Department of Physical and Rehabilitation Medicine, University of Santo Tomas, Manila, Philippines.
Department of Physical and Rehabilitation Medicine, University of Santo Tomas Hospital, Manila, Philippines.
J Ultrasound Med. 2019 Nov;38(11):3043-3052. doi: 10.1002/jum.15012. Epub 2019 Apr 17.
To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS).
Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees' work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross-sectional area, hypervascularity, wrist-to-forearm ratio, wrist-forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO).
A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist-forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4-15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8-8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms.
Combining US findings for the CTO wrist-forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.
确定超声（US）检测腕管综合征（CTS）的诊断能力。
从马尼拉大都市区的办公室招募有和无症状的 CTS 志愿者，这些办公室的员工工作涉及手部/腕部劳动密集型活动。CTS 由参考标准（体格检查和神经传导研究阳性结果）独立诊断。在腕管入口和腕管出口（CTO）处对正中神经（横截面积、高血管性、腕-前臂比、腕-前臂差、肿胀比、扁平比和屈肌支持带的掌弓）进行盲法 US 测量。
共纳入 117 名符合条件的同意参与者（234 只手），其中 54 只手（23.1%）诊断为 CTS。有和无症状的手臂之间没有人体测量差异。年龄大于 33 岁的男性和女性报告 CTS 的可能性是年轻人的 5 倍。CTO 腕-前臂差大于 0.03 cm 与 CTS 相关性最强（优势比，4.7；95%置信区间，1.4-15.9），曲线下面积为 0.58（敏感性，94.4%；特异性，21.7%）。当纳入下一个最强的测量值（CTO 高血管性 1+：优势比，3.8；95%置信区间，1.8-8.1）时，曲线下面积增加至 0.59（敏感性，98.1%；特异性，27.7%）。添加更多的 US 参数不会提高 US 对 CTS 的诊断能力。诊断能力与年龄和 CTS 症状持续时间无关。
结合 CTO 腕-前臂差和高血管性的 US 发现提供了一种敏感的 CTS 替代诊断工具。
