Accuracy of Color Doppler Sonography in Diagnosis of Carpal Tunnel Syndrome

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 General Practitioner, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 General Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common upper extremity impingement neuropathy caused by median nerve compression within the carpal tunnel due to various conditions such as bone abnormalities, inflammation, trauma, neoplastic lesions and endocrinopathies. Increase in carpal tunnel pressure of more than 20 to 30 mmHg blocks the epineural blood flow; so, the nerve function is damaged. Carpal tunnel syndrome is primarily a clinical diagnosis supported by electrodiagnostic studies; in recent years, different imaging modalities, including magnetic resonance imaging (MRI) and ultrasound, are suggested for diagnosis of carpal tunnel syndrome.Methods: During November 2011 and May 2013, 84 patients clinically suspicious for carpal tunnel syndrome were enrolled in our study; the age of patients ranged from 19 to 66 with the average of 43 years and the sex ratio of women to men was 2.7:1. All the patients underwent electerodiagnostic tests (EDT) as the gold standard diagnostic modality and the results of color Doppler sonography (CDS) were compared with electerodiagnostic findings.Findings: According to the ecterodiagnostic tests, patients with positive results of carpal tunnel syndrome were divided into three groups of severity including mild with 9 patients (11%), moderate with 14 cases (17%) and severe with 18 patients (21%). Sensitivity of color Doppler sonography for diagnosis of carpal tunnel syndrome was almost 83%, 71% and 55% in severe, moderate and mild groups of carpal tunnel syndrome, respectively. Specificity of this imaging modality was determined near to 81% in all three groups of the patients.Conclusion: In addition to electerodiagnostic tests, which are considered as the modality of choice for diagnosis of carpal tunnel syndrome, Doppler ultrasound can be a non-invasive imaging procedure for evaluation of patients that are clinically suspicious to this syndrome. Considering three groups of carpal tunnel syndrome based on severity of electerodiagnostic signs, results of color Doppler sonography is more reliable in patients with severe signs.

Keywords


  1. Snell RS. Clinical anatomy for medical students. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003. p. 455-591.
  2. Bickley LS. Bates' guide to physical examination and history taking. 10th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p.601-9.
  3. Canale ST, Beaty JH. Campbell's operative orthopaedics. 12th ed. Philadelphia, PA: Mosby; 2013. p. 626-30.
  4. Rempel D, Evanoff B, Amadio PC, de KM, Franklin G, Franzblau A, et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998; 88(10): 1447-51.
  5. You D, Smith AH, Rempel D. Meta-analysis: association between wrist posture and carpal tunnel syndrome among workers. Saf Health Work 2014; 5(1): 27-31.
  6. Bland JDP, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry 2003; 74(12): 1674-9.
  7. Kothari MJ. Carpal tunnel syndrome: Clinical manifestations and diagnosis. UpTodate [Online]. [cited 2015 Sep 15]; Available from: URL: http://www.uptodate.com/contents/carpal-tunnel-syndrome-clinical-manifestations-and-diagnosis
  8. Browning PD. Carpal tunnel syndrome imaging. Medscape. [Online]. [cited 2015 Oct 9]; Available from: URL:
  9. http://emedicine.medscape.com/article/388525-overview
  10. Bland JD. Carpal tunnel syndrome. BMJ 2007; 335(7615): 343-6.
  11. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58(11): 1589-92.
  12. Cheung DK, MacDermid J, Walton D, Grewal R. The construct validity and responsiveness of sensory tests in patients with carpal tunnel syndrome. Open Orthop J 2014; 8: 100-7.
  13. Akgun H, Yucel M, Oz O, Demirkaya S. Differential diagnosis of carpal tunnel syndrome. Turk Neurosurg 2014; 24(1): 150.
  14. Wang YJ, Yan SH. Improvement of diagnostic rate of carpal tunnel syndrome with additional median-to-ulnar comparative nerve conduction studies. Acta Neurol Taiwan 2013; 22(4): 152-7.
  15. Chen HC, Wang YY, Lin CH, Wang CK, Jou IM, Su FC, et al. A knowledge-based approach for carpal tunnel segmentation from magnetic resonance images. J Digit Imaging 2013; 26(3): 510-20.
  16. Mallouhi A, Pulzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol 2006; 186(5): 1240-5.
  17. Uchiyama S, Itsubo T, Yasutomi T, Nakagawa H, Kamimura M, Kato H. Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2005; 76(8): 1103-8.
  18. Jarvik JG, Yuen E, Haynor DR, Bradley CM, Fulton-Kehoe D, Smith-Weller T, et al. MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology 2002; 58(11): 1597-602.
  19. Horch RE, Allmann KH, Laubenberger J, Langer M, Stark GB. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery 1997; 41(1): 76-82.
  20. Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 2012; 46(2): 287-93.
  21. Moran L, Perez M, Esteban A, Bellon J, Arranz B, del CM. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound 2009; 37(3): 125-31.
  22. Vogelin E, Meszaros T, Schoni F, Constantinescu MA. Sonographic wrist measurements and detection of anatomical features in carpal tunnel syndrome. ScientificWorldJournal 2014; 2014: 657906.
  23. Kim MK, Jeon HJ, Park SH, Park DS, Nam HS. Value of ultrasonography in the diagnosis of carpal tunnel syndrome: correlation with electrophysiological abnormalities and clinical severity. J Korean Neurosurg Soc 2014; 55(2): 78-82.
  24. Abdel Ghaffar MK, El-Shinnawy MA, Fawzy H, Ibrahim SE. Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome. The Egyptian Journal of Radiology and Nuclear Medicine 2012; 43(4): 581-7.
  25. Ashraf AR, Jali R, Moghtaderi AR, Yazdani AH. The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome. Electromyogr Clin Neurophysiol 2009; 49(1): 3-8.
  26. Joy V, Therimadasamy AK, Chan YC, Wilder-Smith EP. Combined Doppler and B-mode sonography in carpal tunnel syndrome. J Neurol Sci 2011; 308(1-2): 16-20.
  27. Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol 2012; 198(2): W181-W184.
  28. Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM, Jajroudi M, Shakiba M, Mazloumi M, et al. Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method. Radiology 2011; 261(2): 499-506.