Ultrasonography as A diagnostic Tool for Clinically Manifested Carpal Tunnel Syndrome with Normal Nerve Conduction Study

Document Type : Original Article

Authors

1 Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

2 Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Abstract

Background: Carpal Tunnel Syndrome [CTS] is a prevalent condition characterized by median nerve compression at the wrist, leading to various neurological symptoms. In this study we evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinically suspected CTS but normal nerve conduction studies [NCS]. 
Objective: This study aimed to evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinically suspected CTS but normal nerve conduction studies [NCS]. Additionally, investigate the role of serum vitamin D levels in CTS and their association with symptom severity for early diagnosis and improved management.
Methods: A cross-sectional case control study was conducted involving 80 participants, divided into a patient group [n=40] with clinically suspected CTS and a control group [n=40]. Participants were recruited from the neurology, rheumatology and rehabilitation departments of Al-Zahraa University Hospital between November 2023 and July 2024. Comprehensive evaluations included nerve conduction study, ultrasonography of median nerve especially median nerve cross sectional area [MN-CSA], wrist forearm ratio, flattening ratio &bowing of flexor retinaculum, and laboratory investigations, including serum 25-hydroxy vitamin D levels.
Results: Neuromuscular ultrasound demonstrated significant differences in ultrasound parameters between patient and control group especially wrist forearm ratio which is the most specific and sensitive parameter. Also, there are significant differences in other ultrasound parameters such as MN CSA and flattening ratio. A positive correlation was found between median nerve cross-sectional area [CSA] at the wrist and disease duration [p < 0.05]. In addition, the study revealed a significant difference in serum 25-hydroxy vitamin D levels between the patient group and the control group with a p-value of <0.001. A negative correlation was observed between serum vitamin D levels and both wrist-forearm ratio and flattening ratio at the mid-carpal tunnel [p < 0.05].
Conclusion: This study highlights the value of neuromuscular ultrasound for diagnosing carpal tunnel syndrome [CTS], even when nerve conduction studies are normal. It also reveals potential links between vitamin D levels and symptom severity.

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