Carpal Tunnel Syndrome: Correlating Preoperative Diagnostic Tools with Intraoperative Findings

Document Type : Original Article

Authors

1 The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Mansoura University

2 The Department of Gastrointestinal Surgery, Faculty of Medicine, Mansoura University

3 The Department of Anesthesia Surgical ICU & Pain Management, Faculty of Medicine, Mansoura University

Abstract

Background: There is no universally accepted gold standard
for decision-making regarding the choice of surgery for
carpal tunnel syndrome. A combination of clinical examination
and electrophysiological studies has been commonly used for
the diagnosis of CTS and grading its severity with the recent
introduction of ultrasonographic examination as a reliable
diagnostic tool. In severe cases of CTS, carpal tunnel release
surgery is usually done, while patients with mild or moderate
degree of the disease usually start with conservative treatment.
Knowing which diagnostic test more accurately reflects the
severity of CTS is mandatory for proper decision-making
regarding management.
Objective: To correlate preoperative diagnostic tools
(clinical presentation, Nerve conduction study, and US)
findings with intraoperative findings to find out which one
of these preoperative diagnostic tools plays the greatest role
in the decision-making process regarding the choice of surgery.
Method: Surgically treated 18 patients diagnosed with
carpal tunnel syndrome (CTS) were included in the study. A
correlation between clinical, electrophysiological, and ultrasonographic
data and intraoperative findings was done.
Results: Statistical analysis shows positive correlation
between clinical, electrophysiological and ultrasonographic
data, and intraoperative findings with electrophysiological
studies being the best and only statistically significant predictor
of severity.
Conclusion: Electrophysiological studies provide the best
predictor of the severity of CTS but more studies are needed
to test the accuracy of these results.

Keywords

Main Subjects


Tuncali D., Barutcu A.Y., Terzioglu A. and Aslan G.:
Carpal tunnel syndrome: Comparison of intraoperative
structural changes with clinical and electrodiagnostic
severity. Br. J. Plast. Surg., 58 (8): 1136-1142. doi:10.1016
/j.bjps.2005.05.010, 2005.
2- Aroori S. and Spence RA.J.: Carpal tunnel syndrome.
Ulster Med. J., 77 (1): 6-17, 2008.
3- Roomizadeh P., Eftekharsadat B., Abedini A., et al.:
Ultrasonographic Assessment of Carpal Tunnel Syndrome
Severity: A Systematic Review and Meta-Analysis. Am.
J. Phys. Med. Rehabil., 98 (5): 373-381. doi:10.1097/
PHM.0000000000001104, 2019.
4- Jerosch-Herold C., Mason R. and Chojnowski A.J.: A
qualitative study of the experiences and expectations of
surgery in patients with carpal tunnel syndrome. J. Hand
Ther Off J. Am. Soc. Hand Ther., 21 (1): 54-61; quiz 62.
doi:10.1197/j.jht.2007.09.001, 2008.
5- Hageman M.G.J.S., Kinaci A., Ju K., Guitton T.G., Mudgal
C.S. and Ring D.: Carpal tunnel syndrome: Assessment
of surgeon and patient preferences and priorities for
decision-making. J. Hand Surg., 39 (9): 1799-1804.e1.
doi:10.1016/ j.jhsa.2014.05.035, 2014.
6- Caliandro P., Giannini F., Pazzaglia C., et al.: A new
clinical scale to grade the impairment of median nerve in
carpal tunnel syndrome. Clin. Neurophysiol Off J Int Fed
Clin. Neurophysiol., 121: 1066-1071. doi:10.1016/
j.clinph.2010.02.002, 2010.
7- Abdelshaheed M.E.: The use of wide awake local anaesthesia
initially applied tourniquet (WALAIAT) in flexor
tendon surgery: a randomized controlled trial. J. Hand
Surg. Eur., Vol. 47 (7): 766-768. doi:10.1177/
17531934221087579, 2022.
8- Abdelshaheed M.E.: Classification and clinical evaluation
of “spare parts” procedures in mutilating hand injuries.
Hand Surg. Rehabil., 40 (1): 75-80. doi:10.1016/
j.hansur.2020.10.008, 2021.
9- Keith M.W., Masear V., Chung K.C., et al.: American
Academy of Orthopaedic Surgeons Clinical Practice
Guideline on diagnosis of carpal tunnel syndrome. J.
Bone Joint Surg. Am., 91 (10): 2478-2479. doi:10.2106/
JBJS.I.00643, 2009.
10- Schrijver H., Gerritsen A., Strijers R., et al.: Correlating
nerve conduction studies and clinical outcome measures
on carpal tunnel syndrome: Lessons from a randomized
controlled trial. J Clin Neurophysiol Off Publ Am. Electroencephalogr
Soc., 22: 216-221, 2005.
11- Yoshii Y., Zhao C. and Amadio P.C.: Recent Advances in
Ultrasound Diagnosis of Carpal Tunnel Syndrome. Diagn
Basel Switz, 10(8). doi:10.3390/diagnostics10080596,
2020.
12- McDonagh C., Alexander M. and Kane D.: The role of
ultrasound in the diagnosis and management of carpal
tunnel syndrome: A new paradigm. Rheumatol. Oxf. Engl.,
54 (1): 9-19. doi:10.1093/rheumatology/keu275, 2015.
13- Torres-Costoso A., Martínez-Vizcaíno V., Álvarez-Bueno
C., Ferri-Morales A. and Cavero-Redondo I.: Accuracy
of Ultrasonography for the Diagnosis of Carpal Tunnel
Syndrome: A Systematic Review and Meta-Analysis. Arch
Phys. Med. Rehabil., 99 (4): 758-765.e10. doi:10.1016/
j.apmr.2017.08.489, 2018.
14- El Miedany Y.M., Aty S.A. and Ashour S.: Ultrasonography
versus nerve conduction study in patients with carpal
tunnel syndrome: Substantive or complementary tests?
Rheumatol. Oxf. Engl., 43 (7): 887-895. doi:10.1093/
rheumatology/keh190, 2004.
15- Yesildag A., Kutluhan S., Sengul N., et al.: The role of
ultrasonographic measurements of the median nerve in
the diagnosis of carpal tunnel syndrome. Clin. Radiol.,
59 (10): 910-915. doi:10.1016/j.crad.2004.03.020, 2004.
16- Kwon B.C., Jung K.I. and Baek G.H.: Comparison of
sonography and electrodiagnostic testing in the diagnosis
of carpal tunnel syndrome. J. Hand Surg., 33 (1): 65-71.
doi:10.1016/j.jhsa.2007.10.014, 2008.
17- Ashraf A.R., Jali R., Moghtaderi A.R. and Yazdani A.H.:
The diagnostic value of ultrasonography in patients with
electrophysiologicaly confirmed carpal tunnel syndrome.
Electromyogr. Clin. Neurophysiol., 49 (1): 3-8, 2009.
18- Fowler J.R., Munsch M., Tosti R., Hagberg W.C. and
Imbriglia J.E.: Comparison of ultrasound and electrodiagnostic
testing for diagnosis of carpal tunnel syndrome:
Study using a validated clinical tool as the reference
standard. J. Bone Joint Surg. Am., 96 (17): e148.
doi:10.2106, 2014.