Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF
  • Original article
  • Open access
  • Published:

Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome

Egyptian Rheumatology and Rehabilitation volume 45, pages 65–73 (2018)Cite this article

Abstract

Objective

The aim of the study was to assess the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (CTS) and to determine the relationships of ultrasonographic measurements with the clinical severity and the electrophysiological grading scale.

Patients and methods

One hundred CTS diseased hands and 100 nondiseased hands were assessed clinically and by nerve conduction studies. We measured ultrasonographic cross-sectional area (CSA) of the median nerve at various levels of the carpal canal (inlet and outlet), flattening ratio (FR), palmar bowing of the flexor retinaculum, wrist/ forearm ratio, as well as median nerve mobility and power doppler signals. Data from patients and controls were compared to determine the diagnostic relations and the grade of severity.

Results

Measures of CSA of the median nerve at the inlet and at the outlet, palmer bowing and inlet/forearm ratio in the CTS group were significantly higher than the control group (P<0.05); 50% of diseased hands showed restriction of mobility of the median nerve, while 31% had doppler signals. Positive correlations of ultrasonographic measurements with patient-oriented measures, clinical severity scale and electrophysiological grade were observed.

Conclusion

Ultrasonographic measurements of CSA at the inlet and flexor retinaculum have a relatively higher diagnostic accuracy than FR for CTS. The correlation between clinical scores, historical-objective-distribution scale, electrophysiological grade and ultrasonographic measurements reflects the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic CTS.

References

  1. Ibrahim I, Khan W, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012; 6(Suppl 1):69

    Article  CAS  Google Scholar 

  2. Jablecki C, Andary M, Ball R, Cherington M, Fisher M, Phillips L, et al. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement). Muscle Nerve 1993; 16:1390-1391

    Article  Google Scholar 

  3. Beekman R, Visser L. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27:26-33

    Article  Google Scholar 

  4. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. Am J Roentgenol 1999; 173:681-684

    Article  CAS  Google Scholar 

  5. Walker F, Cartwright M, Wiesler E, Caress J. Ultrasound of nerve and muscle. Clin Neurophysiol 2004; 115:495-507

    Article  Google Scholar 

  6. Deniz F, Oksuz E, Sarikaya B, Kurt S, Erkorkmaz U, Ulusoy H, etal. Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings. Neurosurgery 2012; 70:610-616

    Article  Google Scholar 

  7. Keles I, Kendi A, Aydn G, Zog S, Orkun S. Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome. Am J Phys Med Rehabil 2005; 84:443-450

    Article  Google Scholar 

  8. Chiou H, Chou Y, Cheng S, Hsu C, Chan R, Tiu C, et al. Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography. J Ultrasound Med 1998; 17:643-648

    Article  CAS  Google Scholar 

  9. Ginn S, Cartwright M, Chloros G, Walker F, Yoon J, Brown M, et al. Ultrasound in the diagnosis of a median neuropathy in the forearm: case report. J Brachial Plex Peripher Nerve Inj 2007; 2:1

    Google Scholar 

  10. Bamidele J, Debbage P, Taljanovic M, Jaschke W, Klauser A. Future of musculoskeletal ultrasound. Curr Radiol Rep 2015; 3:1-11

    Article  Google Scholar 

  11. Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 2008; 119:1353-1357

    Article  Google Scholar 

  12. Keberle M, Jennett M, Kenn W, Reiners K, Peter M, Haerten R, et al. Technical advances in ultrasound and MR imaging of the carpal tunnel. Eur Radiol 2000; 10:1043-1050

    Article  CAS  Google Scholar 

  13. Bachmann LM, Jüni P, Reichenbach S, Ziswiler HR, Kessels AG, Vögelin E. Consequences of different diagnostic ‘goldstandards’ in test accuracy research: carpal tunnel syndromeas an example. Int J Epidemiol 2005; 34:953-955

    Article  Google Scholar 

  14. Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993; 43:2406-2409

    Article  Google Scholar 

  15. ElMiedany Y, Mehanna A, El Gaafary M, Ashour S. Validation of the arabic self-administered questionnaires for clinical diagnosis, global assessment of symptoms severity and functional status of patients with carpal tunnel syndrome, Ann Rheum Dis, 2007, BMJ publishing group british med assoc house. pp. 238-239

  16. Rao BH, Kutub M, Patil S. Carpaltunnel syndrome: assessment of correlation between clinical, neurophysiological and ultrasound characteristics. J Sci Soc 2012; 39:124

    Article  Google Scholar 

  17. Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D’Amico P, et al. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clin Neurophysiol 2002; 113:71-77

    Article  CAS  Google Scholar 

  18. Werner R. Electrodiagnostic evaluation of carpal tunnel syndrome and ulnar neuropathies. PM R 2013; 5:S14-S21

    Article  Google Scholar 

  19. Preston D, Shapiro B. Median neuropathy at the wrist in Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. (3rd ed), Elsevier Health Sciences; 2013. pp. 267-270

  20. Basiri K, Katirji B. Practical approach to electrodiagnosis of the carpal tunnel syndrome: a review. Adv Biomed Res 2015; 4:50

    Article  Google Scholar 

  21. Sander H, Quinto C, Saadeh P, Chokroverty S. Sensitive median-ulnar motor comparative techniques in carpal tunnel syndrome. Muscle Nerve 1999; 22:88-98

    Article  CAS  Google Scholar 

  22. Bland J. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23:1280-1283

    Article  CAS  Google Scholar 

  23. Cartwright M, Walker F. Neuromuscular ultrasound in common entrapment neuropathies. Muscle Nerve 2013; 48:696-704

    Article  Google Scholar 

  24. Kim M, Jeon H, Park S, Park D, Nam H. Value of ultrasonography in the diagnosis of carpal tunnel syndrome: correlation with electrophysiological abnormalities and clinical severity. J Korean Neurosurg Soc 2014; 55:78–82

    Article  Google Scholar 

  25. Ooi C, Wong S, Tan A, Chin A, Bakar R, Goh S, et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal Radiol 2014; 43:1387–1394

    Article  Google Scholar 

  26. Azami A, Maleki N, Anari H, Iranparvar M, Kalantarhormozi M, Tavosi Z. The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome. Int J Rheum Dis 2014; 17:612–620

    Article  Google Scholar 

  27. Klauser A, Ellah M, Halpern E, Siedentopf C, Auer T, Eberle G, et al. Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies? Eur Radiol 2015; 25:2419–2427

    Article  Google Scholar 

  28. Mhoon J, Juel V, Hobson L. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve 2012; 46:861–870

    Article  Google Scholar 

  29. Choi S, Ahn J, Ryu D, Kang C, Jung S, Park M, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography 2015; 34:275

    Article  Google Scholar 

  30. MohammadiA,GhasemiM, MladkovaN, Ansari S. Correlation between the severity of carpal tunnel syndrome and color doppler sonography findings. Am J Roentgenol 2012; 198:W181–W184

    Article  Google Scholar 

  31. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002; 25:918–922

    Article  Google Scholar 

  32. Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: diagnosis with high-resolution sonography. Am J Roentgenol 1992; 159:793–798

    Article  CAS  Google Scholar 

  33. Swen W, Jacobs J, Bussemaker F, De Waard J, Bijlsma J. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist. J Rheumatol 2001; 28:62–69

    CAS  PubMed  Google Scholar 

  34. Wong S, Griffith J, Hui A, Lo S, Fu M, Wong K. Carpal tunnel syndrome: diagnostic usefulness of sonography 1. Radiology 2004; 232:93–99

    Article  Google Scholar 

  35. Buchberger W, Schon G, Strasser K, Jungwirth W. High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med 1991; 10:531–537

    Article  CAS  Google Scholar 

  36. Wong S, Griffith J, Hui A, Tang A, Wong K. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002; 46:1914–1921

    Article  CAS  Google Scholar 

  37. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu H, Oyar O, Guler K, et al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol 2004; 59:910–915

    Article  CAS  Google Scholar 

  38. Hunter J. Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy. Hand Clin 1991; 7:491–504

    CAS  PubMed  Google Scholar 

  39. Nakamichi K, Tachibana S. Restricted motion of the median nerve in carpal tunnel syndrome. J Hand Surg (Edinburgh, Scotland) 1995; 20: 460–464

    Article  CAS  Google Scholar 

  40. Korstanje J, Boer M, Blok J, Amadio P, Hovius S, Stam H, et al. Ultrasonographic assessment of longitudinal median nerve and hand flexor tendon dynamics in carpal tunnel syndrome. Muscle Nerve 2012; 45:721–729

    Article  Google Scholar 

  41. Padua L, Pazzaglia C, Caliandro P, Granata G, Foschini M, Briani C, et al. Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 2008; 119:2064–2069

    Article  CAS  Google Scholar 

  42. Karadag Y, Karadag O, Cicekli E, Ozturk S, Kiraz S, Ozbakir S, et al. Severity of carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int 2010; 30:761–765

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Minia University, Minia, 6111, Egypt

    Faten I. Mohamed, Shereen R. Kamel & Ahmed E. Hafez

Authors
  1. Faten I. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shereen R. Kamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed E. Hafez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shereen R. Kamel.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohamed, F.I., Kamel, S.R. & Hafez, A.E. Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome. Egypt Rheumatol Rehabil 45, 65–73 (2018). https://doi.org/10.4103/err.err_22_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_22_17

Keywords