Tuesday, February 13, 2007

Ultrasonography in carpal tunnel syndrome: Comparison with electrophysiological stage and motor unit number estimate.

(Muscle Nerve 2006 Dec 1;35(3):344-348)

Abstract: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17143879&query_hl=3&itool=pubmed_docsum


Coordinator said...

In this well designed study that included a control group, the authors correlated ultrasound measurements of the median nerve in the carpal tunnel (specifically cross sectional area) with severity of carpal tunnel syndrome based on electrophysiological findings. An increased cross sectional area, especially at the level of the pisiform, correlated with electrophysiological grading. Examiners were blinded as to the experimental groups.

This study further confirms the accuracy and utility of ultrasound for diagnosing carpal tunnel syndrome, as well as assessing its severity. Differences (i.e., enlarged, flattened nerves in carpal tunnel syndrome) between the experimental and control groups were quite convincing, with all parameters revealing a strong statistical difference. Correlating ultrasound findings to electrophysiological severity was less convincing, however. At the level of the pisiform, where correlation to electrophysiological staging was the best, there were strong p-values with acceptable correlation coefficients (about 0.6). At other areas, and when correlating the ultrasound findings to motor unit approximation, the p-values were not as significant, and when they were, the correlation coefficients were low (<<0.5 in many cases).

Considering its emerging utility in carpal tunnel syndrome, I look forward to ultrasound being used to help diagnose other, more rare nerve entrapments, where electrophysiology is not always able to definitively confirm the diagnosis early in the disease process (i.e., when denervation has not occurred) A few examples may include pyriformis syndrome, pudendal nerve entrapment, thoracic outlet syndrome, and suprascapular nerve entrapment, to name a few.

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