Comparative Study Between Physical Examination, Electroneuromyography and Ultrasonography in Diagnosing Carpal Tunnel Syndrome

Overview

Journal Rev Bras Ortop

Specialty Orthopedics

Date 2015 Aug 1

PMID 26229843

Citations 9

Authors

Arnaldo Goncalves de Jesus Filho

Bruno Fajardo do Nascimento

Marcelo de Carvalho Amorim

Ronald Alan Sauaia Naus

Elmano de Araujo Loures

Lucas Moratelli

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the sensitivity of electromyography and ultrasonography in diagnosing carpal tunnel syndrome (CTS), in comparison with physical examination, which is considered to be the gold standard.

Methods: In this cross-sectional study, the medical files of 56 patients with 70 hands affected by CTS who were attended between March 2010 and June 2012 were reviewed. The study included patients with a clinical diagnosis of CTS. The sensitivity of the complementary examinations was analyzed and compared with physical examination.

Results: Nocturnal symptoms were found in 96.4%, thenar atrophy in 62.5% and abnormal sense of touch in 50%. The sensitivities found were: ultrasonography, 67.1% (95% CI: 55.7%-78.6%); an association of physical examination tests, 95.7% (95% CI: 90.0%-100%); and electromyography, 98.6% (95% CI: 95.7%-100%). The presence of atrophy, abnormalities of the sense of touch and longer-duration symptoms increased the sensitivity of ultrasonography and physical examination.

Conclusion: The sensitivity of ultrasonography for CTS was lower than that of electromyography and physical examination.

Citing Articles

Exploring ultrasound and electromyography for carpal tunnel syndrome diagnosis: a comprehensive comparative study and implications for occupational medicine.

Braham S, Moussa A, Bouhoula M, Ben Meriem N, Annen I, Sakly G Front Neurol. 2024; 15:1490873.

PMID: 39722697 PMC: 11668638. DOI: 10.3389/fneur.2024.1490873.

Carpal tunnel syndrome prediction with machine learning algorithms using anthropometric and strength-based measurement.

Yetis M, Kocaman H, Canli M, Yildirim H, Yetis A, Ceylan I PLoS One. 2024; 19(4):e0300044.

PMID: 38630703 PMC: 11023568. DOI: 10.1371/journal.pone.0300044.

Diagnostic accuracy of ultrasonography in diagnosis of Carpal Tunnel Syndrome.

Shaukat A, Aamir H, Ahmad Z, Ahmad U Pak J Med Sci. 2024; 40(4):753-756.

PMID: 38545018 PMC: 10963989. DOI: 10.12669/pjms.40.4.8332.

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review.

Bennett O, Sears E Plast Reconstr Surg Glob Open. 2023; 11(7):e5067.

PMID: 37404780 PMC: 10317486. DOI: 10.1097/GOX.0000000000005067.

Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Dabbagh A, MacDermid J, Yong J, Packham T, Grewal R, Boutsikari E Phys Ther. 2023; 103(6).

PMID: 37366626 PMC: 10294560. DOI: 10.1093/ptj/pzad029.

References

Kuschner S, Ebramzadeh E, Johnson D, Brien W, Sherman R . Tinel's sign and Phalen's test in carpal tunnel syndrome. Orthopedics. 1992; 15(11):1297-302. DOI: 10.3928/0147-7447-19921101-08. View

Fowler J, Maltenfort M, Ilyas A . Ultrasound as a first-line test in the diagnosis of carpal tunnel syndrome: a cost-effectiveness analysis. Clin Orthop Relat Res. 2012; 471(3):932-7. PMC: 3563786. DOI: 10.1007/s11999-012-2662-3. View

Padua L, Lo Monaco M, Valente E, Tonali P . A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve. 1996; 19(1):48-53. DOI: 10.1002/(SICI)1097-4598(199601)19:1<48::AID-MUS6>3.0.CO;2-8. View

Kang S, Kwon H, Kim K, Yun H . Ultrasonography of median nerve and electrophysiologic severity in carpal tunnel syndrome. Ann Rehabil Med. 2012; 36(1):72-9. PMC: 3309326. DOI: 10.5535/arm.2012.36.1.72. View

Dhong E, Han S, Lee B, Kim W . Correlation of electrodiagnostic findings with subjective symptoms in carpal tunnel syndrome. Ann Plast Surg. 2000; 45(2):127-31. DOI: 10.1097/00000637-200045020-00005. View

Makanji H, Zhao M, Mudgal C, Jupiter J, Ring D . Correspondence between clinical presentation and electrophysiological testing for potential carpal tunnel syndrome. J Hand Surg Eur Vol. 2012; 38(5):489-95. DOI: 10.1177/1753193412461860. View

Chen S, Lu C, Huang C, Chuang Y, Tsai N, Chang C . Ultrasonographic median nerve cross-section areas measured by 8-point "inching test" for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms. BMC Med Imaging. 2011; 11:22. PMC: 3292452. DOI: 10.1186/1471-2342-11-22. View

Cartwright M, Hobson-Webb L, Boon A, Alter K, Hunt C, Flores V . Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012; 46(2):287-93. DOI: 10.1002/mus.23389. View

de-la-Llave-Rincon A, Laguarta-Val S, Arroyo-Morales M, Martinez-Perez A, Pareja J, Fernandez-de-Las-Penas C . [Characterisation of pain in patients with carpal tunnel syndrome according to electromyographic severity criteria]. Rev Neurol. 2012; 54(7):407-14. View

10.

Rahmani M, Ghasemi Esfe A, Vaziri-Bozorg S, Bozorg S, Mazloumi M, Khalilzadeh O . The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests. Radiol Med. 2011; 116(3):489-96. DOI: 10.1007/s11547-011-0632-6. View

11.

Watson J . The electrodiagnostic approach to carpal tunnel syndrome. Neurol Clin. 2012; 30(2):457-78. DOI: 10.1016/j.ncl.2011.12.001. View

12.

Durkan J . A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am. 1991; 73(4):535-8. View

13.

Kwon B, Jung K, Baek G . Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am. 2008; 33(1):65-71. DOI: 10.1016/j.jhsa.2007.10.014. View

14.

Werner R, Andary M . Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011; 44(4):597-607. DOI: 10.1002/mus.22208. View

15.

Wilson D, Allen G . Imaging of the carpal tunnel. Semin Musculoskelet Radiol. 2012; 16(2):137-45. DOI: 10.1055/s-0032-1311765. View

16.

de-la-Llave-Rincon A, Puentedura E, Fernandez-de-Las-Penas C . New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med. 2012; 13(72):343-8. View

17.

Ibrahim I, Khan W, Goddard N, Smitham P . Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012; 6:69-76. PMC: 3314870. DOI: 10.2174/1874325001206010069. View

18.

Chen H, Wang Y, Lin C, Wang C, Jou I, Su F . A knowledge-based approach for carpal tunnel segmentation from magnetic resonance images. J Digit Imaging. 2012; 26(3):510-20. PMC: 3649045. DOI: 10.1007/s10278-012-9530-2. View

19.

Fowler J, Gaughan J, Ilyas A . The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2010; 469(4):1089-94. PMC: 3048245. DOI: 10.1007/s11999-010-1637-5. View

20.

Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C . Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR Am J Roentgenol. 1992; 159(4):793-8. DOI: 10.2214/ajr.159.4.1529845. View