title: Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity.
abstract: BACKGROUND
  Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography.
  
  
  METHODS
  The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization.
  
  
  RESULTS
  A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages.
  
  
  CONCLUSIONS
  Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.
authors.affiliation: a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Kutlar
authors.affiliation: a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey.
authors.forename: Ayse Oytun
authors.initials: AO
authors.lastname: Bayrak
authors.affiliation: b Faculty of Medicine, Department of Radiology , Ondokuz Mayis University , Samsun , Turkey.
authors.forename: İlkay Koray
authors.initials: İK
authors.lastname: Bayrak
authors.affiliation: c Faculty of Medicine, Department of Public Health , Ondokuz Mayis University , Samsun , Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Canbaz
authors.affiliation: a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey.
authors.forename: Hande
authors.initials: H
authors.lastname: Türker
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004594:Electrophysiology / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D012372:ROC Curve; D011930:Reaction Time / Q000502:physiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: Carpal tunnel syndrome; Doppler ultrasonography; electrophysiological severity