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American Association for Hand Surgery

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A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared to a "Borderline" Diagnosis
Robert Vernick, Medical Student, University of Pittsburgh, Pittsburgh, PA and John R. Fowler, MD, Department of Orthopaedics, University of Pittsburgh Medical Center, Pittsburgh, PA

Background: Recently, there has been interest in an objective confirmatory diagnostic test for patients with carpal tunnel syndrome (CTS). However, nerve conduction studies (NCS) and ultrasound (US) remain imperfect when compared to clinical diagnosis and/or diagnostic tools such as CTS-6. The purpose of this study is to compare clinical outcomes after carpal tunnel release (CTR) between patients with "borderline" CTS and "clear" CTS as determined by NCS and US.
Methods: This study was a retrospective review of patients who underwent carpal tunnel release (CTR). We collected NCS data, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and US measurements of the median nerve cross-sectional area (MNCSA). The BCTQ was the primary outcome score used in this study that was completed pre-operatively and at 2 weeks, 6 weeks, 6 months, 1-year post-CTR. NCS were performed pre-operatively and distal motor latency (DML) and distal sensory latency (DSL) were recorded. US measurements were obtained at the carpal tunnel inlet and two groups were created: patients with a MNCSA less than 13 ("borderline" CTS) and patients with a MNCSA greater than/equal to 13 ("clear" CTS).
Results: The study included 94 patients with a unilateral diagnosis of CTS. The mean age of participants was 52 years with a total of 78 females and 16 male participants. Borderline CTS was diagnosed in 58 (62%) and clear CTS was diagnosed in 36 (38%) patients. There were no significant differences in BCTQ scores between the borderline and clear CTS groups at any time. At > 6 month follow up, the mean FSS for the borderline CTS group was 1.44 and the mean FSS for the clear CTS group was 1.45, P = 0.97. At > 6 month follow up, the mean SSS for the borderline CTS group was 1.47 and the mean SSS for the clear CTS group was 1.51, P = 0.84. However, there was a significant difference between groups when comparing DML and DSL in the borderline CTS and clear CTS groups. The mean DSL in the borderline CTS group was 3.74 compared to 4.41 in the clear CTS group, P=0.02. The mean DML in the borderline CTS group was 4.59 compared to 5.40 in the clear CTS group, P=0.048.
Conclusion: There was no difference in BCTQ score when using US to classify patients as borderline or clear CTS. However, patients with clear CTS were found to have prolonged DML and DSL when compared to borderline CTS patients.


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