A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared With a "Borderline" Diagnosis.

IF 1.8 Q2 ORTHOPEDICS

HAND Pub Date : 2024-09-01 Epub Date: 2023-03-01 DOI:10.1177/15589447231154026

Robert C Vernick, John R Fowler

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引用次数: 0

Abstract

Background: Nerve conduction studies (NCS) and ultrasound (US) remain imperfect compared with clinical diagnosis and/or diagnostic tools such as carpal tunnel syndrome-6 (CTS-6) for diagnosis of carpal tunne syndrome (CTS). One potential reason for the discrepancy between clinical diagnosis and testing is "borderline" case inclusion. This study aims to compare clinical outcomes after carpal tunnel release (CTR) between "borderline" and "clear" patients with CTS determined by NCS and US.

Methods: This was a retrospective review of patients who underwent CTR. We collected NCS and US measurements of the median nerve cross-sectional area (MNCSA) at the carpal tunnel inlet, and the Boston Carpal Tunnel Questionnaire (BCTQ) scores comprised of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). Ultrasound measurements defined patients as having "borderline" (MNCSA < 13 mm²) or "clear" (MNCSA ≥ 13 mm²) CTS.

Results: The study included 94 unilateral patients with CTS. "Borderline" CTS was diagnosed in 58 patients (62%), and "clear" CTS was diagnosed in 36 patients (38%). No significant differences in BCTQ scores were found between groups. At greater than 6-month follow-up, the mean FSS was 1.44 and 1.45 for clear and borderline groups, respectively (P = .97) and the mean SSS was 1.47 and 1.51, respectively (P = .84). However, a significant difference between groups when comparing distal motor latency (DML) and distal sensory latency (DSL) existed. The mean DSL was 3.71 and 4.44 for the clear and borderline groups, respectively (P = .02). The mean DML was 4.59 and 5.36 (P = .048).

Conclusion: Categorizing CTS diagnosis into "borderline" and "clear" based on preoperative US and NCS testing did not correlate with BCTQ changes after CTR. It remains unclear whether the BCTQ is a valid postoperative assessment tool, despite its frequent use in literature.

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与 "边缘 "诊断相比，超声波检查对腕管综合征的 "明确 "诊断并不能预示更好的结果。

背景：在诊断腕管综合征（CTS）时，神经传导研究（NCS）和超声波（US）与临床诊断和/或诊断工具（如腕管综合征-6（CTS-6））相比仍不完善。临床诊断与检测之间存在差异的一个潜在原因是纳入了 "边缘 "病例。本研究旨在比较腕管松解术（CTR）后 "边缘 "和 "明确 "CTS患者的临床疗效：这是一项对接受腕管松解术患者的回顾性研究。我们收集了腕管入口处正中神经横截面积（MNCSA）的NCS和US测量值，以及由症状严重程度量表（SSS）和功能状态量表（FSS）组成的波士顿腕管问卷（BCTQ）得分。超声测量将患者定义为 "边缘型"（MNCSA < 13 mm2）或 "清晰型"（MNCSA ≥ 13 mm2）CTS：研究纳入了 94 名单侧 CTS 患者。58名患者（62%）被诊断为 "边缘型 "CTS，36名患者（38%）被诊断为 "明确型 "CTS。两组患者的 BCTQ 评分无明显差异。在超过 6 个月的随访中，明确组和边缘组的平均 FSS 分别为 1.44 和 1.45（P = .97），平均 SSS 分别为 1.47 和 1.51（P = .84）。然而，在比较远端运动潜伏期（DML）和远端感觉潜伏期（DSL）时，组间存在明显差异。清晰组和边缘组的平均感觉潜伏期分别为 3.71 和 4.44（P = .02）。DML 的平均值分别为 4.59 和 5.36（P = .048）：结论：根据术前 US 和 NCS 测试将 CTS 诊断分为 "边缘 "和 "明确 "两类与 CTR 后 BCTQ 的变化无关。尽管文献中经常使用 BCTQ，但它是否是有效的术后评估工具仍不清楚。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HAND Medicine-Surgery

CiteScore

3.30

自引率

0.00%

发文量

209

期刊介绍： HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.