Ultrasound Assessment of Carpal Tunnel Syndrome in Comparison with Nerve Conduction Study: A Case-control Study

Journal of Clinical and Diagnostic Research

卷:15

ANEES DUDEKUA¹  SEEMA ULIGADA²  RAJA KOLLU³  SINDHU VASIREDDY⁴  NATARAJU BORAIAH⁵  SREEKANTA SWAMY⁶  H RAMPRAKASH⁷ 

[1] Assistant Professor, Radiodiagnosis and Imaging, East Point College of Medical Sciences, Bengaluru, Karnataka, India.;

[2] Assistant Professor, Radiodiagnosis and Imaging, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.;

[3] Associate Professor, Department of Radiodiagnosis and Imaging, Mallareddy Medical College for Women, Hyderabad, Telangana, India.;

[4] Consultant Neurologist, Department of Neurology, Aster Prime Hospital, Hyderabad, Telangana, India.;

[5] Professor and Head, Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.;

[6] Professor, Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.;

[7] Professor, Radiodiagnosis and Imaging, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.;

关键词: american association of neuromuscular and electrodiagnostic medicine;    boston carpal tunnel questionnaire;    cross-sectional area;    electrodiagnosis;    ultrasonogram;   

DOI  :  10.7860/JCDR/2021/50317.15265

来源: DOAJ

【 摘 要 】

Introduction: Carpal Tunnel Syndrome (CTS) is theentrapment neuropathy which is diagnosed based on theclinical history, examinations and the electrophysiologicalfindings. The Cross-sectional Area (CSA) measurement ofthe median nerve has emerged as an alternative to NerveConduction Studies (NCS) for diagnosis of CTS. This studywas done to correlate NCS and Ultrasonography (USG) inclinically diagnosed CTS patients.Aim: To evaluate the diagnostic value of Cross-sectionalArea (CSA) of median nerve at carpal tunnel inlet inpatients with clinically and NCS confirmed CarpalTunnel Syndrome (CTS) and to assess severity of thesyndrome by NCS and its correlation with USG results.Materials and Methods: This was a hospital based, casecontrol study done on a total of 109 patients of CTS andanalysed during the period from June 2017 to June 2019. Total203 hands of the patients with abnormal NCS formed casegroup while 101 hands from healthy volunteers constitutedthe control group. All the patients underwent neurologicalevaluation by Boston Carpal Tunnel Questionnaire (BCTQ)and were divided into mild, moderate and severe accordingto the score. An electromyography machine was used toperform electrophysiological studies of both the limbs inall subjects. CTS was diagnosed electro-diagnosticallybased on the American Association of Neuromuscular andElectrodiagnostic Medicine (AANEM) guidelines and wereclassified as mild (Grades 1 and 2), moderate (Grades 3and 4), and severe (Grades 5 and 6) grades using Bland’selectrophysiological grading scale. USG was performed forall the subjects and all the data of various investigations wasanalysed using Statistical Package for Social Sciences (SPSS)version 22.0 software. Chi-square test and Mann WhitneyU-test were used as test of significance for qualitative data.Results: The mean age of subjects was 44.38±9.561 years.Strongly significant association was observed in BCTQsymptom, functional and total scores with NCS severity grading(p-value <0.001). Moderately significant association was foundbetween BCTQ symptom and total scores with USG severitygrading (p-value<0.02). Tunnel grade and NCS grade werefound significantly correlated (p-value<0.001). The mean CSAcut-off value of 8.5 mm² at the inlet of carpal tunnel had a goodsensitivity 86.21%, specificity 83.17%, Positive Predictive Value(PPV) 91.1% and Negative Predictive Value (NPV) 75%.Conclusion: The diagnostic accuracy of USG assessment andNCS was found to be correlated comparably and complementeach other in all grades of CTS. USG, can be considereda preferable screening tool by the patients of CTS due to itspainless nature and easy accessibility. It requires minimal timeand many a times detects those structural abnormalities whichhave great therapeutic implications. In mild CTS cases, USGshould always be combined with NCS for proper diagnosis asUSG might give negative result.

【 授权许可】

Unknown