Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies
Received 28 January 2018
Accepted for publication 1 April 2018
Published 10 July 2018 Volume 2018:11 Pages 1319—1325
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Minal Joshi
Peer reviewer comments 2
Editor who approved publication: Dr E. Alfonso Romero-Sandoval
Reza Salman Roghani,1,2 Mohammad Taghi Holisaz,2 Ali Asghar Sahami Norouzi,2 Ahmad Delbari,3 Faeze Gohari,4 Johan Lokk,1 Andrea J Boon5,6
1Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; 2Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 4Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 5Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; 6Department of Neurology, Mayo Clinic, Rochester, MN, USA
Background: Suspecting carpal tunnel syndrome (CTS) in patients with hand pain is usual. Considering the variable rate of false-negative results in nerve conduction study (NCS), as a frequent reference confirmatory standard test, we aimed to evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinical evidence of CTS and normal NCS.
Methods: It was a diagnostic accuracy study conducted in the outpatient clinic of Rofaydeh Hospital, Tehran, Iran, between July 2012 and December 2016; it recruited clinically diagnosed CTS patients and a control group. All participants underwent comprehensive clinical examination, NCS, and high-resolution ultrasonography of the median nerve.
Results: Two hundred and fifty patients with clinical evidence of CTS met the inclusion criteria, of whom 103 (27.1%) had normal NCS and underwent an ultrasound examination. A cutoff point of 9.4 mm2 (mean + 2 standard deviation) for median nerve cross-sectional area at the carpal tunnel inlet from the control group was set to detect 73% abnormality in the case group.
Conclusion: Ultrasonography had a sensitivity rate of 73% in patients with clinical CTS and negative NCS, increasing the overall diagnostic sensitivity for clinically suspected CTS in the electrodiagnostic lab setting to 92%. The study highlights the complementary role of ultrasonography in diagnosing CTS in conjunction with NCS.
Keywords: hand pain, sensitivity, carpal tunnel syndrome, nerve conduction, ultrasonography, false-negative reaction, diagnosis, complementary
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