Assessing diagnostic and severity grading accuracy of ultrasound measurements for carpal tunnel syndrome compared to electrodiagnostics. PM & R : the journal of injury, function, and rehabilitation Yin-Ting, C. n., Miller Olson, E. K., Lee, S. H., Sainani, K. n., Fredericson, M. n. 2020


The combined sensory index (CSI) is the most sensitive electrodiagnostic criteria for carpal tunnel syndrome (CTS), and the CSI and Bland criteria have been shown to predict surgical treatment outcomes. The proposed ultrasound measurements have not been assessed against the CSI for diagnostic accuracy and grading of CTS severity.The primary objective of this paper was to investigate the use of ultrasound evaluations for both diagnosis and assessment of severity grading of CTS in comparison to electrodiagnostic assessment.All patients underwent an electrodiagnostic evaluation using the CSI and Bland severity grading. Each patient underwent an ultrasound evaluation including cross sectional area (CSA), the change in CSA from the forearm to the tunnel (?CSA), and the wrist-forearm ratio (WFR). These measurements were assessed for diagnostic and severity grading accuracy using the CSI as the gold standard.Tertiary academic center PARTICIPANTS: All patients referred for electrodiagnostic evaluation for CTS were eligible for the study. Only those with idiopathic CTS were included and those with prior CTS treatment were also excluded. Ninety-five patients were included in the study.Not Applicable.The primary study outcome measure was concordance between CSI diagnosis and severity categories and the ultrasound measurements. Both outcomes were also assessed using Bland criteria.Optimal cut-points for diagnosis of CTS were found to be CSA =?12?mm2 , ?CSA =?4?mm2 , WFR =?1.4. Using these cut-points, C-statistics comparing diagnosis of CTS using ultrasound measurements versus using the CSI ranged from 0.893-0.966. When looking at CSI severity grading compared to ?CSA, however, the C-statistics were 0.640-0.661 with substantial overlap between severity groups.While ultrasound measurements had high diagnostic accuracy for CTS based on the CSI criteria, ultrasound measurements were unable to adequately distinguish between CSI severity groups among patients with CTS. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/pmrj.12533

View details for PubMedID 33306874