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Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography
Rheumatology International, 07/16/09

Karadag YS et al. – Data suggest that in addition to Carpal tunnel syndrome (CTS) diagnosis, sonographic measurement of cross-sectional area (CSA) could also give additional information about severity of median nerve involvement. Use of ultrasound (US) may cost-effectively reduce the number of nerve conduction study (NCS) in patients with suspected CTS.

• An investigation of the clinical usefulness of evaluating CTS severity based on CSA of median nerve
• Patients underwent:
  • A full clinical examination, including Tinel and Phalen test questioned about symptoms and the secondary causes of CTS
  • Refilled a Turkish version Levine Boston Carpal tunnel syndrome questionnaire (BQ)
• VAS for pain A MyLab 70 US system was used for US examination
• CSA of the median nerve was measured at the proximal inlet of the carpal tunnel
• Nerve conduction studies were carried out; severity of electrophysiological CTS impairment was reported as normal, mild, moderate, severe and extreme
• Agreement between NCS and US in showing CTS was calculated with Cohen’s κ coefficient

• 99 wrists of 54 pts (male/female: 4/50); mean ages of pts were 43.3 yrs
• 49 pts had idiopathic CTS, whereas 5 had secondary CTS
• Symptoms were bilateral in 83.3%
• Differences between groups according to electrophysiologic severity scale in terms of age, BMI, VAS, Boston symptom severity and CSA of median nerve were noted
• Identification of CTS severity showed substantial agreement between the US and NCS
• Also the 4 groups based on US CTS severity classification were different in VAS and Boston symptom severity
• Median nerve swelling detected by calculation of the CSA reflects in itself the degree of nerve damage as expressed by the clinical picture

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