Ann Rehabil Med.  2016 Dec;40(6):1048-1056. 10.5535/arm.2016.40.6.1048.

Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome

• Lee H
• Jee S
• Park SH
• Ahn SC
• Im J
• Sohn MK

• KMID: 2371337
• DOI: http://doi.org/10.5535/arm.2016.40.6.1048

Abstract

OBJECTIVE
To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed.
METHODS
Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated.
RESULTS
Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05).
CONCLUSION
These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.

Keyword

Carpal tunnel syndrome; Quantitative muscle ultrasonography; Electrodiagnostic study; Echo intensity; Peripheral neuropathy

MeSH Terms

Carpal Tunnel Syndrome*
Healthy Volunteers
Humans
Neuromuscular Diseases
Peripheral Nervous System Diseases
Ulnar Nerve
Ultrasonography*

Figure

• 

  Fig. 1 Position for quantitative muscle ultrasonographic measurements in the right abductor pollicis brevis (A) and abductor digiti minimi (B).

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  Fig. 2 Transverse ultrasonography images of the left abductor pollicis brevis (APB) and abductor digiti minimi (ADM) of a control subject. Calculation of muscle thickness and cross-sectional area in the APB (A) and ADM (B).

• 

  Fig. 3 Echo intensity (EI) analysis of ultrasound images. Grayscale images were used to determine muscle EI within each region of interest (ROI). The mean and standard deviation of the pixel brightness in each ROI were automatically calculated by Photoshop software.

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  Fig. 4 Receiver operating characteristic (ROC) curve for abductor pollicis brevis muscle echo intensity to distinguish patients with carpal tunnel syndrome from control subjects. The optimal cutoff point was 22.60 (sensitivity 92.5%, specificity 92.5%).

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  Fig. 5 Pearson correlation scatter plots for study results of echo intensity of abductor pollicis brevis (APB). (A) Distal motor latency of the median nerve (r=0.65). (B) Onset latency of the median sensory nerve (r=0.67). (C) Thickness of APB (r=−0.4). (D) Cross-sectional area (CSA) of APB (r=−0.41).

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