The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study.
OBJECTIVE
To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).


METHODS
Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15-36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0-3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient's assessment of pain (painVAS) and physician's global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.


RESULTS
Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.


CONCLUSIONS
Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Alexander
A
Marschall
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Anja
A
Ficjian
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Martin H
http://orcid.org/0000-0002-7884-6626
MH
Stradner
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Rusmir
R
Husic
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Dorothea
D
Zauner
Department of Neurology, Medical University of Graz, Graz, Austria.
Werner
W
Seel
Department of Neurology, Medical University of Graz, Graz, Austria.
Nicole E
NE
Simmet
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Alexander
A
Klammer
Department of Neurology, Medical University of Graz, Graz, Austria.
Petra
P
Heizer
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Kerstin
K
Brickmann
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Judith
J
Gretler
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Florentine C
FC
Fürst-Moazedi
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Rene
R
Thonhofer
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Josef
J
Hermann
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Winfried B
WB
Graninger
Department of Neurology, Medical University of Graz, Graz, Austria.
Stefan
S
Quasthoff
Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Christian
C
Dejaco
Ann Rheum Dis. 2013 Dec;72 (12 ):1934-9
23212030
J Occup Environ Med. 1998 Jun;40(6):546-55
9636935
Ned Tijdschr Geneeskd. 2008 Jan 12;152(2):76-81
18265795
J Orthop Sports Phys Ther. 2016 Jun;46(6):443-51
27011304
J Reconstr Microsurg. 2013 Oct;29(8):511-6
23757154
J Hand Surg Br. 2001 Oct;26(5):475-80
11560432
Muscle Nerve. 2000 Aug;23(8):1280-3
10918269
ANZ J Surg. 2010 Jan;80(1-2):50-4
20575880
Rheumatology (Oxford). 2015 Jan;54(1):9-19
25118315
Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):50-54
26499997
Arthritis Rheum. 2008 Mar 15;59(3):357-66
18311762
J Bone Joint Surg Am. 2010 Jan;92(1):218-9
20048116
J Clin Neuromuscul Dis. 2012 Mar;13(3):153-8
22538311
BMC Musculoskelet Disord. 2003 May 7;4:9
12734018
Plast Reconstr Surg. 1998 Dec;102(7):2374-80
9858172
Arthritis Rheum. 2005 Feb;52(2):612-9
15692981
J Bone Joint Surg Am. 1993 Nov;75(11):1585-92
8245050
Open Orthop J. 2012;6:69-76
22470412
Clin Neurophysiol. 2002 Jan;113(1):71-7
11801427
Arthritis Rheum. 1995 Jun;38(6):727-35
7779114
Scand J Rheumatol. 2008 May-Jun;37(3):219-24
18465458
Muscle Nerve. 2013 Sep;48(3):331-3
23436589
Handchir Mikrochir Plast Chir. 2007 Aug;39(4):276-88
17724650
Int J Inflam. 2011;2011:231926
21755025
Am J Ind Med. 1996 Jun;29(6):602-8
8773720
Int J Rheum Dis. 2014 Jul;17 (6):612-20
24618125
J Bone Joint Surg Am. 2013 Jun 19;95(12):1067-73
23783202
Clin Exp Rheumatol. 2009 Sep-Oct;27(5):786-93
19917161
Muscle Nerve. 2014 May;49(5):741-4
24037964
Muscle Nerve. 2008 Jun;37(6):804
18506718