Diagnostic Accuracy of Ultrasound Parameters in Carpal Tunnel Syndrome: Additional Criteria for Diagnosis

Abstract

Objectives: To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS).

Methods: Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees' work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross-sectional area, hypervascularity, wrist-to-forearm ratio, wrist-forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO).

Results: A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist-forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4-15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8-8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms.

Conclusions: Combining US findings for the CTO wrist-forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.

Keywords: carpal tunnel syndrome; musculoskeletal ultrasound; nerve conduction studies; ultrasound.