Introduction: Carpal tunnel syndrome is the most common compression neuropathy.Advances in ultrasound imaging have allowed accurate anatomical visualisation of the carpal tunnel.There have subsequently been numerous studies evaluating the role of ultrasonography in diagnosing carpal tunnel syndrome.
Objectives: The purpose of this paper was to systematically review the diagnostic accuracy of ultrasonography in patients with carpal tunnel syndrome.
Methods: A structured Medline search was undertaken,extended by searching reference lists of the studies identified,and screening papers citing the studies identified (Web of Science).The population of interest was patients with carpal tunnel syndrome,we included studies that used symptomatic or healthy controls.The reference standard was nerve conductions studies or other longitudinal clinical history and examination findings.Studies that only presented anatomical observations were excluded.Study quality was assessed using QUADAS and preliminary analysis was performed using Meta-DiSc.
Data Synthesis: 137 studies were identified,of which 27 met our inclusion criteria.Preliminary analysis included the 16 studies that used cross sectional area of the median nerve on ultrasound as the method of diagnosis.Only 50% of the studies stated blinding of the index test to the reference standard.All papers provided sensitivity and specificity data.On the summary receiver operating characteristic curve (sROC),a sensitivity of 84% corresponded to a specificity of 86%.The area under the sROC curve was 0.911. Results of additional analyses will also be presented.
Conclusion: The findings of this systematic review highlight the promise of ultrasonography as a useful tool in the aid of diagnosing carpal tunnel syndrome.These results are particularly relevant in centres with no easy access to electrophysiological studies.