Value of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome : Correlation with Electrophysiological Abnormalities and Clinical Severity

Objective : To investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity. Methods : Two-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity. Results : The mean CSA was $13.7{\pm}4.2mm^2$ in symptomatic hands and $7.9{\pm}1.3mm^2$ in asymptomatic hands. The mean FR was $4.2{\pm}1.0$ in symptomatic hands and $3.4{\pm}0.4$ in asymptomatic hands. The mean PB was $3.5{\pm}0.5$ mm in symptomatic hands and $2.6{\pm}0.3$ mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of $10mm^2$ for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively. Conclusion : Ultrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.