Ting-Yu Lin1, Ke-Vin Chang2,3,4, Wei-Ting Wu5,6, Levent Özçakar7. 1. Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Medical Foundation, Inc, 26546, Yilan, Taiwan. 2. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, 10048, Taipei, Taiwan. kvchang011@gmail.com. 3. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, 10845, Taipei, Taiwan. kvchang011@gmail.com. 4. Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, 11600, Taipei, Taiwan. kvchang011@gmail.com. 5. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, 10048, Taipei, Taiwan. 6. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, 10845, Taipei, Taiwan. 7. Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100, Ankara, Turkey.
Abstract
BACKGROUND: Numerous sonographic modalities and parameters have been used to diagnose carpal tunnel syndrome (CTS), with varying accuracy. Our umbrella review aimed to summarize the evidence from systematic reviews and meta-analyses regarding the use of ultrasound imaging to diagnose CTS. METHODS: Systematic reviews and meta-analyses meeting the inclusion criteria were searched in PubMed, Embase, Medline, Web of Science, and Cochrane databases from inception to March 2022. Critical appraisal, data extraction, and synthesis were performed in accordance with the criteria for conducting an umbrella review. RESULTS: Sixteen reviews were included. Three reviews were classified as high quality, one as moderate, four as low, and eight as critically low. The cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet demonstrated the best reliability and diagnostic accuracy among multiple parameters. A cutoff CSA value of 9-10.5 mm2 gave the highest diagnostic performance in the general population. The degree of CSA enlargement was correlated with CTS severity. Sonoelastography and Doppler ultrasound might provide additional insights into CTS evaluation as median nerve stiffness and vascularity at the wrist were increased in these patients. CONCLUSIONS: Sonography is a reliable tool to diagnose CTS, with inlet CSA being the most robust parameter. Sonoelastography and Doppler ultrasound can serve as auxiliary tools to confirm CTS diagnoses. Further studies are needed to expand the use of sonography for diagnosing CTS, especially in the presence of concomitant neuromuscular disease(s).
BACKGROUND: Numerous sonographic modalities and parameters have been used to diagnose carpal tunnel syndrome (CTS), with varying accuracy. Our umbrella review aimed to summarize the evidence from systematic reviews and meta-analyses regarding the use of ultrasound imaging to diagnose CTS. METHODS: Systematic reviews and meta-analyses meeting the inclusion criteria were searched in PubMed, Embase, Medline, Web of Science, and Cochrane databases from inception to March 2022. Critical appraisal, data extraction, and synthesis were performed in accordance with the criteria for conducting an umbrella review. RESULTS: Sixteen reviews were included. Three reviews were classified as high quality, one as moderate, four as low, and eight as critically low. The cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet demonstrated the best reliability and diagnostic accuracy among multiple parameters. A cutoff CSA value of 9-10.5 mm2 gave the highest diagnostic performance in the general population. The degree of CSA enlargement was correlated with CTS severity. Sonoelastography and Doppler ultrasound might provide additional insights into CTS evaluation as median nerve stiffness and vascularity at the wrist were increased in these patients. CONCLUSIONS: Sonography is a reliable tool to diagnose CTS, with inlet CSA being the most robust parameter. Sonoelastography and Doppler ultrasound can serve as auxiliary tools to confirm CTS diagnoses. Further studies are needed to expand the use of sonography for diagnosing CTS, especially in the presence of concomitant neuromuscular disease(s).
Authors: Christian Dejaco; Martin Stradner; Dorothea Zauner; Werner Seel; Nicole Elisabeth Simmet; Alexander Klammer; Petra Heitzer; Kerstin Brickmann; Judith Gretler; Florentine C Fürst-Moazedi; Rene Thonhofer; Rusmir Husic; Josef Hermann; Winfried B Graninger; Stefan Quasthoff Journal: Ann Rheum Dis Date: 2012-12-04 Impact factor: 19.103
Authors: Adeniyi A Borire; Leo H Visser; Luca Padua; James G Colebatch; William Huynh; Neil G Simon; Matthew C Kiernan; Arun V Krishnan Journal: Muscle Nerve Date: 2016-11-04 Impact factor: 3.217
Authors: Frans J M Bongers; Francois G Schellevis; Wil J H M van den Bosch; Jouke van der Zee Journal: Br J Gen Pract Date: 2007-01 Impact factor: 5.386