Imágenes ecográficas en el diagnótico del síndrome de túnel carpiano…(I)

Nurdan Kotevoglua, b, , and Sibel Gülbahce-Saglama, b aDepartment of Physical Therapy and Rehabilitation, Sisli Etfal Teaching Hospital, Istanbul, Turkey bDepartment of Physical Therapy and Rehabilitation, SSK Izmir Teaching Hospital, Turkey Received 15 May 2003; accepted 16 March 2004. Available online 15 September 2004.

Abstract

In ultrasound evaluation, median nerve can be measured quantitatively with a high reproducibility. In this study we looked for the diagnostic role of ultrasound in the carpal tunnel syndrome and its correlation with some clinical tests as Phalen and Tinnel sign.

Methods. – Twenty-four patients with signs and positive EMG results of CTS along with 14 age and sex matched healthy subjects were evaluated with ultrasound. The flattening ratios, cross-sectional areas of the nerve were calculated. The ultrasonographic results of the patient and control groups were compared with t-test. The correlations between clinical tests were investigated.

Results.– Mean cross-sectional area of the median nerve in the carpal tunnel was 10.29 ± 3.39 mm2 proximally, 15.28 ± 6.16 mm2 in the middle, 13.78 ± 4.76 mm2 distally. Mean flattening ratio in the carpal tunnel was 2.20 ± 0.36 proximally, 2.61 ± 0.54 in the middle, 3.07–0.69 distally. In the control group the cross-sectional areas were as follows: 6.46 ± 0.72 mm2 proximally, 6.94 ± 0.72 mm2 in the middle, 6.65 ± 0.64 were mm2 distally; mean flattenning ratios were 1.76 ± 0.18 proximally, 2.00 ± 0.21 in the middle, 2.36 ± 0.23 distally. At all of the levels the cross-sectional areas were significantly different between the two groups (p < 0.001). The sonographic signs were found correlated with both Phalen test (r = 0.80, p < 0.001), and Tinnel sign (r = 0.70, p < 0.001). The sensitivity and specificity of ultrasound was 89% and 100%, respectively.

Conclusion.– The combination of typical clinical symptoms and at least one pathologically increased sonographic measurement of median nerve is highly predictable for diagnosis of carpal tunnel syndrome.