Abstract
Objective
To investigate the diagnostic performance of available ultrasound (US) parameters,
other than the direct measurements of ulnar nerve size, that is, cross-sectional area
(CSA) and diameter, for diagnosing cubital tunnel syndrome (CuTS).
Data Sources
Databases, including PubMed and Embase, were searched from the earliest record of
CuTS US to April 24, 2018.
Study Selection
Published studies (N=13) comparing US parameters of ulnar nerves between patients
with CuTS and patients without CuTS were included.
Data Extraction
Study design, participants’ demographics, diagnostic references of CuTS, and US parameters
other than the direct measurements of the ulnar nerve size were retrieved from the
included studies.
Data Synthesis
This systematic review comprised 663 CuTS patients and 543 patients without CuTS.
The pooled nerve swelling ratio in the CuTS group was significantly larger than that
of the controls. The mean between-group differences of CSAMax or ME/CSAarm, CSAMax or ME/CSAforearm and CSAMax or ME/CSAwrist were 1.03 (95% confidence interval [CI], 0.77-1.29), 1.38 (95% CI, 0.93-1.82), and
0.83 (95% CI, 0.56-1.11), respectively. Regarding the swelling ratio of CSAMax or ME /CSAarm, the pooled sensitivity and specificity available from the 3 included studies were
0.67 (95% CI, 0.59-0.74) and 0.81 (95% CI, 0.75-0.86), respectively. Similarly, for
the swelling ratio of CSAMax or ME/CSAforearm, the pooled sensitivity and specificity were 0.62 (95% CI, 0.54-0.69) and 0.86 (95%
CI, 0.81-0.90), respectively. Other US parameters identified in this review included
nerve-flattening ratio (maximum diameter/minimum diameter), nerve-to-tunnel ratio
(ulnar nerve CSA/cubital tunnel CSA), nerve echogenicity, and intraneural vascularity,
all of which were reported in a minority of included articles.
Conclusions
Despite the insufficient number of pertinent studies to prove its superiority to other
US measurements, the ulnar nerve-swelling ratio can be a complementary tool for diagnosing
CuTS. The presence of intraneural vascularity, increased flattening ratio, and enlarged
intraneural hypoechoic fraction also seem to be potential US indicators for CuTS diagnosis,
which need to be validated with more prospective studies.
Keywords
List of abbreviations:
CI (confidence interval), CSA (cross-sectional area), CTS (carpal tunnel syndrome), CuTS (cubital tunnel syndrome), ME (medial epicondyle), US (ultrasound)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 25, 2018
Footnotes
Supported by National Taiwan University Hospital, Bei-Hu Branch, Ministry of Science and Technology, Taiwan, Republic of China (grant no. 106-2314-B-002-180-MY3), and Taiwan Society of Ultrasound in Medicine.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
