Ultrasonography of Median Nerve and Electrophysiologic Severity in Carpal Tunnel Syndrome

Objective To investigate the correlation of the ultrasonographic wrist-to-forearm median nerve area ratio (WFR) and cross sectional area of median nerve at the wrist (CSA-W) to the electrophysiologic severity in patients with carpal tunnel syndrome (CTS). Method One hundred and ten wrists electrophysiologically graded as mild, moderate, and severe CTS and 38 healthy controls underwent ultrasonography of median nerve at the distal wrist crease and mid-forearm. WFR and CSA-W were analyzed according to the severity of CTS. Results WFR was 1.12 +/- 0.14, 1.91 +/- 0.33, 2.27 +/- 0.47 and 3.02 +/- 0.97 and the CSAs-W was 7.23 +/- 1.67 mm(2), 13.51 +/- 3.72 mm(2), 14.67 +/- 2.93 mm(2), and 18.74 +/- 6.01 mm(2) in controls, mild (n=28), moderate (n=46), and severe (n=36) CTS, respectively. CSA-W displayed significant differences between the control and the mild CTS, moderate CTS and severe CTS groups. However, there was no significant difference between mild CTS and moderate CTS groups. WFR revealed significant difference between all groups. The sensitivity and specificity of the WFR in grading the severity of CTS were higher than those of the CSA-W. Conclusion Ultrasonography is a useful complementary tool for the evaluation of CTS. Both WFR and CSA-W are highly correlated with severity grade of CTS. However, WFR is superior to CSA-W for diagnosis and grading of the severity of CTS.