Role of ultrasound and electro-diagnostic studies in the diagnosis of carpal tunnel syndrome: A comparative study

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Abstract

BACKGROUND: The current gold standard for the diagnosis of Carpal tunnel syndrome (CTS) is a topic of debate. Nerve conduction studies (NCS) traditionally have been used as the confirmatory test; however, ultrasound (USG) has garnered interest as an alternative diagnostic test for CTS. Ultrasound measurement of the cross sectional area of the median nerve at the carpal tunnel has been proposed as an alternative for confirmation of CTS.

AIM: The aim of the study was to compare the sensitivity and specificity between Ultrasound and Electro-diagnostic Studies in the diagnosis of Carpal Tunnel Syndrome with reference to a validated clinical diagnostic tool i.e. CTS- 6; that combines findings from the history and physical examination.

MATERIALS AND METHODS: 40 (20 Cases and 20 controls) adult patients and adolescents of both sexes with complain of pain and paraesthesia in upper limb were included in this cross sectional study. All patients were evaluated using CTS-6 clinical diagnostic tool. Those patients with CTS score≥12 were considered as positive diagnosis for Carpal Tunnel Syndrome (cases) (Main group). Those patients with CTS Score<12 were taken as Controls. Ultrasound and Electro-diagnostic Studies were performed by individuals blinded to the results of the CTS-6 and ultrasound examination.

RESULTS: We found that USG have sensitivity of 90%, specificity of 85%, and positive predictive value of 85.71% and negative predictive value of 89.47%. Whereas NCS have sensitivity of 85%, specificity of 80%, positive predictive value of 80.95% and negative predictive value of 84.21%.

CONCLUSION: Using CTS-6 clinical tool as a standard reference, the sensitivity and specificity of USG is more than that of NCS.

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About the authors

Benthungo N. Tungoe

Zion Hospital & Research Centre

Email: ben77tungoe@gmail.com
ORCID iD: 0000-0003-2072-1457

MD

India, Dimapur, Nagaland

Rajesh Kumar Chopra

Vardhman Mahavir Medical College & Safdarjung Hospital

Email: drrkchopra58@yahoo.com

MD, Director Professor

India, New Delhi

Yatish Agarwal

Vardhman Mahavir Medical College & Safdarjung Hospital

Email: dryatishagarwal@gmail.com

MD, Consultant & Professor

India, New Delhi

Ashish Jaiman

Vardhman Mahavir Medical College & Safdarjung Hospital

Author for correspondence.
Email: drashishjaiman@gmail.com
ORCID iD: 0000-0002-4625-0107

MD, MBBS, MS(Ortho), Professor

India, New Delhi

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Supplementary files

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2. Fig. 1. Position of the USG probe

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3. Fig. 2. Localizing the Median nerve (M), Pisiform (P) and Scaphoid (S)

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4. Fig. 3. Positive findings on USG showing median nerve CSA of 10.2 mm2

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5. Fig. 4. Negative findings on USG showing median nerve CSA of 4.9 mm2

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6. Fig. 5. Electrodes placement for measuring distal motor latency

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7. Fig. 6. Electrodes placement for measuring distal sensory latency

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Copyright (c) 2021 Tungoe B.N., Chopra R.K., Agarwal Y., Jaiman A.

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