Abstract
Presentation Number: 116
Quantitative Ultrasonography in Patients with Carpal Tunnel
Syndrome: Is it Time to Say Farewell to Nerve Conduction Studies?
Yasser M. A. El Miedany1, Sohair Adel Aty2, Samia Ashour3.
1Rheumatology and Rehab. Dept. Ain Shams University, Cairo,
Egypt; 2Radiology Dept. Ain
Shams University,
Cairo, Egypt; 3Neuropsychiatry Dept. Ain Shams University, Cairo, Egypt
Objective: to assess the optimal discriminatory sonographic
criteria and relevant threshold values in patients with carpal tunnel syndrome
(CTS) and
to evaluate
quantitative ultrasonography (US) as a tool for diagnosis and treatment of
patients suffering from carpal tunnel syndrome in comparison to electrophysiologic
study.
Methods: Seventy-eight patients with CTS
and 78 asymptomatic controls who were matched for age and sex
were enrolled and
underwent ultrasonography
of the wrists.
All patients and control group completed a self-administered questionnaire.
An electrophysiologic testing was done for all patients. Data from the
patient and
the control groups were compared to determine the diagnostic relations
in patients with CTS and grade of severity.
Results: There was a high degree of correlation
between the conduction abnormalities of the median nerve as
detected by
electrodiagnostic tests,
self administered
assessment and the measurement of its cross sectional area (CSA) by US
(p<0.05).
Various levels of disease severity can also be illustrated by US giving
confident results for diagnosis, treatment planning and following the
patients with CTS.
In 16 patients (17%) there was tenosynovitis/localised swelling in the
tendons in the carpal tunnel as the primary cause of CTS. Cutoff point
of 10 mm2 for
the mean CSA of the median nerve was found to be the upper limit for
normal values. In addition, our study revealed that 13.03 mm2 and 15.02
mm2 were the
best cutoff
points to discriminate between the mild and moderate groups; as well
as between moderate and severe groups.
Conclusion: high frequency ultrasound
examination of the median nerve
and measurement of its cross sectional area should be strongly considered
as
a new, alternative
diagnostic modality for the evaluation of CTS. It offers high diagnostic
accuracy as indicated by high correlation to the present standard EMG
as well as patient
oriented measures. Moreover, ultrasound provides a reliable method
for following response to therapy.
Disclosure: Y.M.A. El Miedany,
None; S. Adel Aty, None; S. Ashour,
None.
