J Clin Neurol.  2014 Oct;10(4):348-353. 10.3988/jcn.2014.10.4.348.

Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography

• Kwon HK
• Kang HJ
• Byun CW
• Yoon JS
• Kang CH
• Pyun SB

• KMID: 2287515
• DOI: http://doi.org/10.3988/jcn.2014.10.4.348

Abstract

BACKGROUND AND PURPOSE
To determine the correlation between the cross-sectional area (CSA) of the median nerve measured at the wrist using three-dimensional (3D) ultrasonography (US) and the electrophysiological severity of carpal tunnel syndrome (CTS).
METHODS
We prospectively examined 102 wrists of 51 patients with clinical CTS, which were classified into 3 groups according to the electrodiagnostic (EDX) findings. Median nerve CSAs were measured using 3D US at the carpal tunnel inlet and at the level of maximal swelling.
RESULTS
Ten wrists were negative for CTS. Of the 92 CTS-positive wrists, 23, 30, and 39 were classified as having mild, moderate, and severe CTS, respectively. The median nerve CSA differed significantly between the severe- and moderate-CTS groups (p=0.0007 at the carpal tunnel inlet and p<0.0001 at the maximal swelling site). There was a correlation between median nerve CSA and EDX parameters among those wrists with severe and mild CTS (p<0.0001 at both sites).
CONCLUSIONS
The median nerve CSA as measured by 3D US could provide additional information about the severity of CTS, as indicated by the strong correlation with standard EDX findings.

Keyword

three-dimensional ultrasonography; carpal tunnel syndrome; cross-sectional area; electrophysiological severity; median nerve

MeSH Terms

Bays
Carpal Tunnel Syndrome*
Humans
Median Nerve
Prospective Studies
Ultrasonography*
Wrist

Figure

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  Fig. 1 3D ultrasonography of the median nerve in the carpal tunnel.

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  Fig. 2 Multiplanar display of a 3D ultrasonography volume showing the median nerve (dots) in three orthogonal orientations. The planes are interactive and permit a complete tracing of the median nerve from the distal radius to the proximal carpal tunnel.

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  Fig. 3 Box plot showing the median nerve CSAs measured using 3D ultrasonography at the carpal tunnel inlet (left) and the maximal swelling point (right) in patients with CTS who were stratified according to the severity of their condition based on EDX (NCS). A gradual increase in CSA was observed with worsening CTS severity, with significant differences being apparent at both nerve sites between the severe- and mild-CTS groups (*p<0.0001 at the carpal tunnel inlet; †p<0.0001 at the maximum swelling point) and between the severe- and moderate-CTS groups (‡p=0.0007 at the carpal tunnel inlet; §p<0.0001 at the maximum swelling point). Bold black lines indicate medians and whiskers indicate error bars; ○, outliers; ■, mean values (10.5±4.6, 11.6±2.6, and 17.1±7.5 mm2 in the mild-, moderate-, and severe-CTS groups, respectively, at the carpal tunnel inlet; and 11.7±4.7, 13.0±3.4, and 19.7±7.2 mm2, respectively, at the maximum swelling point). CSAs: cross-sectional areas, CTS: carpal tunnel syndrome, EDX: electrodiagnostic, NCS: nerve conduction study.

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