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging* / Q000502:physiology*; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D012189:Retrospective Studies; D014463:Ultrasonography
Carpal tunnel inlet; Carpal tunnel outlet; Carpal tunnel syndrome; Cross sectional area; Nerve ultrasound; Ultrasound