Evaluation of median nerve in carpal tunnel syndrome by high frequency ultrasound and color Doppler
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20251729Keywords:
Carpal tunnel syndrome, Median nerve, High-frequency ultrasound, Color Doppler, Nerve conduction studiesAbstract
Background: Carpal tunnel syndrome (CTS), the most prevalent entrapment neuropathy of the upper limb, frequently leads to pain, numbness, and functional disability. While nerve conduction studies (NCS) remain the diagnostic gold standard, they have notable drawbacks, including patient discomfort and decreased sensitivity in certain populations. As a result, high-frequency ultrasound and color Doppler have emerged as valuable, non-invasive diagnostic tools that offer real-time visualization of structural deformities and vascular alterations in the median nerve, enhancing diagnostic precision in CTS evaluation. Aim and objective of the study was to evaluate the role of high-frequency ultrasound and color Doppler in diagnosing carpal tunnel syndrome.
Methods: A comparative cross-sectional study was conducted over 9 months in the Department of Radiodiagnosis, Private Medical College, Kerala. 50 clinically suspected CTS patients underwent high-frequency ultrasound and color Doppler evaluation. Parameters assessed included nerve swelling, edema, flattening, palmar bowing, and vascularity.
Results: Most participants were aged between 40-50 years (46%), with a higher proportion of females (86%). Sonographic evaluation revealed that 72% of patients had nerve edema, 80% exhibited nerve swelling, and 60% showed nerve flattening. Palmar bowing was present in 42%, while 24% displayed intraneural vascularity.
Conclusions: High-frequency ultrasound and color Doppler are reliable, non-invasive tools for diagnosing CTS. These imaging modalities support early detection and aid in effective clinical management of CTS.
Metrics
References
Kirchheiner J, Seeringer A. Clinical implications of pharmacogenetics of cytochrome P450 drug metabolizing enzymes. Biochim Biophys Acta. 2007;1770(3):489-94. DOI: https://doi.org/10.1016/j.bbagen.2006.09.019
Rotaru-Zavaleanu AD, Lungulescu CV, Bunescu MG, Vasile RC, Gheorman V, Gresita A, et al. Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies. Front Public Health. 2024;12:1407302. DOI: https://doi.org/10.3389/fpubh.2024.1407302
Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review. Anaesthesia. 2019;74(7):915-28. DOI: https://doi.org/10.1111/anae.14608
Keberle M, Jenett M, Kenn W, Reiners K, Peter M, Haerten R, et al. Technical advances in ultrasound and MR imaging of carpal tunnel syndrome. Eur Radiol. 2000;10(7):1043-50. DOI: https://doi.org/10.1007/s003300000386
Dias AC, Jureidini RA, Araujo-Filho JA, Camerin GR, Zattar LC, Sernik RA, et al. Advanced US of the Skin, Nerves, and Muscles of the Neck: Pearls and Pitfalls with Use of High-Frequency Transducers. Radiographics. 2024;44(10):e240029. DOI: https://doi.org/10.1148/rg.240029
Yoshii Y, Zhao C, Amadio PCJD. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics (Basel). 2020;10(8):596. DOI: https://doi.org/10.3390/diagnostics10080596
Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology. 2002;58(2):289-94. DOI: https://doi.org/10.1212/WNL.58.2.289
Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273-84. DOI: https://doi.org/10.1016/S1474-4422(16)30231-9
Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012;46(2):287-93. DOI: https://doi.org/10.1002/mus.23389
Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review. Ultrasound Med Biol. 2011;37(10):1539-53. DOI: https://doi.org/10.1016/j.ultrasmedbio.2011.06.011
Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol. 2006;186(5):1240-5. DOI: https://doi.org/10.2214/AJR.04.1715
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-7. DOI: https://doi.org/10.1148/radiol.2501080397
Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 2008;79(1):63-7. DOI: https://doi.org/10.1136/jnnp.2007.115337
Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum. 2002;46(7):1914-21. DOI: https://doi.org/10.1002/art.10385
Ghasemi-Esfe AR, Khalilzadeh O, Mazloumi M, Vaziri-Bozorg SM, Niri SG, Kahnouji H, et al. Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta Radiol. 2011;52(2):191-7. DOI: https://doi.org/10.1258/ar.2010.100299