Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

Authors, Editors, Case Information Author: Charis Hoppe, BSc Affiliation: University of California, San Francisco (UCSF) Co Author(s): William Berrigan, M.D. Senior Editor: Laura Mattson, DO Clinical Vignette: 45-year-old female with intermittent numbness of the left hand in digits 1-3, worse at night, without significant weakness presents for ultrasound evaluation. Type of Probe Used: 2-14L, RS85 Left wrist carpal tunnel inlet unlabeled SAX Left carpal tunnel inlet short axis view. Left wrist carpal tunnel inlet labeled SAX Left carpal tunnel inlet short axis view. The median nerve is seen in short axis in the middle of the screen, with the cross sectional area measuring 17mm2. Left wrist carpal tunnel inlet unlabeled LAX Left carpal tunnel inlet long axis view. Left wrist carpal tunnel inlet labeled LAX Left carpal tunnel inlet long axis view. The median nerve is seen in long axis, crossing under the transverse carpal ligament (TCL) with the flexor tendons seen just deep to the nerve. The nerve appears widened/enlarged proximal to the ligament and tapered/narrowed as it crosses under the TCL; this can be termed an "hourglass sign" and is consistent with swelling of the nerve just proximal to the site of compression. Interpretation Image Interpretation: The median nerve is hypoechoic and enlarged in appearance, measuring 17mm2 at the wrist crease. The flexor tendons are normal in appearance without tear or evidence of tenosynovitis. Unremarkable Guyon's canal. Ultrasound findings are compatible with a clinical diagnosis of carpal tunnel syndrome. Teaching Pearl: Ultrasound of the median nerve is an evidenced-based diagnostic tool for carpal tunnel syndrome (CTS). Studies show similar sensitivity and specificity of US as compared to the clinical CTS-6 score and nerve conduction studies in the diagnosis of CTS (Fowler JR, Cipolli W, Hanson T. A Comparison of Three Diagnostic Tests for Carpal Tunnel Syndrome Using Latent Class Analysis. J Bone Joint Surg Am. 2015 Dec 2;97(23):1958-61. doi: 10.2106/JBJS.O.00476. PMID: 26631997.). The main measurement of interest is maximal cross sectional area (CSA) at the carpal tunnel inlet, with the following thresholds: <10mm2 normal, 10-12mm2 borderline, >12mm2 abnormal (Smith, J. Carpal Tunnel with Dr. Jay Smith: AMSSM Sports Ultrasound Case Presentation. YouTube. December 18, 2020. https://www.youtube.com/watch?v=3rjdXSts8dc). If borderline, the Wrist-Forearm ratio (WFR) can also be used, with > or = 1.4 being abnormal (Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol. 2008 Jun;119(6):1353-7. doi: 10.1016/j.clinph.2008.01.101. Epub 2008 Apr 1. PMID: 18387336.).
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Left wrist carpal tunnel inlet unlabeled SAX

Left wrist carpal tunnel inlet labeled SAX

Left wrist carpal tunnel inlet unlabeled LAX

Left wrist carpal tunnel inlet labeled LAX

Interpretation

UPCOMING EVENTS

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