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Correlation Between Ultrasound Cross-sectional Area, Electrodiagnostic Studies, Patient Self-Assessment, and CTS-6 in Carpal Tunnel Syndrome
Nicole J. Jarrett, MD; Beverly L. Hersh, BA; John R. Fowler, MD
University of Pittsburgh Medical School, Pittsburgh, PA

Background: Electrodiagnostic testing has long been the reference standard for objective evaluation of carpal tunnel syndrome (CTS). However, it is expensive, time-consuming, and painful for patients. There has been increasing interest in the use of ultrasound cross-sectional area (CSA) at the carpal tunnel inlet to diagnose carpal tunnel syndrome, but there have been only a few small studies to compare it to subjective patient self-assessments and the Carpal Tunnel Syndrome-6 (CTS-6), both validated tools for assessment of CTS.
Methods: Eighty-nine median nerves were prospectively evaluated in 52 patients. Ultrasound cross-sectional area was measured at the proximal wrist crease by the senior author. Distal motor and sensory latencies (DML and DSL) were evaluated from patientsí electrodiagnostic studies. Each patient filled out the Boston Carpal Tunnel Questionnaire (BCTQ), which separated into Symptom Severity Score (SSS) and Functional Status Score (FSS). Based upon the patientís history and physical, each median nerve was also assigned a CTS-6 score. Spearmanís coefficients were used to compare the modalities.
Results: As expected, the CTS-6 score was significantly correlated with both measures of the BCTQ (FSS p=0.012 and SSS p=0.000). Ultrasound CSA was also significantly correlated with SSS (p=0.001) and CTS-6 (p=0.004), but not FSS. DML was significantly correlated with SSS (p=0.016), but not FSS or CTS-6. DSL was not significantly correlated with FSS, SSS, or CTS-6.
Conclusion: Ultrasound CSA was more closely correlated with both SSS and CTS-6 than any electrodiagnostic measurement. This data further supports its usage as a confirmatory study for clinically suspected carpal tunnel syndrome.


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