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Vol. 4. Issue 3.
Pages 100-106 (May - June 2008)
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Vol. 4. Issue 3.
Pages 100-106 (May - June 2008)
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Validity and Usefulness of Echography in the Carpal Tunnel Syndrome
Validez y utilidad de la ecografía en el síndrome del túnel carpiano
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Diana Peiteado Lópeza,
Corresponding author
diapeitead@yahoo.es

Correspondence: Unidad de Reumatología. Hospital Universitario La Paz. P.° de la Castellana, 263. 28034 Madrid. España.
, Cristina Bohórquez Herasa, Eugenio de Miguel Mendietaa, Susana Santiago Pérezb, Arturo Ugalde Canitrob, Emilio Martín Molaa
a Unidad de Reumatología, Hospital Universitario La Paz, Madrid, Spain
b Unidad de Neurofisiología, Hospital Universitario La Paz, Madrid, Spain
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Objective

To evaluate the accuracy and utility of ultrasonography for the diagnosis of carpal tunnel syndrome (CTS).

Material and method

Prospective and blind study of 75 wrists in 42 consecutive patients with suspected CTS. Electrodiagnostic testing (EDT) was used as gold standard. We measure different ultrasonographic parameters and based on a fitted receiver operating characteristic curve, we estimated post-test probabilities for the proximal, middle, and distal cross-sectional area of median nerve. We analyzed interobserver and interreader reliability by 3 different explorers and 2 different readers, cost and the patient discomfort.

Results

Mean ultrasound measurements were significantly higher in the EDT positive group. There was a high concordance between sonography and nerve conduction. A cut-off of 9.5 mm2 resulted in the correct classification of 83% of cases (sensitivity 88% and specificity 67%). Conversely, a cut-off of >14 mm2 or <7 mm2 had excellent power to rule in CTS, with a post-test probability of 100% of specificity and sensitivity respectively. The interobserver acquisition ICC was 0.915-0.980, and the inter-reader ICC was 0.912-0.987. Ultrasound cost savings in this study were €3217.59 (€42.9 per symptomatic wrist) and the discomfort perceived by the patient was significantly lesser 6.3 versus 56 in EDT (P<.0005).

Conclusions

Ultrasound median nerve crosssectional area is reliable and may be used to accurately rule in or rule out CTS. Sonography as a first-line test is costeffective and is more satisfactory to the patients.

keys words:
Sonography
Carpal tunnel syndrome
Imaging diagnostic
Reliability
Objetivo

Evaluar la validez y la utilidad de la ecografía en el síndrome del túnel carpiano (STC).

Material y método

Estudio ecográfico ciego y prospectivo en 75 carpos de 42 pacientes consecutivos con sospecha de STC. Se utiliza la electromiografía (EMG) como prueba de referencia. Se miden distintos parámetros ecográficos y mediante curvas ROC se estiman las probabilidades tras la prueba para los diferentes cortes del área de sección transversal del mediano (AST). Se analiza la fiabilidad entre explorador y lector con tres exploradores diferentes y dos lectores. Finalmente se efectúa un estudio de costes y de satisfacción del paciente.

Resultados

Las medias de los parámetros ecográficos son significativamente mayores en el grupo con STC. Hay una alta concordancia entre la ecografía y la conducción nerviosa. Un punto de corte del AST en 9,5 mm2 clasifica correctamente el 83% de los casos (sensibilidad del 88% y especificidad del 67%). Un punto de corte mayor de 14 mm2 o menor de 7 mm2 tiene una probabilidad tras la prueba para el STC del 100% de especificidad y sensibilidad respectivamente. Los coeficientes de correlación intraclase (ICC) entre observadores fueron 0,915-0,980, y entre lectores, 0,912-0,987. La ecografía puede resultar más económica y ahorrar en el estudio 3.217,59 euros (42,9 euros por muñeca sintomática). El malestar percibido por los pacientes fue significativamente menor: EVA, 6,3 con ecografía frente a 56 con el EMG (p < 0,0005).

Conclusiones

La ecografía es fiable y válida para definir si hay o no STC. La ecografía como prueba de primera línea es coste-efectiva y más satisfactoria para los pacientes.

Palabras clave:
Ecografía
Síndrome del túnel carpiano
Diagnóstico por imagen
Fiabilidad
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References
[1.]
P.A. Nathan, R.C. Keniston, K.D. Meadows, R.S. Lockwood.
Predictive value of nerve conduction measurements at the carpal tunnel.
Muscle Nerve, 16 (1993), pp. 1377-1382
[2.]
V.G. Iyer.
Understanding nerve conduction and electromyographic studies.
Hand Clin, 9 (1993), pp. 273-287
[3.]
I. Duncan, P. Sullivan, F. Lomas.
Sonography in the diagnosis of carpal tunnel syndrome.
AJR Am J Roentgenol, 173 (1999), pp. 681-684
[4.]
P.E. Wright.
Carpal tunnel and ulnar tunnel syndromes and stenosing tenosynovitis.
Campbell's operative orthopaedics, 8th, pp. 3435-3437
[5.]
W. Buchberger, W. Judmaier, G. Birbamer, M. Lener, C. Schmidauer.
Carpal tunnel syndrome: diagnosis with high resolution sonography.
AJR Am J Roentgenol, 159 (1992), pp. 793-798
[6.]
K. Nakamichi, S. Tachibana.
Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy.
Muscle Nerve, 26 (2002), pp. 798-803
[7.]
L. Sarria, T. Cabada, R. Cozcolluela, T. Martinez-Berganza, S. Garcia.
Carpal tunnel syndrome: usefulness of sonography.
Eur Radiol, 10 (2000), pp. 1920-1925
[8.]
W. Buchberger.
Radiologic imaging of the carpal tunnel.
Eur J Radiol, 25 (1997), pp. 112
[9.]
A. Yesildag, S. Kutluhan, N. Sengul, O. Oyar, K. Guler, U.K. Gulsoy.
The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome.
Clin Radiol, 59 (2004), pp. 910-915
[10.]
D. Lee, M.T. van Holsbeeck, P.K. Janevski, D.L. Ganos, D.M. Ditmars, V.B. Darian.
Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography.
Radiol Clin North Am, 37 (1999), pp. 859-872
[11.]
W.A. Sween, J.W. Jacobs, F.E. Bussemaker, J.W. de Ward, J.W. Bijlsma.
Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist.
J Rheumatol, 28 (2001), pp. 62-69
[12.]
H.R. Koyuncuoglu, S. Kutluhan, A. Yesildag, O. Oyar, K. Guler, A. Ozden.
The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests.
Eur J Radiol, 56 (2005), pp. 365-369
[13.]
S.M. Wong, J.F. Griffith, A.C. Hui, A. Tang, K.S. Wong.
Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome.
Arthritis Rheum, 46 (2002), pp. 1914-1921
[14.]
H.R. Ziswiler, S. Reichenbach, E. Vögelin, L.M. Bachmann, P.M. Villiger, P. Jüni.
Diagnostic value of sonography in patients with suspected carpal tunnel syndrome. A prospective study.
Arthritis Rheum, 52 (2005), pp. 304-311
[15.]
S.M. Wong, J.F. Griffith, A.C. Hui, S.K. Lo, M. Fu, K.S. Wong.
Carpal tunnel syndrome: diagnostic usefulness of sonography.
Radiology, 232 (2004), pp. 93-99
[16.]
American Association of Electrodiagnostic Medicine American Academy of Neurology and American Academy of Physical Medicine and Rehabilitation.
Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement).
Muscle Nerve, 16 (1993), pp. 1390-1391
[17.]
L.P. Kamolz, K.F. Schrogendorfer, M. Rab, W. Girsch, H. Gruber, M. Frey.
The precision of ultrasound imaging and its relevance for carpal tunnel syndrome.
Surg Radiol Anat, 23 (2001), pp. 117-121
[18.]
K.I. Nakamichi, S. Tachibana.
Enlarged median nerve in idiopathic carpal tunnel syndrome.
Muscle Nerve, 23 (2000), pp. 1713-1718
[19.]
R. Beekman, L.H. Visser.
Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature.
Muscle Nerve, 27 (2003), pp. 26-33
Copyright © 2008. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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