Document Type : Original Article
- Zahra Mirzaasgari
- Bahram Haghi-Ashtiani
- Farshid Refaiean
- Farzan Vahedifard
- Amir Sina Homayooni
- Mahsa Sobhkhiz
Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment syndrome in the upper limbs, for which pregnancy is a known risk factor. CTS diagnosis is confirmed via nerve conduction studies (NCSs), which sometimes is expensive, and the electrical stimulation makes it an unpleasant diagnostic modality, especially for pregnant subjects. Recently, high-frequency ultrasonography (HF-USG) is known as a diagnostic method. This study is concerned with determining the diagnostic value of this modality for CTS among pregnant women.
Methods: This cross-sectional case-control study was conducted with 40 CTS cases and 40 matched controls. The HF-USG of wrists was performed bilaterally on all participants with a focus on the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) inlet.
Results: Mean MNCSA was statistically different between the CTS group (11.71 ± 1.86 mm2, range: 8 to 18 mm2) and the control group (6.75 ± 1.38 mm2, range: 4 to 11 mm2) (P < 0.001). The receiver operating characteristic (ROC) curve was drawn, and the cross-sectional area (CSA) cut-off point of 8.5 mm2 showed sensitivity and specificity of 98% and 93%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 95% and 98%, respectively, with the mentioned point as the diagnostic threshold.
Conclusion: HF-USG of the median nerve can be utilized as a preferable alternative to NCS (the current gold standard diagnostic method) in pregnant women, due to its convenience and lower cost, or at least, it can be used as a screening tool among pregnant women with suspicious symptoms.
- Wright AR, Atkinson RE. Carpal tunnel syndrome: An update for the primary care physician. Hawaii J Health Soc Welf 2019; 78(11 Suppl 2): 6-10.
- Mondelli M, Rossi S, Monti E, Aprile I, Caliandro P, Pazzaglia C, et al. Prospective study of positive factors for improvement of carpal tunnel syndrome in pregnant women. Muscle Nerve 2007; 36(6): 778-83.
- Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: A review of the recent literature. Open Orthop J 2012; 6: 69-76.
- Ablove RH, Ablove TS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ 2009; 108(4): 194-6.
- Wright C, Smith B, Wright S, Weiner M, Wright K, Rubin D. Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity. Obstet Med 2014; 7(2): 90-4.
- Finsen V, Zeitlmann H. Carpal tunnel syndrome during pregnancy. Scand J Plast Reconstr Surg Hand Surg 2006; 40(1): 41-5.
- Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain management in pregnancy: Multimodal approaches. Pain Res Treat 2015; 2015: 987483.
- El MY, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 2008; 75(4): 451-7.
- Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008; 67(1): 146-52.
- Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000; 20 Spec No: S199-S213.
- Sonoo M, Menkes DL, Bland JDP, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018; 3: 78-88.
- Lu Y, Meng Z, Pan X, Qin L, Wang G. Value of high-frequency ultrasound in diagnosing carpal tunnel syndrome. Int J Clin Exp Med 2015; 8(12): 22418-24.
- Ogur T, Yakut ZI, Teber MA, Alp F, Turan A, Tural A, et al. Ultrasound elastographic evaluation of the median nerve in pregnant women with carpal tunnel syndrome. Eur Rev Med Pharmacol Sci 2015; 19(1): 23-30.
- Mehrpour M, Mirzaasgari Z, Rohani M, Safdarian M. Diagnostic value of median nerve ultrasonography for screening of carpal tunnel syndrome in hypothyroid patients: A cross-sectional study. Iran J Neurol 2016; 15(2): 70-4.
- McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford) 2015; 54(1): 9-19.
- Kim HJ, Park SH. Median nerve injuries caused by carpal tunnel injections. Korean J Pain 2014; 27(2): 112-7.
- Elnady B, Rageh EM, Ekhouly T, Fathy SM, Alshaar M, Fouda ES, et al. Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity. BMC Musculoskelet Disord 2019; 20(1): 634.
- Wang LY, Leong CP, Huang YC, Hung JW, Cheung SM, Pong YP. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J 2008; 31(5): 469-76.
- Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2008; 79(1): 63-7.
- Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. J Clin Ultrasound 2009; 37(7): 389-93.
- Salman RR, Hashemi SE, Holisaz MT, Gohari F, Delbari A, Lokk J. The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment. Clin Interv Aging 2018; 13: 1953-62.
- Azami A, Maleki N, Anari H, Iranparvar AM, Kalantarhormozi M, Tavosi Z. The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome. Int J Rheum Dis 2014; 17(6): 612-20.
- 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.
- Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A. Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med 2010; 13(6): 516-21.