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Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review

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Abstract

Background

Numerous sonographic modalities and parameters have been used to diagnose carpal tunnel syndrome (CTS), with varying accuracy. Our umbrella review aimed to summarize the evidence from systematic reviews and meta-analyses regarding the use of ultrasound imaging to diagnose CTS.

Methods

Systematic reviews and meta-analyses meeting the inclusion criteria were searched in PubMed, Embase, Medline, Web of Science, and Cochrane databases from inception to March 2022. Critical appraisal, data extraction, and synthesis were performed in accordance with the criteria for conducting an umbrella review.

Results

Sixteen reviews were included. Three reviews were classified as high quality, one as moderate, four as low, and eight as critically low. The cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet demonstrated the best reliability and diagnostic accuracy among multiple parameters. A cutoff CSA value of 9–10.5 mm2 gave the highest diagnostic performance in the general population. The degree of CSA enlargement was correlated with CTS severity. Sonoelastography and Doppler ultrasound might provide additional insights into CTS evaluation as median nerve stiffness and vascularity at the wrist were increased in these patients.

Conclusions

Sonography is a reliable tool to diagnose CTS, with inlet CSA being the most robust parameter. Sonoelastography and Doppler ultrasound can serve as auxiliary tools to confirm CTS diagnoses. Further studies are needed to expand the use of sonography for diagnosing CTS, especially in the presence of concomitant neuromuscular disease(s).

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Funding

This work was funded by the National Taiwan University Hospital, Bei-Hu Branch; Ministry of Science and Technology (MOST 106–2314-B-002–180-MY3 and 109–2314-B-002–114-MY3); and the Taiwan Society of Ultrasound in Medicine.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Medical Foundation, Inc, 26546, Yilan, Taiwan

    Ting-Yu Lin

  2. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, 10048, Taipei, Taiwan

    Ke-Vin Chang & Wei-Ting Wu

  3. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, 10845, Taipei, Taiwan

    Ke-Vin Chang & Wei-Ting Wu

  4. Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, 11600, Taipei, Taiwan

    Ke-Vin Chang

  5. Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100, Ankara, Turkey

    Levent Özçakar

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  1. Ting-Yu Lin
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Correspondence to Ke-Vin Chang.

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Lin, TY., Chang, KV., Wu, WT. et al. Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review. J Neurol 269, 4663–4675 (2022). https://doi.org/10.1007/s00415-022-11201-z

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