Abstract
Objectives
To provide a quantitative analysis of ultrasonographic measurements and possible pathophysiology
of carpal tunnel syndrome by comparing cross-sectional areas of the median nerve,
carpal tunnel, and nerve/tunnel index and the difference in ultrasonographic findings
between affected and nonaffected hands and between sexes.
Design
Blinded comparison study.
Setting
Secondary referral and training hospital of institutional practice.
Participants
Patients (N=51; 42 women, 9 men) with suspected carpal tunnel syndrome who underwent
sonography within 1 week after the electrodiagnostic study.
Interventions
Not applicable.
Main Outcome Measures
Electrodiagnostic and ultrasonographic studies were conducted on both upper extremities.
Cross-sectional areas of the median nerve and carpal tunnel were measured at 2 separate
levels; proximal and distal cross-sectional areas of the carpal tunnel were each measured
at the scaphoid-pisiform and trapezium-hamate levels, respectively.
Results
Comparison between normative (n=24) and abnormal hands (n=78) revealed the following:
the mean proximal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel
index of electrodiagnostically normative hands were 10.941mm2, 192.43mm2, and 5.635%, respectively, whereas those of abnormal hands were 13.74mm2, 208.87mm2, and 6.693%, respectively, showing statistically significant differences for all
(P<.05). Distal measurements of the cross-sectional area of the median nerve, carpal
tunnel, and nerve/tunnel index were 10.088mm2, 150.4mm2, and 6.762%, respectively, in normative hands, and 11.178mm2, 149.6mm2, and 7.493%, respectively, in abnormal hands, showing no statistically significant
differences (P>.05). In women, proximal cross-sectional areas of the median nerve and nerve/tunnel
index of abnormal hands showed statistically significant differences, but no ultrasonographic
measurement with a statistically significant difference was observed in men.
Conclusions
Compared with nonaffected hands, the proximal cross-sectional areas of the median
nerve and carpal tunnel were greater, but the distal ultrasonographic measurements
were not in affected hands. Ultrasonographic findings of carpal tunnel syndrome were
different according to sex.
Keywords
List of abbreviations:
BMI (body mass index), CSA (cross-sectional area), CTS (carpal tunnel syndrome), EMG (electromyography), US (ultrasonography)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Carpal tunnel syndrome: prevalence in the general population.J Clin Epidemiol. 1992; 45: 373-376
- Sonography in the diagnosis of carpal tunnel syndrome.AJR Am J Roentgenol. 1999; 173: 681-684
- Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome.Chang Gung Med J. 2008; 31: 469-476
- Carpal tunnel syndrome: diagnostic usefulness of sonography.Radiology. 2004; 232: 93-99
- Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome.J Clin Ultrasound. 2009; 37: 389-393
- Trigger wrist caused by a tumor of the tendon sheath in a teenager.Am J Orthop. 2001; 30: 233-234
- "Trigger finger at the wrist" due to anomalous flexor digitorum superficialis muscle belly within the carpal tunnel.Chir Main. 2007; 26: 238-242
- Carpal tunnel syndrome: diagnosis with high-resolution sonography.AJR Am J Roentgenol. 1992; 159: 793-798
- High-resolution ultrasonography of the carpal tunnel.J Ultrasound Med. 1991; 10: 531-537
- Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography.Radiol Clin North Am. 1999; 37: 859-872
- The ultrasonographic findings of the median nerve in the carpal tunnel according to age and sex of normal Korean adults.J Korean Acad Rehab Med. 2008; 32: 564-569
- The nerve/tunnel index: a new diagnostic standard for carpal tunnel syndrome using sonography: a pilot study.J Ultrasound Med. 2012; 31: 23-29
- Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation.Muscle Nerve. 1993; 16: 1390-1391
- Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers.Radiology. 2009; 250: 171-177
- Electrodiagnostic medicine.2nd ed. Hanley & Belfus Inc, Philadelphia2002
- Radiologic imaging of the carpal tunnel.Eur J Radiol. 1997; 25: 112-117
- Ultrasound of the musculoskeletal system.Springer, Heidelberg2007
- Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?.Rheumatology (Oxford). 2004; 43: 887-895
Article Info
Publication History
Published online: May 31, 2013
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
