Ultrasound Parameters other than the Direct Measurement of Ulnar Nerve Size for Diagnosing Cubital Tunnel Syndrome: a Systemic Review and Meta-analysis

Publication date: Available online 25 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Ing-Jeng Chen, Ke-Vin Chang, Wei-Ting Wu, Levent Özçakar

ABSTRACT

Objective

To investigate the diagnostic performance of available ultrasound (US) parameters, other than the direct measurements of ulnar nerve size i.e. cross-sectional area (CSA) and diameter, for diagnosing cubital tunnel syndrome (CuTS).

Data Sources

Databases, including PubMed and Embase, were searched from the earliest record of CuTS ultrasound to April 24th, 2018.

Study Selection

Thirteen published studies comparing US parameters of ulnar nerves between patients with CuTS and healthy controls were included.

Data Extraction

Study design, participants' demographics, diagnostic references of CuTS, and US parameters other than the direct measurements of the ulnar nerve size were retrieved from the included studies.

Data Synthesis

This systematic review comprised 663 CuTS patients and 543 healthy controls. The pooled nerve swelling ratio in the CuTS group was significantly larger than that of the controls. The mean between-group differences of CSA _{Max or ME}/ CSA _arm, CSA _{Max or ME}/ CSA _forearm and CSA _{Max or ME}/ CSA _wrist were 1.03 (95% confidence interval (CI), 0.77 to 1.29), 1.38 (95% CI, 0.93 to 1.82) and 0.83 (95% CI, 0.56 to 1.11), respectively. With regard to the swelling ratio of CSA _{Max or ME (medial epicondyle)} / CSA _arm, the pooled sensitivity and specificity available from the three included studies were 0.67 (95% CI, 0.59-0.74) and 0.81 (95% CI, 0.75-0.86), respectively. Similarly, for the swelling ratio of CSA _{Max or ME} / CSA _forearm, the pooled sensitivity and specificity were 0.62 (95% CI, 0.54-0.69) and 0.86 (95% CI, 0.81-0.90), respectively. Other US parameters identified in this review included nerve-flattening ratio (maximum diameter / minimum diameter), nerve-to-tunnel ratio (ulnar nerve CSA / cubital tunnel CSA), nerve echogenicity, and intra-neural vascularity, all of which were reported in a minority of included articles.

Conclusions

Despite the insufficient number of pertinent studies to prove its superiority to other US measurements, the ulnar nerve-swelling ratio can be a complementary tool for diagnosing CuTS. The presence of intra-neural vascularity, increased flattening ratio, and enlarged intra-neural hypoechoic fraction also seem to be potential US indicators for CuTS diagnosis, which need to be validated with more prospective studies.

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