High-frequency ultrasound in carpal tunnel syndrome:assessment of patient eligibility for surgical treatment


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Journal of Ultrasonography

Polish Ultrasound Society (Polskie Towarzystwo Ultrasonograficzne)

Subject: Medicine


ISSN: 2084-8404
eISSN: 2451-070X





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VOLUME 15 , ISSUE 62 (September 2015) > List of articles

High-frequency ultrasound in carpal tunnel syndrome:assessment of patient eligibility for surgical treatment

Katarzyna Kapuścińska * / Andrzej Urbanik

Keywords : median nerve, carpal tunnel syndrome,  entrapment neuropathy,  ultrasound

Citation Information : Journal of Ultrasonography. Volume 15, Issue 62, Pages 283-291, DOI: https://doi.org/10.15557/JoU.2015.0025

License : (CC BY-NC-ND 3.0)

Received Date : 03-March-2015 / Accepted: 26-June-2015 / Published Online: 13-September-2016



Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical) are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2) with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2, max. 31 mm2). Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%). Increased nerve vascularity on the transverse section was present in 50 patients (80.65%). Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment effi cacy.

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1. Żyluk A, Puchalski P: Historia naturalna zespołu kanału nadgarstka – przegląd piśmiennictwa. Pol Orthop Traumatol 2010; 75: 261–266.
2. Kwon BC, Jung KI, Baek GH: Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am 2008; 33: 65–71.
3. Klauser AS, Faschingbauer R, Bauer T et al.: Entrapment neuropathies
II: carpal tunnel syndrome. Semin Musculoskelet Radiol 2010; 14:487–500.
4. Żyluk A, Walaszek I, Szlosser Z: No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome. J Hand Surg Eur Vol 2014; 39: 161–166.
5. Claes F, Kasius KM, Meulstee J, Verhagen WI: Comparing a new ultrasound approach with electrodiagnostic studies to confi rm clinically defi ned carpal tunnel syndrome: a prospective, blinded study. Am J Phys Med Rehabil 2013; 92: 1005–1011.
6. Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A:The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol 2005;56: 365–369.
7. Toros T: Commentary on Zyluk et al. No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome; and Yalçın et al. Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness. J Hand Surg Eur Vol 2014; 39: 172–174.
8. Lange J: Carpal tunnel syndrome diagnosed using ultrasound as a fi rstline exam by the surgeon. J Hand Surg Eur Vol 2013; 38: 627–632.
9. Smidt MH, Visser LH: Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008; 38: 987–991.
10. Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP: Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. J Clin Ultrasound 2009; 37: 389–393.
11. Ziswiler HR, Reichenbach S, Vögelin E, Bachmann LM, Villiger PM, Jüni P: Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum 2005; 52:304–311.
12. Klauser AS, Halpern EJ, De Zordo T et al.: Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009; 250: 171–177.
13. Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G: Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol 2006; 186: 1240–1245.
14. Naranjo A, Ojeda S, Rúa-Figueroa I, Garcia-Duque O, Fernández-Palacios J, Carmona L: Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgery. Scand J Rheumatol 2010; 39: 409–412. 
15. Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM, Jajroudi M, Shakiba M, Mazloumi M et al.: Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method. Radiology 2011; 261: 499–506.
16. Joy V, Therimadasamy AK, Chan YC, Wilder-Smith EP: Combined Doppler and B-mode sonography in carpal tunnel syndrome. J Neurol Sci 2011; 308: 16–20.