Carpal Tunnel Syndrome PIP Clinical Module - Stage 2-Evidence-based Guideline: Neuromuscular Ultrasound for the Diagnosis of Carpal Tunnel Syndrome

Evidence-based Guideline: Neuromuscular Ultrasound for the Diagnosis of Carpal Tunnel Syndrome

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This document is an evidence-based guideline for the use of neuromuscular ultrasound in the diagnosis of carpal tunnel syndrome (CTS). The document outlines the accuracy of ultrasound for diagnosing CTS and the added value of ultrasound when used in conjunction with electrodiagnostic studies. <br /><br />The guideline concludes that neuromuscular ultrasound measurement of median nerve cross-sectional area at the wrist is accurate and can be used as a diagnostic test for CTS. The sensitivity of ultrasound ranged from 65% to 97%, the specificity ranged from 72.7% to 98%, and the accuracy ranged from 79% to 97%. <br /><br />There is also evidence to suggest that neuromuscular ultrasound adds value to electrodiagnostic studies when diagnosing CTS, as it can detect structural abnormalities such as biﬁd median nerves, persistent median arteries, and tenosynovitis. The prevalence of these abnormalities in the general population is not known, so the sensitivity and specificity of ultrasound for these structures cannot be calculated based on currently available data.<br /><br />The guideline recommends that if available, neuromuscular ultrasound should be considered to screen for structural abnormalities at the wrist in those with CTS. However, the guideline also notes that screening for structural abnormalities may be more useful in those with atypical CTS presentations, such as unilateral CTS or sudden onset.<br /><br />The guideline suggests several areas for future research, including the development of a standardized protocol for using neuromuscular ultrasound in the diagnosis of CTS, further research on other ultrasound parameters for diagnosing CTS, large population-based studies to assess structural abnormalities, and studies to determine whether neuromuscular ultrasound changes treatment strategies and outcomes in those with CTS.

Keywords

neuromuscular ultrasound

diagnosis

carpal tunnel syndrome

median nerve cross-sectional area

sensitivity

specificity

accuracy

electrodiagnostic studies

structural abnormalities

future research

CTS