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Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy

Year 2024, Volume: 7 Issue: 3, 284 - 289, 27.05.2024
https://doi.org/10.32322/jhsm.1461031

Abstract

Aims: The aim is to evaluate sonographic parameters in pregnant women diagnosed with carpal tunnel syndrome compared to electrodiagnostic tests, to determine whether these parameters have sufficient accuracy to allow their use in clinical practice.
Methods: This retrospective study examines pregnant women aged 18-40 in the 3rd trimester who received a final diagnosis of carpal tunnel syndrome between 2021-2023 at Prof. Dr. Cemil Taşçıoğlu City Hospital. Pregnant women with symptomatic complaints were divided into two groups: those with positive electrodiagnostic test results indicating carpal tunnel syndrome and those with negative electrodiagnostic test results, forming the control group. All pregnant women participating in the study had their median nerve cross-sectional area, flexor carpi radialis, cross-sectional area, wrist-to-forearm ratio, and MN-CSA/FCR ratio (expressed as a percentage called NTR) values examined.
Results: In pregnant women with carpal tunnel syndrome, the median nerve cross-sectional area values were observed to surpass those in the control cohort (10.06±3.24 vs. 7.84±2.52)(p<0.001). The wrist-to-forearm ratio in pregnant women with carpal tunnel syndrome (2.1±0.5) was statistically higher compared to the control group (1.0±0.1)(p<0.001). The NTR values in the pregnant women with carpal tunnel syndrome (CTS) were also higher than those in the control group (0.92±0.36 vs. 0.80±0.23)
(p=0.036). The best cut-off for median nerve cross-sectional area values was calculated to be >8.6 mm². The best cut-off point for MN-CSA/FCR values was found to be >0.84%. The best cut-off for wrist-to-forearm ratio values was calculated as >1.4 mm². A receiver operating characteristic curve was generated, and the wrist-to-forearm ratio cut-off point of 1.4 showed a sensitivity of 97.1% and a specificity of 69.2%.
Conclusion: Ultrasonography is useful in the diagnosis of pregnancy-related CTS. It has provided comparable results to electrodiagnostic tests and is additionally practical, cost-effective, and swift.

Ethical Statement

Ethics Committee Approval: The study was approved by the institutional review board of Okmeydanı Cemil Tascıoglu Clinical Research Ethics Committee Date:06.02.23 No:87

Supporting Institution

NONE

Project Number

87

Thanks

none

References

  • Murciano Casas MP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as a diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: study protocol for a diagnostic testing study. PLoS One. 2023;18(11):e0281221.
  • Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosci. 2015;20(1):4-9.
  • Yoshii Y, Zhao C, Amadio PC. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics. 2020;10(8):596.
  • Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus. 2020;12(3):e7333.
  • Yahia M, El Shambaky A, Lasheen D. Elastosonography and electrodiagnosis about symptomatic and functional grading of carpal tunnel syndrome. Arch Rheumatol. 2023;38(4):620-632.
  • Padua L, Cuccagna C, Giovannini S, et al. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol. 2023;22(3):255-267.
  • Alanazy MH, Albulaihe H, Alhumayyd Z, Albarrak AM, Abuzinadah AR. A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome. Brain Behav. 2021; 11(4):e02056.
  • Elseddik M, Alnowaiser K, Mostafa RR, et al. Deep learning-based approaches for enhanced diagnosis and comprehensive understanding of carpal tunnel syndrome. Diagnostics. 2023; 13(20):3211.
  • Billakota S, Hobson-Webb LD. Standard median nerve ultrasound in carpal tunnel syndrome: a retrospective review of 1,021 cases. Clin Neurophysiol Pract. 2017;2:188-191.
  • Fischer J, Thompson NW, Harrison JWK. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. In: Banaszkiewicz P, Kader D, eds. Classic Papers in Orthopaedics. Springer: 2014.
  • Sezgin M, İncel NA, Sevim S, Çamdeviren H, As İ, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and validity of the Turkish version of the Boston questionnaire. Disab Rehab. 2006;28(20):1281-1286.
  • Meems M, Truijens SEM, Spek V, Visser LH, Pop VJM. Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2017;211:231-232.
  • Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason. 2023;23(95):e313-e327.
  • Bolak Boratav H, Toker Ö, Küey L. Postpartum depression and its psychosocial correlates: a longitudinal study among a group of women in Turkey. Women Health. 2016;56(5):502-521.
  • Jansen MC, Duraku LS, Hundepool CA, et al. Management of recurrent carpal tunnel syndrome: systematic review and meta-analysis. J Hand Surg Am. 2022;47(4):388.e1-388.e19.
  • Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthopaed Surg. 2009;17(6):389-396.
  • Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-guided interventions for carpal tunnel syndrome: a systematic review and meta-analyses. Diagnostics. 2023;13(6):1138.
  • Hebbard P, Thomas P, Fransch SV, Cichowitz A, Franzi S. Microinvasive carpal tunnel release using a retractable needle-mounted blade. J Ultrasound Med. 2021;40(7):1451-1458.
  • Hirsiger S, Schlimme N, Rossel JB, Christen S, Grobbelaar AO, Vögelin E. The inlet and outlet ratio: retrospective and prospective study on an improved diagnostic ultrasound tool for carpal tunnel syndrome. J Hand Surg Glob Online. 2023;5(3):303-309.
  • Goncu Ayhan S, Ayhan E, Çaglar AT, Sahin D. Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study. J Obstetr Gynaecol. 2022;42(6):1769-1774.
  • Roomizadeh P, Eftekharsadat B, Abedini A, et al. Ultrasonographic assessment of carpal tunnel syndrome severity: a systematic review and meta-analysis. Am J Physic Med Rehab. 2019;98(5):373-381.
  • Borire AA, Hughes AR, Lueck CJ, Colebatch JG, Krishnan AV. Sonographic differences in carpal tunnel syndrome with normal and abnormal nerve conduction studies. J Clin Neurosci. 2016; 34:77-80.
  • Falsetti P, Conticini E, Baldi C, et al. A novel ultrasonographic anthropometric-independent measurement of median nerve swelling in carpal tunnel syndrome: the “nerve/tendon ratio” (NTR). Diagnostics. 2022;12(11):2621.
  • Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg. 2008;33(1):65-71.
  • Şahin F, Bayraktarli RY, Mihmanlı V. Pregnancy carpal tunnel: nerve/tendon ratio (NTR)-a new paradigm. Clin Experim Obstetr Gynecol. 2024;51(3):69.
  • Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011;469(4):1089-1094.
  • Kapuścińska K, Urbanik A. Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment. J Ultrasonograp. 2016;16(64):16-24.
  • Ekhtiari S, Phillips M, Dhillon D, Shahabinezhad A, Bhandari M. Understanding the learning curve of carpal tunnel release with ultrasound guidance: a review. Cureus. 2023;15(7):e41938.
  • Seror P. Conduction blocks of the median nerve at the wrist in pregnancy and postpartum carpal tunnel syndromes. Muscle Nerve. 2023;68(4):380-387.
  • Wu WT, Lin CY, Shu YC, et al. The potential of ultrasound radiomics in carpal tunnel syndrome diagnosis: a systematic review and meta-analysis. Diagnostics. 2023;13(20):3280.
Year 2024, Volume: 7 Issue: 3, 284 - 289, 27.05.2024
https://doi.org/10.32322/jhsm.1461031

Abstract

Project Number

87

References

  • Murciano Casas MP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as a diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: study protocol for a diagnostic testing study. PLoS One. 2023;18(11):e0281221.
  • Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosci. 2015;20(1):4-9.
  • Yoshii Y, Zhao C, Amadio PC. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics. 2020;10(8):596.
  • Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus. 2020;12(3):e7333.
  • Yahia M, El Shambaky A, Lasheen D. Elastosonography and electrodiagnosis about symptomatic and functional grading of carpal tunnel syndrome. Arch Rheumatol. 2023;38(4):620-632.
  • Padua L, Cuccagna C, Giovannini S, et al. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol. 2023;22(3):255-267.
  • Alanazy MH, Albulaihe H, Alhumayyd Z, Albarrak AM, Abuzinadah AR. A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome. Brain Behav. 2021; 11(4):e02056.
  • Elseddik M, Alnowaiser K, Mostafa RR, et al. Deep learning-based approaches for enhanced diagnosis and comprehensive understanding of carpal tunnel syndrome. Diagnostics. 2023; 13(20):3211.
  • Billakota S, Hobson-Webb LD. Standard median nerve ultrasound in carpal tunnel syndrome: a retrospective review of 1,021 cases. Clin Neurophysiol Pract. 2017;2:188-191.
  • Fischer J, Thompson NW, Harrison JWK. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. In: Banaszkiewicz P, Kader D, eds. Classic Papers in Orthopaedics. Springer: 2014.
  • Sezgin M, İncel NA, Sevim S, Çamdeviren H, As İ, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and validity of the Turkish version of the Boston questionnaire. Disab Rehab. 2006;28(20):1281-1286.
  • Meems M, Truijens SEM, Spek V, Visser LH, Pop VJM. Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2017;211:231-232.
  • Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason. 2023;23(95):e313-e327.
  • Bolak Boratav H, Toker Ö, Küey L. Postpartum depression and its psychosocial correlates: a longitudinal study among a group of women in Turkey. Women Health. 2016;56(5):502-521.
  • Jansen MC, Duraku LS, Hundepool CA, et al. Management of recurrent carpal tunnel syndrome: systematic review and meta-analysis. J Hand Surg Am. 2022;47(4):388.e1-388.e19.
  • Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthopaed Surg. 2009;17(6):389-396.
  • Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-guided interventions for carpal tunnel syndrome: a systematic review and meta-analyses. Diagnostics. 2023;13(6):1138.
  • Hebbard P, Thomas P, Fransch SV, Cichowitz A, Franzi S. Microinvasive carpal tunnel release using a retractable needle-mounted blade. J Ultrasound Med. 2021;40(7):1451-1458.
  • Hirsiger S, Schlimme N, Rossel JB, Christen S, Grobbelaar AO, Vögelin E. The inlet and outlet ratio: retrospective and prospective study on an improved diagnostic ultrasound tool for carpal tunnel syndrome. J Hand Surg Glob Online. 2023;5(3):303-309.
  • Goncu Ayhan S, Ayhan E, Çaglar AT, Sahin D. Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study. J Obstetr Gynaecol. 2022;42(6):1769-1774.
  • Roomizadeh P, Eftekharsadat B, Abedini A, et al. Ultrasonographic assessment of carpal tunnel syndrome severity: a systematic review and meta-analysis. Am J Physic Med Rehab. 2019;98(5):373-381.
  • Borire AA, Hughes AR, Lueck CJ, Colebatch JG, Krishnan AV. Sonographic differences in carpal tunnel syndrome with normal and abnormal nerve conduction studies. J Clin Neurosci. 2016; 34:77-80.
  • Falsetti P, Conticini E, Baldi C, et al. A novel ultrasonographic anthropometric-independent measurement of median nerve swelling in carpal tunnel syndrome: the “nerve/tendon ratio” (NTR). Diagnostics. 2022;12(11):2621.
  • Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg. 2008;33(1):65-71.
  • Şahin F, Bayraktarli RY, Mihmanlı V. Pregnancy carpal tunnel: nerve/tendon ratio (NTR)-a new paradigm. Clin Experim Obstetr Gynecol. 2024;51(3):69.
  • Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011;469(4):1089-1094.
  • Kapuścińska K, Urbanik A. Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment. J Ultrasonograp. 2016;16(64):16-24.
  • Ekhtiari S, Phillips M, Dhillon D, Shahabinezhad A, Bhandari M. Understanding the learning curve of carpal tunnel release with ultrasound guidance: a review. Cureus. 2023;15(7):e41938.
  • Seror P. Conduction blocks of the median nerve at the wrist in pregnancy and postpartum carpal tunnel syndromes. Muscle Nerve. 2023;68(4):380-387.
  • Wu WT, Lin CY, Shu YC, et al. The potential of ultrasound radiomics in carpal tunnel syndrome diagnosis: a systematic review and meta-analysis. Diagnostics. 2023;13(20):3280.
There are 30 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Original Article
Authors

Recep Yılmaz Bayraktarlı 0000-0001-6980-649X

Fatih Şahin 0000-0002-1621-5896

Kaan Işın 0000-0001-8193-6756

Project Number 87
Publication Date May 27, 2024
Submission Date March 29, 2024
Acceptance Date April 19, 2024
Published in Issue Year 2024 Volume: 7 Issue: 3

Cite

AMA Bayraktarlı RY, Şahin F, Işın K. Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy. J Health Sci Med / JHSM. May 2024;7(3):284-289. doi:10.32322/jhsm.1461031

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