The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Publication date: Available online 3 October 2016
Source:Clinical Neurophysiology
Author(s): Anita Csillik, Dániel Bereczki, László Bora, Zsuzsanna Arányi
ObjectiveA retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS).Methods118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet.ResultsCSA at the outlet (median: 18 mm²) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15 mm²) and its wrist-to-forearm-ratio (median: 2.2) (p <0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet. LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet / distal tunnel versus inlet / proximal tunnel (p <0.001).ConclusionMedian nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal.SignificanceThe addition of CSA outlet measurements to inlet measurements increased CTS ultrasonographic diagnostic sensitivity and accuracy by 15% and 10%, respectively.



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