Limited evidence supports not routinely using ultrasound for the diagnosis of carpal tunnel syndrome.
Management of Carpal Tunnel Syndrome
Endorsed by: ASSH, ASPS, ACR, ACS, ASA
There were five high quality (Naranjo, 2007; Moran, 2009; Ziswiler, 2005; Wong, 2004; Claes, 2013) and seven moderate quality studies (Abdel Ghaffar, 2012; Dejaco, 2013; Fowler, 2014; Hashemi, 2009; Moghtaderi, 2012; Nakamichi, 2002; Pastare, 2009) evaluating ultrasound for the diagnosis of CTS compared with EDS as the reference standard. These studies showed conflicting results regarding the utility of ultrasound (US) as either a rule in or rule out test in the diagnosis of CTS. In general, there was variation between the studies for the cut-off value for making the diagnosis or for exclusion of CTS. The ideal location for measuring the cross-sectional area (CSA) of the median nerve for indicating the diagnosis of CTS also varied between studies. There is a general agreement that a CSA greater than 12-13 mm is strongly correlated with EDS. As a rule out study for CTS, there is a strong correlation with CSA below 8 mm. One moderate quality (Abdel Ghaffar, 2012) and one low quality study (Mallouhi, 2006) suggest that a US measurement of nerve hypervascularity may have a strong association as a rule out study for CTS.
- Abdel Ghaffar,M.K.; El-Shinnawy,M.A.; Fawzy,H.; Ibrahim,S.E. Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome. Egyptian Journal of Radiology and Nuclear Medicine; 2012/12: 4
- Claes,F.; Kasius,K.M.; Meulstee,J.; Verhagen,W.I. Comparing a new ultrasound approach with electrodiagnostic studies to confirm clinically defined carpal tunnel syndrome: a prospective, blinded study. Am J Phys Med Rehabil.; 2013/11: 11
- Dejaco,C.; Stradner,M.; Zauner,D.; Seel,W.; Simmet,N.E.; Klammer,A.; Heitzer,P.; Brickmann,K.; Gretler,J.; Furst-Moazedi,F.C.; Thonhofer,R.; Husic,R.; Hermann,J.; Graninger,W.B.; Quasthoff,S. Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann.Rheum.Dis; 2013/12: 12
- Fowler,J.R.; Munsch,M.; Tosti,R.; Hagberg,W.C.; Imbriglia,J.E. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am; 2014/9/3: 17
- Hashemi,A.-H.; Homa,M.; Naghibi,S.; Hejrani,B.; Sobhani,S.; Afsharian,A.; Shaban,M. Wrist sonography versus electrophysiologic studies in diagnosis of carpal tunnel syndrome. Neurosurgery Quarterly; 2009/9: 3
- Moghtaderi,A.; Sanei-Sistani,S.; Sadoughi,N.; Hamed-Azimi,H. Ultrasound evaluation of patients with moderate and severe carpal tunnel syndrome. Prague.Med Rep.; 2012: 1
- Moran,L.; Perez,M.; Esteban,A.; Bellon,J.; Arranz,B.; del,Cerro M. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound; 2009/3: 3
- Nakamichi,K.; Tachibana,S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve; 2002/12: 6
- Naranjo,A.; Ojeda,S.; Mendoza,D.; Francisco,F.; Quevedo,J.C.; Erausquin,C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?. Clin Exp.Rheumatol.; 2007/11: 6
- Pastare,D.; Therimadasamy,A.K.; Lee,E.; Wilder-Smith,E.P. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. J Clin Ultrasound; 2009/9: 7
- Wong,S.M.; Griffith,J.F.; Hui,A.C.; Lo,S.K.; Fu,M.; Wong,K.S. Carpal tunnel syndrome: diagnostic usefulness of sonography. ; 2004/7: 1
- Ziswiler,H.R.; Reichenbach,S.; Vogelin,E.; Bachmann,L.M.; Villiger,P.M.; Juni,P. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum.; 2005/1: 1