Ratio and difference of the cross-sectional area of median nerve to ulnar nerve in diagnosing carpal tunnel syndrome: a case control study

Yi-Wei Chang, Tsung-Cheng Hsieh, I-Shiang Tzeng, Valeria Chiu, Pei-Jung Huang, Yi-Shiung Horng, Yi-Wei Chang, Tsung-Cheng Hsieh, I-Shiang Tzeng, Valeria Chiu, Pei-Jung Huang, Yi-Shiung Horng

Abstract

Background: To evaluate the diagnostic accuracy of the median-to-ulnar nerve ratio (MUR) and the median-to-ulnar nerve difference (MUD) in patients with carpal tunnel syndrome (CTS).

Methods: In this study, 32 patients with CTS and 32 healthy volunteers were evaluated. All participants received a series of tests and ultrasound examination for the evaluation of the following criteria: cross-sectional area of the median nerve at the pisiform level (CSA-P), swelling ratio (SR), MUR, MUD, and flattening ratio (FR).

Results: CSA-P, SR, MUR, and MUD were all significantly larger in the patients with CTS than in the healthy volunteers. The areas under the receiver operator characteristic curves of MUD, MUR, CSA-P, and SR were 0.78, 0.75, 0.70, and 0.61 respectively. MUD had higher sensitivity (84%) than MUR, CSA-P, and SR (sensitivity: 63, 63, and 53%, respectively).

Conclusions: By using the ulnar nerve area at the pisiform level as an internal control parameter, the MUD and MUR methods showed higher diagnostic accuracy than SR in patients with CTS. Further application of these methods in research and clinical settings is recommended.

Trial registration: Clinicaltrial.gov NCT03033173. Registered 18 January 2017. Retrospectively registered.

Keywords: Carpal tunnel syndrome; Median nerve; Median nerve entrapment; Ulnar nerve; Ultrasound.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cross-sectional area of the median nerve (large encircled area) and the ulnar nerve (small encircled area) at the pisiform level; P: pisiform bone; S: scaphoid bone
Fig. 2
Fig. 2
Median nerve cross sectional area at the distal radioulnar joint level (U: Ulnar bone; R: Radius bone)
Fig. 3
Fig. 3
Long axis and short axis of median nerve at the pisiforms level (P: pisiform bone; S: scaphoid bone)

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