Journal CME November 2024, Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of severity of carpal tunnel syndrome-PM R - 2024 - Sheen - Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of

PM R - 2024 - Sheen - Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of

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This study, led by Soun Sheen and colleagues, explores the relationship between electrodiagnostic findings and neuromuscular ultrasound measurements in diagnosing and assessing the severity of carpal tunnel syndrome (CTS). Conducted as a retrospective cohort study at an academic tertiary care center, it assessed patients aged 18 and over with upper limb electrodiagnostic studies and neuromuscular ultrasound.<br /><br />The study involved 1359 limbs from 1004 patients, with nearly 60% being female, averaging 53.9 years of age. Researchers identified a significant association between the severity of CTS, determined by electrodiagnostic evaluations, and ultrasound measurements of the median nerve's cross-sectional area (CSA) at the wrist and the wrist-to-forearm ratio (WFR). As CTS severity increased from normal to severe, the mean CSA and WFR also increased, suggesting that ultrasound findings correlate to electrodiagnostic severity.<br /><br />Results demonstrated a statistical significance (p < .001) in the association between median nerve enlargement and CTS severity, showing that ultrasound can be a valuable tool in both confirming CTS diagnosis and evaluating its severity. The mean CSA ranged from 7.01 mm² in normal cases to 14.69 mm² in severe CTS. Meanwhile, mean WFR levels increased from 1.24 in electrodiagnostically normal cases to 2.71 in severe cases, providing an alternative measure for CTS severity.<br /><br />The study emphasizes ultrasound's advantage over traditional electrodiagnostic studies due to its non-invasive, painless, and rapid nature, though it acknowledges limitations in assessing conditions beyond CTS, like proximal nerve issues. Despite its retrospective nature, potentially introducing bias, it reinforces a direct association between CTS electrodiagnostic severity and ultrasound measurements, suggesting the potential role of ultrasound in managing CTS without sole reliance on electrodiagnostic studies.<br /><br />The findings contribute to the ongoing debate about diagnostic tools for CTS, supporting the use of ultrasound as both a diagnostic and severity-assessment tool in conjunction with electrodiagnostic methods.

Keywords

carpal tunnel syndrome

electrodiagnostic findings

neuromuscular ultrasound

median nerve

cross-sectional area

wrist-to-forearm ratio

retrospective cohort study

ultrasound diagnostics

CTS severity

non-invasive assessment