Iranian Journal of Neurology 2017. 16(4):164-167.

Determination of cut-off point of cross-sectional area of median nerve at the wrist for diagnosing carpal tunnel syndrome
Majid Ghasemi, Sanaz Masoumi, Behnaz Ansari, Mahboobeh Fereidan-Esfahani, Seyed Morteza Mousavi

Abstract


Background: The most common entrapment mononeuropathy of the upper extremity is carpal tunnel syndrome (CTS). It consists 90% of entrapment neuropathies. The purpose of this study was to compare cross-sectional area (CSA) of the median nerve at the wrist in CTS patients and healthy controls and define the best cut-off point of CSA to differentiate patients and controls in Iranian population.

Methods: In this study, 45 patients with confirmed idiopathic CTS and 62 healthy controls were evaluated. Based on electrophysiological findings, patients were divided based on CTS severity into three groups of mild, moderate and severe. The largest CSA was measured at the level of distal wrist crease which is consistent with carpal tunnel inlet.

Results: Mean CSA was 0.124 ± 0.031 mm2, 0.146 ± 0.028 mm2 and 0.194 ± 0.062 mm2 in mild, moderate and severe CTS patients respectively, and 0.077 ± 0.011 mm2 in controls. Our results showed that participants with CSA > 0.010 had CTS with 100% specificity and 83.12% sensitivity.

Conclusion: It is possible to diagnose CTS by measuring CSA and using above-mentioned cut-off point.

Keywords


Carpal Tunnel Syndrome; Electrophysiology; Ultrasonography

Full Text:

PDF

References


-Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2):153-8.

-Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Medical J 2008; 77(1):6-17.

- Schappert SM,Rechtsteiner EA.Ambulatory medical care utilization estimates for 2006.Natl Health Stat Report 2008; 6:1–29.

- Deniz FE, Oksüz E, Sarikaya B, Kurt S, Erkorkmaz U, Ulusoy H, et al.: Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings. Neurosurgery 2012;70: 610-616.

- De Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45(4): 373-6.

- Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of crosssectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound 2009; 37: 125 – 131.

- Dalili AR, Mardani Kivi M, Alizadeh A, Hatamian HR, Hoseininejad M, Peyrazm H, et al. Comparison between Sonography and Electrodiagnostic Testing in the Diagnosis of Carpal Tunnel Syndrome Anesthesiology and Pain. 2011; 2(5):43-51. [In Persian].

- Benjamin M,Sucher DO.Grading Severity of Carpal Tunnel syndrome in Electrodiagnosticreports.EMG Labs of Arizona arthritis& rheumatology associates,2013.

-Jablecki CK, Andary MT, So YT, et al. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee.Muscle Nerve 1993;16(2):1392-414.

-Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2004; 29(4):515-22.

Fu T, Cao M, Liu F, Zhu J, Ye D, Feng X, et al. Carpal tunnel syndrome assessment with ultrasonography: Value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers. PLoS One 2015; 10(1): e0116777.

- Karadağ YS, Karadağ O, Ciçekli E, Oztürk S, Kiraz S, Ozbakir S, et al. Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int 2010;30: 761-765.

- Yazdchi M, Tarzemani MK, Mikaeili H, Ayromlu H, Ebadi H. Sensitivity and specificity of median nerve ultrasonography in diagnosis of carpal tunnel syndrome. Int J Gen Med 2012; 5: 99-103.

- Sarria L, Cabada T, Cozcolluela R, Martinez-Berganza T, Garcia S. Carpal tunnel syndrome: usefulness of sonography. EurRadiol 2000; 10(12): 1920-5.

- Pinilla I, Martin-Hervas C, Sordo G, et al. The usefulness of ultrasonography in the diagnosis of carpal tunnel syndrome. J Hand SurgEurVol 2008; 33(4):435-9.

-Mohammadi A, Afshar A, Etemadi A, et al. Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome.Arch Iran Med 2010;13(6):516-21.

-Lee D, van Holsbeeck MT, Janevski PK, et al. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. RadiolClin North Am 1999; 37(4):859-72.

-Sarraf P, Malek M, Ghajarzadeh M, et al. The best cut off point for median nerve cross sectional area at the level of carpal tunnel inlet. Acta Medica Iranica 2013; 52(8):613-618.

- Ziswiler HR, ReichenbachS,Vogelin E, Bachmann LM, Villiger PM, et al.Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum2005; 52: 304-311.

-Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle & nerve. 2002; 26(6):798-803.

-Ulaşli AM, Duymuş M, Nacir B, RanaErdem H, Koşar U . Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and are liable method for its calculation. Muscle Nerve 2013; 47:396–402.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.