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Media type:
E-Article
Title:
Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: A prospective study
Contributor:
Ziswiler, Hans‐Rudolf;
Reichenbach, Stephan;
Vögelin, Esther;
Bachmann, Lucas M.;
Villiger, Peter M.;
Jüni, Peter
Published:
Wiley, 2005
Published in:
Arthritis & Rheumatism, 52 (2005) 1, Seite 304-311
Language:
English
DOI:
10.1002/art.20723
ISSN:
0004-3591;
1529-0131
Origination:
Footnote:
Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To determine the diagnostic value of sonography in patients with suspected carpal tunnel syndrome (CTS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a prospective study of 110 wrists in 74 consecutive patients with suspected CTS who had been referred to a tertiary care center. We determined the largest cross‐sectional area of the median nerve at the carpal tunnel. Because of the lack of a universally accepted reference standard, we first examined the association of sonography with nerve conduction. Then, we compared sonography with a reference standard based on the combination of nerve conduction studies and signs and symptoms. Sonography and reference standard tests were performed independently and interpreted under blinded conditions. Based on a fitted receiver operating characteristic curve, we estimated likelihood ratios (LRs) and posttest probabilities for different cutoffs.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was a high concordance between sonography and nerve conduction. Based on the combined reference standard, a cutoff of 10 mm<jats:sup>2</jats:sup> resulted in approximately equal sensitivity and specificity, but only moderate LRs. A cutoff of <8 mm<jats:sup>2</jats:sup> had satisfactory power to rule out CTS: the fitted‐negative LR was 0.13. Conversely, a cutoff of ≥12 mm<jats:sup>2</jats:sup> had excellent power to rule in CTS, with a fitted‐positive LR of 19.9. For nerves ≥12 mm<jats:sup>2</jats:sup> and a pretest probability of 70% expected in patients with suspected CTS in tertiary care, we found a posttest probability of CTS of 98%.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Depending on setting and purpose, different cutoff values for the largest cross‐sectional area may be used to accurately rule in or rule out CTS. Using sonography as a first‐line test may cost‐effectively reduce the number of nerve conduction studies in patients with suspected CTS. A large‐scale, randomized controlled trial is required to determine the effects of sonography on clinical outcomes, the number of nerve conduction studies performed, and the total cost.</jats:p></jats:sec>