Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy

Benedito Felipe Rabay Pimentel, Flávio Faloppa, Marcel Jun Sugawara Tamaoki, João Carlos Belloti, Benedito Felipe Rabay Pimentel, Flávio Faloppa, Marcel Jun Sugawara Tamaoki, João Carlos Belloti

Abstract

Background: The aim of this study was to evaluate the effectiveness of two diagnostic tests routinely used for diagnosing carpal tunnel syndrome (CTS)-ultrasonography (US) and nerve conduction studies (NCS)-by comparing their accuracy based on surgical results, with the remission of paresthesia as the reference standard.

Methods: We enrolled 115 patients, all of the female gender with a high probability of a clinical diagnosis of CTS. All patients underwent US and NCS for a diagnosis and subsequent surgical treatment. As a primary outcome, the accuracy of the US and NCS diagnoses was measured by comparing their diagnoses compared with those determined by the surgical outcomes. Their accuracy was secondarily evaluated based on before and after scores of the Boston Carpal Tunnel Questionnaire (BCTQ).

Results: Overall, 104 patients (90.4%) were diagnosed with CTS by the surgical reference standard, 97 (84.3%) by NCS, and 90 (78.3%) by US. The concordance of NCS and surgical treatment (p < 0.001; kappa = 0.648) was superior to that of US and surgical treatment (p < 0.001; kappa = 0.423). The sensitivity and specificity of US and NCS were similar (p = 1.000 and p = 0.152, respectively: McNemar's test). The BCTQ scores were lower after surgery in patients diagnosed by both US and NCS (p < 0.001and p < 0.001, respectively: analysis of variance).

Conclusions: US and NCS effectively diagnosed CTS with good sensitivity but were not effective enough to rule out a suspicion of CTS.

Trial registration: This study was registered at September, 10 th, 2015, and the registration number was NCT02553811 .

Keywords: Carpal tunnel syndrome; Clinical diagnosis; Diagnostic accuracy; Diagnostic practices; Electrodiagnostic testing; Electromyograph; Nerve conduction studies; Surgical treatment; Ultrasonography; Ultrasound.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics and Research Committees of Federal University of São Paulo/Paulista School of Medicine, São Paulo, São Paulo State, Brazil (approval No. 244468) on 12 April 2013 and Paraiba Valley Regional Hospital and Taubaté University Hospital, University of Taubaté, Taubaté, São Paulo State, Brazil (No. 009/13) on 18 June 2013 approved this study. We have obtained the written informed consent for participation in the study from all participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison between observed, expected concordances and Kappa coefficient of the US and NCS
Fig. 2
Fig. 2
Flowchart of the diagnostic intervention results
Fig. 3
Fig. 3
Interval confidence for sensitivity, specificity, positive and negative predictive value of the US and NCS
Fig. 4
Fig. 4
Confidence Interval for positive likelihood ratios (RV+) of the US and NCS
Fig. 5
Fig. 5
Confidence Interval for negative likelihood ratios (RV-) of the US and NCS
Fig. 6
Fig. 6
Evolution of the BCTQ score averages for symptom severity scale by the ultrasonography
Fig. 7
Fig. 7
Evolution of the BCTQ score averages for symptom severity by nerve conduction studies
Fig. 8
Fig. 8
Evolution of the mean BCTQ scores for functional status by the ultrasonograph
Fig. 9
Fig. 9
Evolution of the mean BCTQ scores for functional status by nerve conduction studies

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