| Objective:To evaluate the relationship between symptoms,clinical severity,neurophysiological characteristics with median nerve cross-sectional area(CSA)at the level of carpal tunnel outlet at ultrasonography(USG)and its utility in diagnosis of carpal tunnel syndrome(CTS).Materials and Methods: All the patients with carpal tunnel syndrome who met the criteria of the group and matched with the age and sex matched healthy volunteers were examined by the median nerve conduction and ultrasonography.A multidimensional assessment of CTS was done using historic and objective scale(Hi-Ob scale)for clinical severity,Boston carpal tunnel questionnaire(BCTQ)for patient-oriented measures,neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel outlet.1.Participants44 patients with a total of 74 wrists attending to the Neurology department and out patient department diagnosed as carpal tunnel syndrome using the criteria were chosen.Judge by the doctors of neurology clinic?neurology ward and psychological clinic of huangshan city hospital from Sept.2015 to Jan.2017.And we selected the asymptomatic wrists of the 44 patients and 36 wrists of 18 healthy volunteers of age and gender matched.2.Statistical analysisData was obtained and analyzed using SPSS software version 20.To compare the test results of USG CSA and NCV between the carpal tunnel syndrome group and the control group.The measurement data is expressed by the mean and standard deviation.The parameters between two groups were compared using independent samples t test.Count data is expressed by the frequency form.Groups were compared by chi square test(x2).The sensitivity,specificity,Jorden index(sensitivity + specificity-1)and the area under the ROC curve were used to evaluate the diagnostic results.The relationship between the indexes of electrophysiological detection of the median nerve and the results of the ultrasonic cross sectional area at the exit of the carpal tunnel were determined by Pearson correlation analysis.P<0.05 was statistically significant.Results:1.The independent samples t test was used to compare the electrophysiological indexes of the carpal tunnel syndrome group and the control group.The results showed that SCV(thumb wrist),SCV(middle finger wrist),SNAP(thumb)of the carpal tunnel syndrome group were 38 + 10.34m/s,40.26 + 9.72m/s,15.38 + 11.03 V,were less than which of the control group,the difference was statistically significant(P<0.001).DML was 4.46 + 2.38 ms,which was higher than the control group,the difference was statistically significant(P<0.001).CAMP was 12.61 + 4.53 mV,there was no significant difference between the two groups(P=0.968).Diagnositic tests were used to evaluate the diagnostic efficacy of NCV testing.The results showed that the sensitivity of NCV diagnosis was 75.7%,the specificity was98%,the Jorden index(Youdens index)comprehensive evaluate the results of NCV,and the NCV index for Jorden(0.757+0.980-1=0.737).The area under the ROC curve was used to evaluate the diagnostic value of NCV test.The results showed that the area under the ROC curve was 0.868(0.803-0.934),and the results were statistically significant(P<0.001).2.Compared with independent sample t test on the carpal tunnel syndrome groupand the control group.Compared with the control group,the cross-section area at the carpal tunnel outlet level of the carpal tunnel syndrome were larger.The difference wan statistically significant(P<0.001).The ROC curve was used to evaluate the diagnostic value of ultrasonography detection(cross-sectional area).The results showed that the area under the ROC curve(0.851)(0.779-0.924).According to the principle of maximum Jorden exponent,find out the cut off value of CSA is 8.5mm2,the corresponding sensitivity was 79.7%,specificity was 84%.3.With linear trend test,different electrophysiological level between the patients with ultrasonic detection and classification were compared,suggesting that different levels of Hi-OB,BTCQ with different grades and different electrophysiological grade patients and ultrasound examination showed no linear classification change trend.(P>0.05).4.Pearson linear correlation analysis was used to analyze the correlation between the indexes of nerve conduction test and the cross-sectional area of the wrist.The results showed that SCV(thumb wrist),SCV(middle finger wrist),SNAP(thumb)has a negative correlation with the cross-sectional area at the outlet of the carpal tunnel;there is a positive correlation between DML and the cross-sectional area at the outlet of the carpal tunnel,the results were statistically significant(P<0.05).There was no correlation between CAMP and the cross-sectional area at the outlet of the carpal tunnel(P>0.05).Conclusion:1.Compared with the control group,the CSA of the median nerve at the carpal tunnel outlet of carpal tunnel syndrome group increased significantly,which has a diagnostic value for carpal runnel syndrome.2.Compared with the control group,the SCV and SNAP of the median nerve in the carpal tunnel syndrome group were decreased,and the DML was prolonged,which hada great significance in the diagnosis of carpal tunnel syndrome.There was no significant difference in CAMP amplitude of the median nerve.3.Nerve conduction test and ultrasonic examination are valuable in the diagnosis of carpal tunnel syndrome,but the effect of electrophysiological detection is better than that of ultrasonic diagnosis(cross-sectional area).4.There was a negative correlation between the decrease of SCV and the decrease of SNAP amplitude in the median nerve and the cross-sectional area of the median nerve at the outlet of the carpal tunnel.There was a positive correlation between the DML extension and the cross-sectional area,and there was no significant correlation between the decrease of CAMP amplitude and the cross-sectional area.5.There was no significant correlation between the severity of nerve conduction test and the CSA of the median nerve at the outlet of the carpal tunnel in patients with carpal tunnel syndrome. |
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