title: Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities.
abstract: BACKGROUND
  Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but not adequately studied in India.
  
  
  OBJECTIVE
  To study clinical tests, nerve conduction studies (NCS), ultrasonography (USG), and magnetic resonance imaging (MRI) in diagnosing CTS.
  
  
  METHODS
  We diagnosed CTS in 54 patients (93 hands) out of 60 screened patients with symptoms compatible with CTS, including 19 control patients (23 hands). We conducted provocative tests and calculated Boston Carpal tunnel Questionnaire (BCTQ) symptom (S) and function (F) scores. NCS positive patients were classified into mild, mild-to-moderate, moderate, severe, and all-CTS groups. Median nerve anteroposterior, transverse, circumference (CIR), and cross-sectional area (CSA) at inlet (I), middle (M), and outlet (O) each was measured by USG in all patients. MRI was done in 26 patients (39 hands).
  
  
  RESULTS
  Phalen, hand elevation and pressure provocation tests had higher sensitivity, Tinel's test had higher specificity and tethered median nerve and tourniquet tests had low sensitivity and moderate specificity. USG had low sensitivity but high specificity, and MRI had moderate sensitivity. USG in patients compared to controls was significantly abnormal in CSA-I, CIR-I, and CSA-O. Significant correlation was found between BCTQ-S and NCS and BCTQ-S and CIR-O. CIR-M, CIR-O, CSA-M, and CSA-I had correlation with NCS. MRI was significant in moderate and in moderate + severe groups combined and associated pathologies were detected in 59% patients.
  
  
  CONCLUSIONS
  NCS remain gold standard but USG and MRI help increase sensitivity and detect mass lesions amenable to surgery.
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Gaurav M
authors.initials: GM
authors.lastname: Kasundra
authors.affiliation: Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Isha
authors.initials: I
authors.lastname: Sood
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Amita N
authors.initials: AN
authors.lastname: Bhargava
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Bharat
authors.initials: B
authors.lastname: Bhushan
authors.affiliation: Department of Radiology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Kirti
authors.initials: K
authors.lastname: Rana
authors.affiliation: Satyam Imaging Centre, Mathuradas Mathur Hospital, Jodhpur, India.
authors.forename: Hemant
authors.initials: H
authors.lastname: Jangid
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Khichar
authors.initials: K
authors.lastname: Shubhkaran
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, India.
authors.forename: Guruprasad S
authors.initials: GS
authors.lastname: Pujar
keywords: Boston Carpal Tunnel Questionnaire; carpal tunnel syndrome; magnetic resonance imaging; nerve conduction study; ultrasonography