Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo J C, Erausquin C
Department of Rheumatology, Hospital de Gran Canaria Dr. Negrin, University of Las Palmas de Gran Canaria, Spain.
Clin Exp Rheumatol. 2007 Nov-Dec;25(6):853-9.
Our hypothesis is that sonography performed by the rheumatologist in patients with suspected carpal tunnel syndrome (CTS) has higher diagnostic value compared to physical evaluation.
Adult patients with suspected idiopathic CTS, defined by sensory symptoms over the distribution of the median nerve with or without positive results with the Phalen and/or the Tinel's maneuvers were included. The diagnosis of CTS was indicated by typical symptoms daily for at least 3 months and a positive nerve conduction study. One rheumatologist unaware of the clinical and electrodiagnostic results performed an ultrasound examination of the median nerve for the area ranging from the inlet to the outlet of the carpal tunnel. Mean cross-sectional area at each level, flattening ratio and bowing of flexor retinaculum were obtained.
Sixty-eight patients with 105 affected wrists were examined. Tinel's and Phalen's signs had a closer sensitivity (73% and 67% respectively) and specificity (40% and 30% respectively). The best swelling nerve cut-off by sonography was 9.7 mm2 at the tunnel inlet, with a sensitivity of 86%, a specificity of 48% and accuracy of 77%. A 100% positive predictive value was reached with a cross-sectional area of 13 mm2, involving 33 hands (31% of the whole sample). Maximal cross sectional area and the measurement of flexor retinaculum had an accuracy of 72% and 73% respectively. Combination of physical maneuvers and sonography not yielded more accuracy than cross-sectional area itself.
In patients with clinical history of idiopathic CTS and positive nerve conduction study, sonography performed by the rheumatologist has higher diagnostic value than physical maneuvers.
我们的假设是，与体格检查相比，由风湿病学家对疑似腕管综合征（CTS）患者进行超声检查具有更高的诊断价值。
纳入成年疑似特发性CTS患者，其定义为正中神经分布区域有感觉症状，且Phalen试验和/或Tinel征结果为阳性或阴性。CTS的诊断依据为典型症状持续至少3个月且神经传导检查阳性。一名不了解临床和电诊断结果的风湿病学家对腕管从入口到出口区域的正中神经进行超声检查。获取每个水平的平均横截面积、屈肌支持带扁平率和弯曲度。
对68例患者的105只患腕进行了检查。Tinel征和Phalen征的敏感性（分别为73%和67%）和特异性（分别为40%和30%）相近。超声检查发现的最佳肿胀神经截断值在腕管入口处为9.7平方毫米，敏感性为86%，特异性为48%，准确率为77%。横截面积为13平方毫米时阳性预测值达到100%，涉及33只手（占整个样本的31%）。最大横截面积和屈肌支持带测量的准确率分别为72%和73%。体格检查与超声检查相结合的准确性并不高于横截面积本身。
对于有特发性CTS临床病史且神经传导检查阳性的患者，风湿病学家进行的超声检查比体格检查具有更高的诊断价值。
