The Correlation between Ultrasonographic Findings of Median Nerve and Clinical Scale and Electrodiagnotic Data in Carpal Tunnel Syndrome

수근관 증후군에서 임상양상척도 및 신경전기진단 결과와 정중신경 초음파 소견의 상관관계

  • Lee, Gyu-Ho (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine) ;
  • Kim, Sei-Joo (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine) ;
  • Yoon, Joon-Shik (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine) ;
  • Park, Byung-Kyu (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine) ;
  • Cho, Jung-Mo (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine) ;
  • Jung, Jin-Seok (Department of Physical Medicine and Rehabilitation, Korea University School of Medicine)
  • 이규호 (고려대학교 의과대학 재활의학교실) ;
  • 김세주 (고려대학교 의과대학 재활의학교실) ;
  • 윤준식 (고려대학교 의과대학 재활의학교실) ;
  • 박병규 (고려대학교 의과대학 재활의학교실) ;
  • 조정모 (고려대학교 의과대학 재활의학교실) ;
  • 정진석 (고려대학교 의과대학 재활의학교실)
  • Received : 2010.06.10
  • Accepted : 2010.10.13
  • Published : 2010.12.31

Abstract

Background: The aim of this study is to identify the correlation between ultrasonographic findings of median nerve and clinical scale and electrophysiologic data in carpal tunnel syndrome. Methods: Forty three patients (79 hands) with electrophysiologically confirmed carpal tunnel syndrome were evaluated. Clinical symptoms were examined by Historical-Objective (Hi-Ob) scale. Electrophysiologic data and Padua scale were used for severity of electrophysiology. In ultrasonographic study, cross sectional area and flattening ratio of median nerve were measured at distal wrist crease level (DWC), 1cm proximal to distal wrist crease level, and 1cm distal to distal wrist crease level. The correlation between Hi-Ob scale, electrophysiologic data and ultrasonography was measured with Spearman rank test. Results: The mean Hi-Ob scale was 2.4. Mean Padua scale was 4.0. In ultrasnonographic study, cross sectional area and flattening ratio were $0.112\;cm^2{\pm}0.025$ and $3.0{\pm}0.6$ at 1cm proximal to DWC level, $0.118{\pm}0.026\;cm^2$ and $2.9{\pm}0.4$ at DWC level, and $0.107{\pm}0.032\;cm^2$ and $3.0{\pm}0.4$ at 1 cm distal to DWC level. Hi-Ob scale was not correlated with cross sectional area and flattening ratio of median nerve. Hi-Ob scale was correlated with Padua scale positively (r=0.44) and correlated with amplitudes of CMAP and SNAP, negatively (r=-0.33; r=-0.30). Cross sectional area of median nerve was significantly correlated with Padua scale, amplitudes and latencies of CMAP and amplitudes of SNAP. Conclusions: Ultrasonographic findings of median nerve and electrodiagnostic data had statistically significant correlation. Consequently, ultrasonography could be an adjunctive method in diagnosis of carpal tunnel syndrome.

Keywords

References

  1. Jung SH, Paik NJ, Bang MS, Han TR. Comparison of various clinical scales with electrophysiological scales for carpal tunnel syndrome. J Kor Ass EMG 2005;7:79-89.
  2. Kotevoglu N, Gulbahce-Saglam S. Ultrasound imaging in the diagnosis of carpal tunnel syndrome and its relevance to clinical evaluation. Joint Bone Spine 2005;72:142-145. https://doi.org/10.1016/j.jbspin.2004.03.012
  3. Osterman AL. The double crush syndrome. Orthop Clin North Am 1979;19:147-155.
  4. Kang KB, Kim SJ. Electrophysiological findings of patients with upper extremity complaints in diagnosing the carpal tunnel syndrome. J Korean Acad of Rehab Med 1993;17:9-17.
  5. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2008;79:63-67. https://doi.org/10.1136/jnnp.2007.115337
  6. Bayrak IK, Bayrak AO, Tilki HE, Nural MS, Sunter T. Ultrasonography in carpal tunnel syndrome: comparison with electrophysiological stage and motor unit number estimate. Muscle Nerve 2007;35:344-348. https://doi.org/10.1002/mus.20698
  7. Altinok T, Karakas HM. Ultrasonographic evaluation of agerelated changes in bowing of the flexor retinaculum. Surg Radiol Anat 2004;26:501-503. https://doi.org/10.1007/s00276-004-0268-5
  8. Keles I, Karagulle Kendi AT, Aydin G, Zog SG, Orkun S. Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome. Am J Phys Med Rehabil 2005;84:443-450. https://doi.org/10.1097/01.phm.0000163715.11645.96
  9. Park GY, Bae JH, Oh JS, Lim JG, Son DG. Ultrasonographic findings of mild and very mild carpal tunnel syndrome. J Korean Acad Rehab Med 2008;32:62-72.
  10. Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D'Amico P, et al. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clinical Neurophysiol 2002;113:71-77. https://doi.org/10.1016/S1388-2457(01)00704-0
  11. Cho JM, Yoon JS, Kim SJ, Park BK, Lee GH, Jeong JS. Feasibility of ultrasonographic area ratio of median nerve in the diagnosis of carpal tunnel syndrome in Korea. J Korean Acad Rehab Med 2009;33:627-631.
  12. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96:211-217.
  13. Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle Nerve 2002;26:798-803. https://doi.org/10.1002/mus.10276
  14. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology 2004;43:887-895. https://doi.org/10.1093/rheumatology/keh190