Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Published:September 22, 2017DOI:



      To evaluate the accuracy of inlet and outlet ultrasonography measurements for the diagnosis of carpal tunnel syndrome (CTS).

      Data Sources

      MEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases were systematically searched from inception to February 2017.

      Study Selection

      Observational studies comparing the diagnostic accuracy of inlet and outlet ultrasonography measurements were selected.

      Data Extraction

      Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves were used to summarize overall test performance.

      Data Synthesis

      Twenty-eight published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of CTS were 31.11 (95% CI, 20.42–47.40) for inlet-level and 16.94 (95% CI, 7.58–37.86) for outlet-level measurements. The 95% confidence region for the point that summarizes overall test performance of the included studies occurred where the cutoffs ranged from 9.0 to 12.6mm2 for inlet-level measurements and from 9.5 to 10.0mm2 for outlet-level measurements.


      Both ultrasonography measurements for the diagnosis of CTS showed sufficient accuracy for their use in clinical settings, although the overall accuracy was slightly higher for inlet-level than for outlet-level measurements. The addition of outlet and inlet measurements does not increase the accuracy for the diagnosis. Therefore, the inlet-level ultrasonography measurement appears to be an appropriate method for the diagnosis of CTS.


      List of abbreviations:

      AUC (area under the curve), CI (confidence interval), CTS (carpal tunnel syndrome), dOR (diagnostic odds ratio), HSROC (hierarchical summary receiver operating characteristic), NLR (negative likelihood ratio), PLR (positive likelihood ratio)
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