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Ultrasound Parameters Other Than the Direct Measurement of Ulnar Nerve Size for Diagnosing Cubital Tunnel Syndrome: A Systemic Review and Meta-analysis

  • Ing-Jeng Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ke-Vin Chang
    Correspondence
    Corresponding author Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Neijiang Street, Wanhua District, Taipei 108, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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  • Wei-Ting Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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  • Levent Özçakar
    Affiliations
    Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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      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)
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