Highlights
- •Intra- and interrater reliability and known-group validity of cross-sectional area (CSA) measurements of the median nerve taken at the carpal tunnel inlet are consistently well-supported in the literature.
- •There is conflicting evidence on the concurrent validity of measures of median nerve CSA taken at the carpal tunnel inlet when electrodiagnostic studies are used as the reference standard.
- •The findings of this scoping review indicate a 3.1%-37% false negative rate and a 0-32.1% false positive rate when diagnosing carpal tunnel syndrome, using inlet CSA cutoff values between 8.5 mm2 to 12.6 mm2.
- •In comparing data on inlet and outlet CSA measurements, there is more evidence to support the use of measuring CSA at the carpal tunnel inlet. The diagnostic utility values including sensitivity, specificity, and positive and negative likelihood ratios were consistently less for outlet CSA when compared to inlet CSA.
- •There is conflicting evidence on known-group validity of the flattening ratio when measured at the level of the hamate.
Abstract
Background
Diagnostic ultrasound is becoming more available and has potential for identifying
carpal tunnel syndrome (CTS), but there is a lack of consensus on optimal measurement
parameters and interpretation.
Purpose
The purpose of this systematic review was to analyze and summarize recent published
data evaluating measurement properties of diagnostic ultrasound for use in individuals
with CTS.
Methods
Five databases were searched to identify studies reporting on diagnostic measurement
in individuals ≥18 years of age. Thirty-four studies underwent critical appraisal
using Center for Evidence Based Medicine guidelines for diagnostic study accuracy.
Each team member independently reviewed and scored the studies and consensus was reached
through discussion.
Results
Seventeen studies evaluating 21 unique nerve or tunnel measurements and 9 measurement
ratios were included. Measurements of median nerve cross sectional area (CSA) taken
at the carpal tunnel inlet consistently demonstrated good to excellent interrater
reliability (ICC=0.83-0.93) and good intrarater reliability (r>0.81). All studies
supported inlet CSA in differentiating between individuals with and without CTS. Carpal
tunnel inlet CSA measurements demonstrated a moderate correlation to the Padua severity
classification (r = 0.71), but this varied between studies. Diagnostic accuracy of
CSA measured at the carpal tunnel inlet using diagnostic cutoff values ranging from
8.5 mm2 to 12.6 mm2 resulted in a range sensitivity (63%-96.9%) and specificity (67.9%-100%).
Conclusion
The US measurement most supported was the median nerve CSA measured at the carpal
tunnel inlet. There was no evidence supporting the routine use of diagnostic US for
individuals with suspected CTS, and no additional evidence to support replacement
of electrodiagnostic studies by US. More research is needed to determine use of US
for classifying CTS severity or as a differential diagnostic tool for conditions that
mimic CTS.
Level of Evidence
N/A
Keywords
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JHT Read for Credit
Quiz: # 844
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The design of the study is.
- a.prospective cohort
- b.case series
- c.systematic review
- d.RCTs
- a.
- # 2.Study scores were
- a.reached through a consensus of the team after discussion
- b.validated by computer analysis
- c.randomly reviewed by team members
- d.dictated by pre-established norms
- a.
- # 3.CSA of the median nerve was shown to have
- a.excellent sensitivity, but poor specificity
- b.little clinical value
- c.excellent correlation to the CSA of the ulnar nerve
- d.good intrarater reliability and excellent interrater reliability
- a.
- # 4.CSA measures were taken at the
- a.midpalmar level
- b.the level of the distal wrist crease
- c.carpal tunnel inlet
- d.carpal tunnel outlet
- a.
- # 5.The evidence is that ultrasound should replace EMG & NCV in the evaluation of CTS
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: April 14, 2021
Accepted:
April 5,
2021
Received in revised form:
March 2,
2021
Received:
March 6,
2020
Footnotes
The authors have no disclosures.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
