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The role of diagnostic ultrasound in the examination of carpal tunnel syndrome: an update and systematic review

Erickson M, Lawrence M, Lucado A

Journal of Hand Therapy 2022 Apr-Jun;35(2):215-225

systematic review

BACKGROUND: Diagnostic ultrasound is becoming more available and has potential for identifying carpal tunnel syndrome (CTS), but there is a lack of consensus on optimal measurement parameters and interpretation. PURPOSE: The purpose of this systematic review was to analyze and summarize recent published data evaluating measurement properties of diagnostic ultrasound for use in individuals with CTS. METHODS: Five databases were searched to identify studies reporting on diagnostic measurement in individuals >= 18 years of age. Thirty-four studies underwent critical appraisal using Center for Evidence Based Medicine guidelines for diagnostic study accuracy. Each team member independently reviewed and scored the studies and consensus was reached through discussion. RESULTS: Seventeen studies evaluating 21 unique nerve or tunnel measurements and 9 measurement ratios were included. Measurements of median nerve cross sectional area (CSA) taken at the carpal tunnel inlet consistently demonstrated good to excellent interrater reliability (ICC = 0.83 to 0.93) and good intrarater reliability (r > 0.81). All studies supported inlet CSA in differentiating between individuals with and without CTS. Carpal tunnel inlet CSA measurements demonstrated a moderate correlation to the Padua severity classification (r = 0.71), but this varied between studies. Diagnostic accuracy of CSA measured at the carpal tunnel inlet using diagnostic cutoff values ranging from 8.5 mm2 to 12.6 mm2 resulted in a range sensitivity (63% to 96.9%) and specificity (67.9% to 100%). CONCLUSION: The US measurement most supported was the median nerve CSA measured at the carpal tunnel inlet. There was no evidence supporting the routine use of diagnostic US for individuals with suspected CTS, and no additional evidence to support replacement of electrodiagnostic studies by US. More research is needed to determine use of US for classifying CTS severity or as a differential diagnostic tool for conditions that mimic CTS. LEVEL OF EVIDENCE: N/A

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