KARPAL TÜNEL SENDROMU TANISINDA ULTRASONOGRAFİNİN YERİ

Karpal tünel sendromu (KTS) median sinirin karpal tünel içerisinde sıkışmasına bağlı gelişen ve toplumda en sık görülen tuzak nöropatidir. KTS tanısında genel yaklaşım klinik ve fizik muayene testleri ile klinik olarak konulan tanının elektrofizyolojik çalışmalar ve/veya çeşitli görüntüleme modaliteleri ile desteklenmesidir. Ultrasonografinin KTS değerlendirmesinde kullanımı giderek artmaktadır. Ultrasonografi ile sinirdeki yapısal değişikliklerin yanı sıra elektrofizyolojik incelemeler ile tespit edilemeyen diğer patolojiler de değerlendirilebilmektedir. Hasta için zararsız olması, iyonlaştırıcı radyasyon içermemesi, invaziv olmaması, taşınabilir olması, dinamik değerlendirme sağlaması, daha ucuz ve ulaşılabilir bir yöntem olması avantajlarıdır. Bu derlemede amacımız KTS tanısında kullanılan bir yöntem olan ultrasonografinin yerini tartışmaktır.

The Role of Ultrasonography in The Dıagnosıs of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the community due to the compression of the median nerve in the carpal tunnel. The general approach in the diagnosis of CTS is clinical diagnosis based on the use of clinical and physical examination tests and the diagnosis is supported by electrophysiological studies and / or various imaging modalities. The using of ultrasonography in the evaluation of CTS is increasing day by day. The other pathologies, except the structural changes in the nerve, which cannot be detected by electrophysiological examinations can also be evaluated by ultrasonography. The advantages of ultrasonography are being harmless for the patient, free of ionizing radiation, non-invasive, portable, dynamic evaluation, cheaper and accessible method. In this review, our aim is to discuss the diagnostic potential of ultrasonography in the evaluation of the diagnosis of CTS

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1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. Jama. 1999;282(2):153-8.
2. Pourmemari MH, Heliovaara M, Viikari-Juntura E, Shiri R. Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors. Muscle & nerve. 2018;58(4):497-502.
3. Preston DC SB. Median neuropathy at the wristElectromyography and Neuromuscular Disorders. Clinical-Electrophysiologic Correlations. 3rd ed: Elsevier; 2013. p. 267.
4. Bland JD. Carpal tunnel syndrome. Current opinion in neurology. 2005;18(5):581-5.
5. Schueknke M SE, Schumacher U. The carpal tunnel. In: Lamperti ED RR, editor. General Anatomy and the Musculoskeletal System. New York: Thieme; 2006. p. 354.
6. Seiler JG, 3rd, Daruwalla JH, Payne SH, Faucher GK. Normal Palmar Anatomy and Variations That Impact Median Nerve Decompression. The Journal of the American Academy of Orthopaedic Surgeons. 2017;25(9):e194-e203.
7. Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. American journal of physical medicine & rehabilitation. 1997;76(6):451-7.
8. Szabo RM, Gelberman RH, Dimick MP. Sensibility testing in patients with carpal tunnel syndrome. The Journal of bone and joint surgery American volume. 1984;66(1):60- 4.
9. Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, et al. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. European radiology. 2007;17(2):509-22.
10. Samanci Y, Karagoz Y, Yaman M, Atci IB, Emre U, Kilickesmez NO, et al. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome. Clinical neurology and neurosurgery. 2016;150:152-8.
11. Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging clinics of North America. 2004;14(1):93- 102.
12. Radack DM, Schweitzer ME, Taras J. Carpal tunnel syndrome: are the MR findings a result of population selection bias? AJR American journal of roentgenology. 1997;169(6):1649-53.
13. Hochman MG, Zilberfarb JL. Nerves in a pinch: imaging of nerve compression syndromes. Radiologic clinics of North America. 2004;42(1):221-45.
14. Buchberger W. Radiologic imaging of the carpal tunnel. European journal of radiology. 1997;25(2):112-7.
15. Vahed LK, Arianpur A, Gharedaghi M, Rezaei H. Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome. European Journal of Translational Myology. 2018;28(2).
16. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 2000;20(suppl_1):S199-S217.
17. Roll SC, Volz KR, Fahy CM, Evans KD. Carpal tunnel syndrome severity staging using sonographic and clinical measures. Muscle & nerve. 2015;51(6):838-45.
18. Cartwright MS, Walker FO, Newman JC, Arcury TA, Mora DC, Haiying C, et al. Muscle intrusion as a potential cause of carpal tunnel syndrome. Muscle & nerve. 2014;50(4):517-22.
19. Tas S, Staub F, Dombert T, Marquardt G, Senft C, Seifert V, et al. Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study. Neurosurgical focus. 2015;39(3):E6.
20. Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR American journal of roentgenology. 1992;159(4):793-8.
21. Georgiev GP, Karabinov V, Kotov G, Iliev A. Medical Ultrasound in the Evaluation of the Carpal Tunnel: A Critical Review. Cureus. 2018;10(10):e3487.
22. Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. Journal of clinical ultrasound : JCU. 2009;37(3):125-31.
23. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-7.
24. Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis and rheumatism. 2002;46(7):1914-21.
25. Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiologic clinics of North America. 1999;37(4):859-72.
26. Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle & nerve. 2002;26(6):798-803.
27. Kele H, Verheggen R, Bittermann HJ, Reimers CD. The potential value of ultrasonography in the evaluation of carpal tunnel syndrome. Neurology. 2003;61(3):389-91.
28. Mallouhi A, Pulzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR American journal of roentgenology. 2006;186(5):1240-5.
29. Wiesler ER, Chloros GD, Cartwright MS, Smith BP, Rushing J, Walker FO. The use of diagnostic ultrasound in carpal tunnel syndrome. The Journal of hand surgery. 2006;31(5):726-32.
30. Sarria L, Cabada T, Cozcolluela R, Martinez-Berganza T, Garcia S. Carpal tunnel syndrome: usefulness of sonography. European radiology. 2000;10(12):1920-5.
31. Miyamoto H, Halpern EJ, Kastlunger M, Gabl M, Arora R, Bellmann-Weiler R, et al. Carpal tunnel syndrome: diagnosis by means of median nerve elasticity—improved diagnostic accuracy of US with sonoelastography. Radiology. 2014;270(2):481-6.
32. Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. The Journal of hand surgery. 2008;33(1):65-71.
33. Ghasemi-Esfe AR, Khalilzadeh O, Mazloumi M, VaziriBozorg SM, Niri SG, Kahnouji H, et al. Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta radiologica. 2011;52(2):191-7.
34. Ulaşli AM, Duymuş M, Nacir B, Rana Erdem H, Koşar U. Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation. Muscle & nerve. 2013;47(3):396-402.
35. Roll SC, Evans KD, Li X, Freimer M, Sommerich CM. Screening for carpal tunnel syndrome using sonography. Journal of Ultrasound in Medicine. 2011;30(12):1657-67.
36. Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. JBJS. 2014;96(17):e148.
37. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. Journal of Neurology, Neurosurgery & Psychiatry. 2008;79(1):63-7.
38. Sernik RA, Abicalaf CA, Pimentel BF, Braga-Baiak A, Braga L, Cerri GG. Ultrasound features of carpal tunnel syndrome: a prospective case-control study. Skeletal radiology. 2008;37(1):49-53.
39. Ziswiler HR, Reichenbach S, Vögelin E, Bachmann LM, Villiger PM, Jüni P. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2005;52(1):304-11.
40. El Miedany Y, Aty S, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology. 2004;43(7):887-95.
41. Swen WA, Jacobs JW, Bussemaker FE, de Waard JW, Bijlsma JW. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist. The Journal of rheumatology. 2001;28(1):62- 9.
42. Ooi CC, Wong SK, Tan AB, Chin AY, Bakar RA, Goh SY, et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal radiology. 2014;43(10):1387- 94.
43. Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo JC, Erausquin C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome? Clinical and experimental rheumatology. 2007;25(6):853-9.
44. Kantarci F, Ustabasioglu FE, Delil S, Olgun DC, Korkmazer B, Dikici AS, et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. European radiology. 2014;24(2):434-40.
45. Kang S, Kwon HK, Kim KH, Yun HS. Ultrasonography of median nerve and electrophysiologic severity in carpal tunnel syndrome. Annals of rehabilitation medicine. 2012;36(1):72-9.
46. Keles I, Karagulle Kendi AT, Aydin G, Zog SG, Orkun S. Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome. American journal of physical medicine & rehabilitation. 2005;84(6):443-50.
47. Ashraf AR, Jali R, Moghtaderi AR, Yazdani AH. The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome. Electromyography and clinical neurophysiology. 2009;49(1):3-8.
48. Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. Journal of clinical ultrasound : JCU. 2009;37(7):389-93.
49. Altinok T, Baysal O, Karakas HM, Sigirci A, Alkan A, Kayhan A, et al. Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome. Clinical radiology. 2004;59(10):916-25.
50. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR American journal of roentgenology. 1999;173(3):681-4.
51. Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A. Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Archives of Iranian medicine. 2010;13(6):516- 21.
52. Wang LY, Leong CP, Huang YC, Hung JW, Cheung SM, Pong YP. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung medical journal. 2008;31(5):469-76.
53. Rahmani M, Esfe AG, Bozorg S, Mazloumi M, Khalilzadeh O, Kahnouji H. The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests. La radiologia medica. 2011;116(3):489-96.
54. Miyamoto H, Morizaki Y, Kashiyama T, Tanaka S. Greyscale sonography and sonoelastography for diagnosing carpal tunnel syndrome. World journal of radiology. 2016;8(3):281.
55. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-7.
56. Tajika T, Kobayashi T, Yamamoto A, Kaneko T, Takagishi K. Diagnostic utility of sonography and correlation between sonographic and clinical findings in patients with carpal tunnel syndrome. Journal of Ultrasound in Medicine. 2013;32(11):1987-93.
57. Roll SC, Evans KD, Li X, Freimer M, Sommerich CM. Screening for carpal tunnel syndrome using sonography. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine. 2011;30(12):1657-67.
58. Fu T, Cao M, Liu F, Zhu J, Ye D, Feng X, et al. Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers. PloS one. 2015;10(1):e0116777.
59. Wessel LE, Marshall DC, Stepan JG, Sacks HA, Nwawka OK, Miller TT, et al. Sonographic Findings Are Associated With Carpal Tunnel Symptom Severity. J Hand Surg Am. 2018; pii: S0363-5023(17)31113-9.
60. Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clinical orthopaedics and related research. 2011;469(4):1089-94.
61. Chan K-Y, George J, Goh K-J, Ahmad TS. Ultrasonography in the evaluation of carpal tunnel syndrome: Diagnostic criteria and comparison with nerve conduction studies. Neurology Asia. 2011;16(1):57-64.
62. Nakamichi KI, Tachibana S. Ultrasonographic measurement of median nerve cross‐sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2002;26(6):798-803.
63. Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. The Journal of bone and joint surgery American volume. 2014;96(17):e148.
64. Fowler JR, Maltenfort MG, Ilyas AM. Ultrasound as a firstline test in the diagnosis of carpal tunnel syndrome: a cost-effectiveness analysis. Clinical Orthopaedics and Related Research. 2013;471(3):932-7.
65. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. Journal of neurology, neurosurgery, and psychiatry. 2008;79(1):63-7.
66. Nkrumah G, Blackburn AR, Goitz RJ, Fowler JR. Ultrasonography Findings in Severe Carpal Tunnel Syndrome. Hand. 2018:1558944718788642.
67. Klauser AS, Ellah MMA, Halpern EJ, Siedentopf C, Auer T, Eberle G, et al. Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies? European radiology. 2015;25(8):2419-27.
68. Aseem F, Williams JW, Walker FO, Cartwright MS. Neuromuscular ultrasound in patients with carpal tunnel syndrome and normal nerve conduction studies. Muscle & nerve. 2017;55(6):913-5.
69. Billakota S, Hobson-Webb LD. Standard median nerve ultrasound in carpal tunnel syndrome: A retrospective review of 1,021 cases. Clinical neurophysiology practice. 2017;2:188-91.
70. Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle & nerve. 2008;38(2):987-91.
71. Kim JY, Yoon JS, Kim SJ, Won SJ, Jeong JS. Carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographic ratio after surgery. Muscle & nerve. 2012;45(2):183-8.
72. Colak A, Kutlay M, Pekkafali Z, Saracoglu M, Demircan N, Şimşek H, et al. Use of sonography in carpal tunnel syndrome surgery. Neurologia medico-chirurgica. 2007;47(3):109-15.
73. Miwa T, Miwa H. Ultrasonography of carpal tunnel syndrome: clinical significance and limitations in elderly patients. Internal Medicine. 2011;50(19):2157-61.
74. Kantarci F, Ustabasioglu FE, Delil S, Olgun DC, Korkmazer B, Dikici AS, et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. European radiology. 2014;24(2):434-40.