Ann Rehabil Med.  2018 Feb;42(1):85-91. 10.5535/arm.2018.42.1.85.

Carpal Tunnel Syndrome Assessment With Ultrasonography: A Comparison Between Non-diabetic and Diabetic Patients

  • 1Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea.


To investigate the diagnostic value of cross-sectional area (CSA) and wrist to forearm ratio (WFR) in patients with electro-diagnosed carpal tunnel syndrome (CTS) with or without diabetes mellitus (DM).
We retrospectively studied 256 CTS wrists and 77 healthy wrists in a single center between January 1, 2008 and January 1, 2013. The CSA and WFR were calculated for each wrist. Patients were classified into four groups according to the presence of DM and CTS: group 1, non-DM and non-CTS patients; group 2, non-DM and CTS patients; group 3, DM and non-CTS patients; and group 4, DM and CTS patients. To determine the optimal cut-off value, receiver operating characteristic (ROC) curve analysis was performed.
The CSA and WFR were significantly different among the groups (p < 0.001). The ROC curve analysis of non-DM patients revealed CSA ≥10.0 mm2 and WFR ≥1.52 as the most powerful diagnostic values of CTS. The ROC curve analysis revealed CSA ≥12.5 mm2 and WFR ≥1.87 as the most powerful diagnostic values of CTS.
Ultrasonographic assessment for the diagnosis of CTS requires a particular cut-off value for diabetic patients. Based on the ROC analysis results, improved accurate diagnosis is possible if WFR can be applied regardless of presence or absence of DM.


Carpal tunnel syndrome; Ultrasonography; Electrodiagnosis; Diabetes mellitus

MeSH Terms

Carpal Tunnel Syndrome*
Diabetes Mellitus
Retrospective Studies
ROC Curve


  • Fig. 1 Ultrasonographic probe position at two different levels. Ultrasonographic transverse scanning was done. The cross-sectional areas of the maximal swelling point of the median nerve were measured at the wrist (A) and 12 cm proximal to this level (B).

  • Fig. 2 The receiver operating characteristic (ROC) curve analysis of the CSA and WFR values for the diagnosis of carpal tunnel syndrome in total patients (A), DM patients (B), and non-DM patients (C). CSA, cross-sectional area; WFR, wrist to forearm ratio; AUC, area under the curve; DM, diabetes mellitus.


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