Skeletal Radiol DOI 10.1007/s00256-014-1929-z
SCIENTIFIC ARTICLE
Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies Chin Chin Ooi & Siew Kune Wong & Agnes B. H. Tan & Andrew Y. H. Chin & Rafidah Abu Bakar & Shy Yunn Goh & P. Chandra Mohan & Robert T. J. Yap & Meng Ai Png
Received: 28 February 2014 / Revised: 29 April 2014 / Accepted: 28 May 2014 # ISS 2014
Abstract The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms Electronic supplementary material The online version of this article (doi:10.1007/s00256-014-1929-z) contains supplementary material, which is available to authorized users. C. C. Ooi (*) : S. K. Wong : R. Abu Bakar : S. Y. Goh : P. C. Mohan : M. A. Png Department of Diagnostic Radiology, Singapore General Hospital, Block 2, level 1, Outram Road, 169608 Singapore, Singapore e-mail: [email protected] S. K. Wong e-mail: [email protected] R. Abu Bakar e-mail: [email protected] S. Y. Goh e-mail: [email protected] P. C. Mohan e-mail: [email protected] M. A. Png e-mail: [email protected] A. B. H. Tan : A. Y. H. Chin : R. T. J. Yap Department of Hand Surgery, Singapore General Hospital, Outram Road, 169608 Singapore, Singapore A. B. H. Tan e-mail: [email protected] A. Y. H. Chin e-mail: [email protected] R. T. J. Yap e-mail: [email protected]
of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79 %; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm2). There was a good correlation between the severity of NCS and CSA (r=0.78, p
SCIENTIFIC ARTICLE
Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies Chin Chin Ooi & Siew Kune Wong & Agnes B. H. Tan & Andrew Y. H. Chin & Rafidah Abu Bakar & Shy Yunn Goh & P. Chandra Mohan & Robert T. J. Yap & Meng Ai Png
Received: 28 February 2014 / Revised: 29 April 2014 / Accepted: 28 May 2014 # ISS 2014
Abstract The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms Electronic supplementary material The online version of this article (doi:10.1007/s00256-014-1929-z) contains supplementary material, which is available to authorized users. C. C. Ooi (*) : S. K. Wong : R. Abu Bakar : S. Y. Goh : P. C. Mohan : M. A. Png Department of Diagnostic Radiology, Singapore General Hospital, Block 2, level 1, Outram Road, 169608 Singapore, Singapore e-mail: [email protected] S. K. Wong e-mail: [email protected] R. Abu Bakar e-mail: [email protected] S. Y. Goh e-mail: [email protected] P. C. Mohan e-mail: [email protected] M. A. Png e-mail: [email protected] A. B. H. Tan : A. Y. H. Chin : R. T. J. Yap Department of Hand Surgery, Singapore General Hospital, Outram Road, 169608 Singapore, Singapore A. B. H. Tan e-mail: [email protected] A. Y. H. Chin e-mail: [email protected] R. T. J. Yap e-mail: [email protected]
of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79 %; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm2). There was a good correlation between the severity of NCS and CSA (r=0.78, p
