Evaluation of the Cross-Sectional Area of the Median Nerve by Ultrasonography in Patients With Carpal Tunnel Syndrome
,
Abstract
The use of ultrasonography (US) as a non-invasive method to evaluate and diagnose musculoskeletal disorders has increased in recent years. This cross-sectional study assessed the cross-sectional area (CSA) of the median nerve using US in patients with carpal tunnel syndrome (CTS). Clinical and demographic data of patients were recorded. Nerve conduction studies (NCS), US, and needle electromyography (EMG) were performed. In addition, US evaluated the flattening ratio (FR) and CSA of the median nerve. This study assessed 600 wrists of 300 patients with CTS referred to Golestan Hospital (Ahvaz, Iran) for nine months. There were 102 males and 198 females, with a mean age of 46.83±9.50 years. Many patients were aged 40-59 years old. Furthermore, 240 patients had bilateral CTS. The hands affected by CTS were categorized into three groups based on the severity of CTS: mild (298 hands, 49.7%), moderate (164 hands, 27.3%), and severe (138 hands, 23%). Substantial differences were detected in the average age, CSA of the median nerve, body mass index (BMI), ring-finger method (RF), FR, and outcomes in Tinel's sign and Phalen's test based on the severity of CTS (P<0.05). The increase in CSA of the median nerve was related to the severity of CTS. In addition, the US could effectively evaluate the severity of CTS. Utilizing US to measure the CSA of the median nerve was beneficial for identifying and assessing the severity of CTS. However, it should not be regarded as a substitute for NCS. Integrating NCS, US, and needle EMG can enhance diagnostic accuracy and provide more comprehensive insights into severity and underlying causes of CTS. These findings may help healthcare professionals prioritize and improve the quality of diagnosis, treatment, and care for patients with CTS.
1. Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus 2020;12:e7333.
2. Demino C, Fowler JR. The sensitivity and specificity of nerve conduction studies for diagnosis of carpal tunnel syndrome: a systematic review. Hand (N Y) 2021;16:174-8.
3. Ashworth N. Carpal tunnel syndrome. BMJ 2014;349:g6437.
4. Feng B, Chen K, Zhu X, Ip WY, Andersen LL, Page P, et al. Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health 2021;21:57.
5. 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;15:1273-84.
6. Sonoo M, Menkes DL, Bland JD, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018;3:78-88.
7. El-Shewi IEH, Tawfeek AA, Mohamed AA, Mostafa MA. Role of conventional ultrasound and shear wave elastography of median nerve in diagnosis and differentiation of carpal tunnel syndrome severity in correlation with electrodiagnostic studies. Egypt J Radiol Nucl Med 2024;55:53.
8. Alkaphoury MG, Dola EF. Ultrasound and magnetic resonance imaging neurography assessment of diagnostic criteria in patients with carpal tunnel syndrome using electrophysiological tests as gold standard: A prospective study. SAGE Open Med. 2024;12:20503121231218889.
9. Murciano Casas MdlP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study. Plos One 2023;18:e0281221.
10. Shan S, Rehman A, Nasir S, Khaliq T, Mahmood R, Mujtaba G. Comparison of Ultrasonographic Assessment of Cross Sectional Area of the Median Nerve in the Diagnosis of Carpel Tunnel Syndrome with Nerve Conduction Studies. Pakistan J Med Health Sci 2023;17:307.
11. Wu H, Zhao HJ, Xue WL, Wang YC, Zhang WY, Wang XL. Ultrasound and elastography role in pre-and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome. Front Neurol 2022;13:1079737.
12. Gonzalez‐Suarez CB, Fidel BC, Cabrera JTC, Dela Cruz FC, Gesmundo MVT, Regala CFG, et al. Diagnostic accuracy of ultrasound parameters in carpal tunnel syndrome: additional criteria for diagnosis. J Ultrasound Med 2019;38:3043-52.
13. Penry VB, Mehta RKG, Alavi RH. Neuromuscular Ultrasound of the Median Nerve at the Carpal Tunnel. J Vis Exp 2022(188):e63982.
14. Zaki HA, Shaban E, Salem W, Bilal F, Fayed M, Hendy M, et al. A comparative analysis between ultrasound and electromyographic and nerve conduction studies in diagnosing carpal tunnel syndrome (CTS): a systematic review and meta-analysis. Cureus 2022;14:e30476.
15. Fargaly SN, Bland JD. Do nerve conduction studies or ultrasound imaging correlate more closely with subjective symptom severity in carpal tunnel syndrome? Muscle Nerve 2023;68:264-8.
16. Chen J, Fowler JR. Ultrasound Findings in Patients with Normal Nerve Conduction despite Clinical Signs and Symptoms Consistent with Carpal Tunnel Syndrome. Plast Reconstr Surg 2022;150:1025e-32e.
17. Rayegani SM, Bayat M. Sonographic evaluation of median nerve cross‐sectional area in a normal Iranian population: A cross‐sectional study. Health Sci Rep 2023;6:e1393.
18. Tawfeek AA, Nawito AM, Azmy RM, Hassan A, Afifi LM, Elkholy SH. Role of concentric needle single fiber electromyography in detection of subclinical motor involvement in carpal tunnel syndrome. Egypt J Neurol Psychiatr Neurosurg 2018;54:2.
19. El-Emary WS, Hassan MM. Needle electromyography in carpal tunnel syndrome: is it valuable or predictable? Egypt Rheumatol Rehabil 2016;43:41-6.
20. Lyu S, Zhang M, Zhang B, Yu J, Zhu J, Gao L, et al. Application of ultrasound images‐based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross‐sectional area. J Clin Ultrasound 2023;51:1198-204.
21. Sertbas Y, Dortcan N, Derin Cicek E, Sertbas M, Okuroglu N, Erman H, et al. The role of ultrasound in determining the presence and severity of carpal tunnel syndrome in diabetic patients. J Investig Med 2023;71:655-63.
22. Yoshii Y, Zhao C, Amadio PC. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics (Basel) 2020;10:596.
23. Angelopoulou C, Chrysafis I, Keskinis A, Tilkeridis K, Trypsianis G, Paraskevopoulos K, et al. Does Ultrasonography, In Conjunction with Nerve Conduction Study, Plays Any Role in The Diagnosis and The Evaluation of Severity in Patients with Clinically Diagnosed Carpal Tunnel Syndrome? A Prospective Study. Front in Med Case Rep 2021;1:1-13.
24. Aggarwal P, Jirankali V, Garg SK. Accuracy of high‐resolution ultrasonography in establishing the diagnosis of carpal tunnel syndrome. ANZ J Surg 2020;90:1057-61.
25. Husain A, Omar SA, Habib SS, Al-Drees AM, Hammad D. F-ratio, a surrogate marker of carpal tunnel syndrome. Neurosciences Journal (Riyadh) 2009;14:19-24.
26. Asbeutah A, Dashti M, AlMajran A, Ghayyath A. Sonographic measurement of cross-sectional area of the median nerve in academic dentists without symptoms or signs of carpal tunnel syndrome. J of Diag Med Sonograph 2019;35:105-11.
27. El-Karabaty H, Hetzel A, Galla T, Horch R, Lücking C, Glocker F. The effect of carpal tunnel release on median nerve flattening and nerve conduction. Electromyogr Clin Neurophysiol 2005;45:223-7.
28. WAKODE DS, WAKODE DN. Utility of Ring Finger Sensory Nerve Conduction Comparative Study for Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients Medical Science. Indian J Appl Res 2016;6:230-2.
29. Kadhim ZM, Abd BA. The Difference In Sensory Latency Of Median-Radial Nerves In The Diagnosis Of Carpal Tunnel Syndrome. Ann Trop Med Health 2019;22: 1-6.
30. Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006;31:919. e1-. e7.
31. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome. J Bone Joint Surg Am 2016;98:1750-4.
32. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation, Neurology AAo, Medicine AAoP, Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: Summary statement. Muscle Nerve 2002;25:918-22.
33. Padua L, Lo Monaco M, Padua R, Gregori B, Tonali P. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18:145-50.
34. Ramezani Z, Behafarid S, Kashefi H. Comparison of the diagnostic values of clinical examination, sonography and electrodiagnosis in the diagnosis of carpal tunnel syndrome. Sci J Kurdistan Univ Med Sci 2021;25:68-78.
35. ARTI H, DEHGHAN M, ABRISHAM KS. COMPARISON OF TREATMENT RESULTS OF CARPAL TUNNEL SYNDROME BY OPEN SURGICAL TECHNIQUE AND ARTHROSCOPIC RELEASE, 2005.
36. Rayegani SM, Kargozar E, Eliaspour D, Raeissadat SA, Sanati E, Bayat M. Diagnostic value of ultrasound compared to electro diagnosis in carpal tunnel syndrome. J Patient Saf Qual Improv 2014;2:142-7.
37. Karimi N, Tabrizi N, Moosavi M. Prevalence of carpal tunnel syndrome and associated risk factors. J Mazandaran Univ Med Sci 2017;26:179-84.
38. Samadzadeh S, Motameni M, Rezaei M, Rezaei C, Faroukhi J. The comparison between ultrasonography and electrodiagnosis value in diagnosing carpal tunnel syndrome. J Kermanshah Univ Med Sci 2013;17e77101.
39. Maleki N, Azami A, Anari H, Iranparvar Alamdari M, Tavosi Z, Hajaty S. Value of ultrasonography in the diagnosis of carpal tunnel syndrome confirmed by nerve conduction study. Sci J Kurdistan Univ Med Sci 2014;19:58-66.
40. Dalili AR, Mardani-Kivi M, Alizadeh A, Hatamian HR, Hoseininejad M, Peyrazm H, et al. Comparison between sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Anesthesiol Pain 2011;2:43-51.
41. Matur Z, Zengin T, Bolu NE, Oge AE, OGE AE. Prevalence of Carpal Tunnel Syndrome Symptoms Among Young Dentists. Cureus 2023;15:e43358.
42. Lund CB, Mikkelsen S, Thygesen LC, Hansson GÅ, Thomsen JF. Movements of the wrist and the risk of carpal tunnel syndrome: a nationwide cohort study using objective exposure measurements. Occup Environ Med 2019;76:519-26.
43. Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol 2015;29:440-53.
44. Georgiew F, Otfinowska E, Adamczyk T. An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome. Med Rehabil 2009;13:17-22.
45. Descatha A, Huard L, Aubert F, Barbato B, Gorand O, Chastang JF. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome. Semin Arthritis Rheum 2012;41:914-22.
46. Fowler JR, Byrne K, Pan T, Goitz RJ. False-positive rates for nerve conduction studies and ultrasound in patients without clinical signs and symptoms of carpal tunnel syndrome. J Hand Surg Am 2019;44:181-5.
47. McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford) 2015;54:9-19.
48. Bang M, Kim JM, Kim HS. The usefulness of ultrasonography to diagnose the early stage of carpal tunnel syndrome in proximal to the carpal tunnel inlet: A prospective study. Medicine (Baltimore) 2019;98:e16039.
49. Kim JM, Kim MW, Ko YJ. Correlating ultrasound findings of carpal tunnel syndrome with nerve conduction studies. Muscle Nerve 2013;48:905-10.
50. 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;250:171-7.
51. Rubin DI, Dimberg EL. Needle EMG of thenar muscles in less severe carpal tunnel syndrome. J Clin Neurophysiol 2018;35:481-4.
52. Berk E, Nacitarhan V. The relationship between median nerve axon count and clinical findings and electrophysiological parameters in patients with carpal tunnel syndrome. Ann Med Res 2019;26:1039-44.
53. Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. Ultrasound Med Biol 2011;37:1539-53.
54. Aseem F, Williams JW, Walker FO, Cartwright MS. Neuromuscular ultrasound in patients with carpal tunnel syndrome and normal nerve conduction studies. Muscle Nerve 2017;55:913-5.
55. Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67:146-52.
56. Kerasnoudis A, Ntasiou E, Tsiami S, Sarholz M, Baraliakos X, Krogias C. Nerve sonography in the diagnostic evaluation of primary and secondary carpal tunnel syndrome in rheumatoid arthritis. J Neuroimaging 2024;34:120-6.
57. Uz C, Umay E. Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality. Acta Orthop Belg 2023;89:167-72.
58. Allam AFA, Sadek AF, AbuSamra MF, Ismail AH, Allam MFAB. The correlation between pre-operative ultrasonographic median nerve evaluation and the operative procedure in CTS. Egypt J Radiol Nucl Med 2020;51:1-7.
59. Drakopoulos D, Mitsiokapa E, Karamanis E, Kontogeorgakos V, Mavrogenis AF. Ultrasonography provides a diagnosis similar to that of nerve conduction studies for carpal tunnel syndrome. Orthopedics 2019;42:e460-e4.
60. Panicker P, Iype T. Nerve Ultrasound Findings in Carpal Tunnel Syndrome and its Correlation with Clinical and Electrophysiological Data. J Med Sci 2022;8:59-64.
61. Liao YY, Wu CC, Kuo TT, Chen JP, Hsu YW, Yeh CK. Carpal tunnel syndrome diagnosis by a self‐normalization process and ultrasound compound imaging. Med Phys 2012;39:7402-11.
2. Demino C, Fowler JR. The sensitivity and specificity of nerve conduction studies for diagnosis of carpal tunnel syndrome: a systematic review. Hand (N Y) 2021;16:174-8.
3. Ashworth N. Carpal tunnel syndrome. BMJ 2014;349:g6437.
4. Feng B, Chen K, Zhu X, Ip WY, Andersen LL, Page P, et al. Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health 2021;21:57.
5. 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;15:1273-84.
6. Sonoo M, Menkes DL, Bland JD, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018;3:78-88.
7. El-Shewi IEH, Tawfeek AA, Mohamed AA, Mostafa MA. Role of conventional ultrasound and shear wave elastography of median nerve in diagnosis and differentiation of carpal tunnel syndrome severity in correlation with electrodiagnostic studies. Egypt J Radiol Nucl Med 2024;55:53.
8. Alkaphoury MG, Dola EF. Ultrasound and magnetic resonance imaging neurography assessment of diagnostic criteria in patients with carpal tunnel syndrome using electrophysiological tests as gold standard: A prospective study. SAGE Open Med. 2024;12:20503121231218889.
9. Murciano Casas MdlP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study. Plos One 2023;18:e0281221.
10. Shan S, Rehman A, Nasir S, Khaliq T, Mahmood R, Mujtaba G. Comparison of Ultrasonographic Assessment of Cross Sectional Area of the Median Nerve in the Diagnosis of Carpel Tunnel Syndrome with Nerve Conduction Studies. Pakistan J Med Health Sci 2023;17:307.
11. Wu H, Zhao HJ, Xue WL, Wang YC, Zhang WY, Wang XL. Ultrasound and elastography role in pre-and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome. Front Neurol 2022;13:1079737.
12. Gonzalez‐Suarez CB, Fidel BC, Cabrera JTC, Dela Cruz FC, Gesmundo MVT, Regala CFG, et al. Diagnostic accuracy of ultrasound parameters in carpal tunnel syndrome: additional criteria for diagnosis. J Ultrasound Med 2019;38:3043-52.
13. Penry VB, Mehta RKG, Alavi RH. Neuromuscular Ultrasound of the Median Nerve at the Carpal Tunnel. J Vis Exp 2022(188):e63982.
14. Zaki HA, Shaban E, Salem W, Bilal F, Fayed M, Hendy M, et al. A comparative analysis between ultrasound and electromyographic and nerve conduction studies in diagnosing carpal tunnel syndrome (CTS): a systematic review and meta-analysis. Cureus 2022;14:e30476.
15. Fargaly SN, Bland JD. Do nerve conduction studies or ultrasound imaging correlate more closely with subjective symptom severity in carpal tunnel syndrome? Muscle Nerve 2023;68:264-8.
16. Chen J, Fowler JR. Ultrasound Findings in Patients with Normal Nerve Conduction despite Clinical Signs and Symptoms Consistent with Carpal Tunnel Syndrome. Plast Reconstr Surg 2022;150:1025e-32e.
17. Rayegani SM, Bayat M. Sonographic evaluation of median nerve cross‐sectional area in a normal Iranian population: A cross‐sectional study. Health Sci Rep 2023;6:e1393.
18. Tawfeek AA, Nawito AM, Azmy RM, Hassan A, Afifi LM, Elkholy SH. Role of concentric needle single fiber electromyography in detection of subclinical motor involvement in carpal tunnel syndrome. Egypt J Neurol Psychiatr Neurosurg 2018;54:2.
19. El-Emary WS, Hassan MM. Needle electromyography in carpal tunnel syndrome: is it valuable or predictable? Egypt Rheumatol Rehabil 2016;43:41-6.
20. Lyu S, Zhang M, Zhang B, Yu J, Zhu J, Gao L, et al. Application of ultrasound images‐based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross‐sectional area. J Clin Ultrasound 2023;51:1198-204.
21. Sertbas Y, Dortcan N, Derin Cicek E, Sertbas M, Okuroglu N, Erman H, et al. The role of ultrasound in determining the presence and severity of carpal tunnel syndrome in diabetic patients. J Investig Med 2023;71:655-63.
22. Yoshii Y, Zhao C, Amadio PC. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics (Basel) 2020;10:596.
23. Angelopoulou C, Chrysafis I, Keskinis A, Tilkeridis K, Trypsianis G, Paraskevopoulos K, et al. Does Ultrasonography, In Conjunction with Nerve Conduction Study, Plays Any Role in The Diagnosis and The Evaluation of Severity in Patients with Clinically Diagnosed Carpal Tunnel Syndrome? A Prospective Study. Front in Med Case Rep 2021;1:1-13.
24. Aggarwal P, Jirankali V, Garg SK. Accuracy of high‐resolution ultrasonography in establishing the diagnosis of carpal tunnel syndrome. ANZ J Surg 2020;90:1057-61.
25. Husain A, Omar SA, Habib SS, Al-Drees AM, Hammad D. F-ratio, a surrogate marker of carpal tunnel syndrome. Neurosciences Journal (Riyadh) 2009;14:19-24.
26. Asbeutah A, Dashti M, AlMajran A, Ghayyath A. Sonographic measurement of cross-sectional area of the median nerve in academic dentists without symptoms or signs of carpal tunnel syndrome. J of Diag Med Sonograph 2019;35:105-11.
27. El-Karabaty H, Hetzel A, Galla T, Horch R, Lücking C, Glocker F. The effect of carpal tunnel release on median nerve flattening and nerve conduction. Electromyogr Clin Neurophysiol 2005;45:223-7.
28. WAKODE DS, WAKODE DN. Utility of Ring Finger Sensory Nerve Conduction Comparative Study for Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients Medical Science. Indian J Appl Res 2016;6:230-2.
29. Kadhim ZM, Abd BA. The Difference In Sensory Latency Of Median-Radial Nerves In The Diagnosis Of Carpal Tunnel Syndrome. Ann Trop Med Health 2019;22: 1-6.
30. Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006;31:919. e1-. e7.
31. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome. J Bone Joint Surg Am 2016;98:1750-4.
32. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation, Neurology AAo, Medicine AAoP, Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: Summary statement. Muscle Nerve 2002;25:918-22.
33. Padua L, Lo Monaco M, Padua R, Gregori B, Tonali P. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18:145-50.
34. Ramezani Z, Behafarid S, Kashefi H. Comparison of the diagnostic values of clinical examination, sonography and electrodiagnosis in the diagnosis of carpal tunnel syndrome. Sci J Kurdistan Univ Med Sci 2021;25:68-78.
35. ARTI H, DEHGHAN M, ABRISHAM KS. COMPARISON OF TREATMENT RESULTS OF CARPAL TUNNEL SYNDROME BY OPEN SURGICAL TECHNIQUE AND ARTHROSCOPIC RELEASE, 2005.
36. Rayegani SM, Kargozar E, Eliaspour D, Raeissadat SA, Sanati E, Bayat M. Diagnostic value of ultrasound compared to electro diagnosis in carpal tunnel syndrome. J Patient Saf Qual Improv 2014;2:142-7.
37. Karimi N, Tabrizi N, Moosavi M. Prevalence of carpal tunnel syndrome and associated risk factors. J Mazandaran Univ Med Sci 2017;26:179-84.
38. Samadzadeh S, Motameni M, Rezaei M, Rezaei C, Faroukhi J. The comparison between ultrasonography and electrodiagnosis value in diagnosing carpal tunnel syndrome. J Kermanshah Univ Med Sci 2013;17e77101.
39. Maleki N, Azami A, Anari H, Iranparvar Alamdari M, Tavosi Z, Hajaty S. Value of ultrasonography in the diagnosis of carpal tunnel syndrome confirmed by nerve conduction study. Sci J Kurdistan Univ Med Sci 2014;19:58-66.
40. Dalili AR, Mardani-Kivi M, Alizadeh A, Hatamian HR, Hoseininejad M, Peyrazm H, et al. Comparison between sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Anesthesiol Pain 2011;2:43-51.
41. Matur Z, Zengin T, Bolu NE, Oge AE, OGE AE. Prevalence of Carpal Tunnel Syndrome Symptoms Among Young Dentists. Cureus 2023;15:e43358.
42. Lund CB, Mikkelsen S, Thygesen LC, Hansson GÅ, Thomsen JF. Movements of the wrist and the risk of carpal tunnel syndrome: a nationwide cohort study using objective exposure measurements. Occup Environ Med 2019;76:519-26.
43. Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol 2015;29:440-53.
44. Georgiew F, Otfinowska E, Adamczyk T. An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome. Med Rehabil 2009;13:17-22.
45. Descatha A, Huard L, Aubert F, Barbato B, Gorand O, Chastang JF. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome. Semin Arthritis Rheum 2012;41:914-22.
46. Fowler JR, Byrne K, Pan T, Goitz RJ. False-positive rates for nerve conduction studies and ultrasound in patients without clinical signs and symptoms of carpal tunnel syndrome. J Hand Surg Am 2019;44:181-5.
47. McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford) 2015;54:9-19.
48. Bang M, Kim JM, Kim HS. The usefulness of ultrasonography to diagnose the early stage of carpal tunnel syndrome in proximal to the carpal tunnel inlet: A prospective study. Medicine (Baltimore) 2019;98:e16039.
49. Kim JM, Kim MW, Ko YJ. Correlating ultrasound findings of carpal tunnel syndrome with nerve conduction studies. Muscle Nerve 2013;48:905-10.
50. 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;250:171-7.
51. Rubin DI, Dimberg EL. Needle EMG of thenar muscles in less severe carpal tunnel syndrome. J Clin Neurophysiol 2018;35:481-4.
52. Berk E, Nacitarhan V. The relationship between median nerve axon count and clinical findings and electrophysiological parameters in patients with carpal tunnel syndrome. Ann Med Res 2019;26:1039-44.
53. Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. Ultrasound Med Biol 2011;37:1539-53.
54. Aseem F, Williams JW, Walker FO, Cartwright MS. Neuromuscular ultrasound in patients with carpal tunnel syndrome and normal nerve conduction studies. Muscle Nerve 2017;55:913-5.
55. Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67:146-52.
56. Kerasnoudis A, Ntasiou E, Tsiami S, Sarholz M, Baraliakos X, Krogias C. Nerve sonography in the diagnostic evaluation of primary and secondary carpal tunnel syndrome in rheumatoid arthritis. J Neuroimaging 2024;34:120-6.
57. Uz C, Umay E. Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality. Acta Orthop Belg 2023;89:167-72.
58. Allam AFA, Sadek AF, AbuSamra MF, Ismail AH, Allam MFAB. The correlation between pre-operative ultrasonographic median nerve evaluation and the operative procedure in CTS. Egypt J Radiol Nucl Med 2020;51:1-7.
59. Drakopoulos D, Mitsiokapa E, Karamanis E, Kontogeorgakos V, Mavrogenis AF. Ultrasonography provides a diagnosis similar to that of nerve conduction studies for carpal tunnel syndrome. Orthopedics 2019;42:e460-e4.
60. Panicker P, Iype T. Nerve Ultrasound Findings in Carpal Tunnel Syndrome and its Correlation with Clinical and Electrophysiological Data. J Med Sci 2022;8:59-64.
61. Liao YY, Wu CC, Kuo TT, Chen JP, Hsu YW, Yeh CK. Carpal tunnel syndrome diagnosis by a self‐normalization process and ultrasound compound imaging. Med Phys 2012;39:7402-11.
| Files | ||
| Issue | Vol 62 No 6 (2024) | |
| Section | Original Articles | |
| Keywords | ||
| Ultrasonography Carpal tunnel syndrome Electrodiagnostic Median nerve Nerve conduction study | ||
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How to Cite
1.
Shamsaei G, Behzadinia L, Kashipazha D, Shalilahmadi D, Mohammadi S. Evaluation of the Cross-Sectional Area of the Median Nerve by Ultrasonography in Patients With Carpal Tunnel Syndrome. Acta Med Iran. 2025;62(6):346-354.
