The Clinical Study Of High Frequency Ultrasound In The Diagnosis And Prognostic Evaluation Of Carpal Tunnel Syndrome

Part One The value of high frequency ultrasound in the diagnosis of carpal tunnel syndromeObjective:To investigate the value of high frequency ultrasound in the diagnosis of carpal tunnel syndrome(CTS).Methods:From May 2014 to May 2016,thirty-two patients(39 hands)with CTS were included in CTS group,and twenty asymptomatic controls(40 hands)in control group.They all underwent high frequency ultrasound test pre-operatively.The following parameters were evaluated:the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane.Results:The baseline from CTS and control groups had no significant difference(P>0.05).The cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane were higher in CTS group(t=3.672,2.267,3.243,3.603,2.663,3.765,P=0.049,0.011,0.025,0.003,0.017,0.000).Correlation analysis showed that a significant correlation was found in the cross-sectional area of pea bone,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane(P=0.003,0.031,0.009,0.000,0.000),but not in the cross-sectional area of the distal Hamate plane(P=0.342).ROC curve showed the diagnostic thresholds of the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane were 0.126,0.093,0.376,1.286,0.469 and 3.154.The diagnostic sensitivity was 84.6,79.5,89.7,87.0,73.6 and 92.3%,respectively.The corresponding specificity was 72.5,77.2,82.5,78.1,71.1 and 74.6%,respectively.Conclusion:1.High frequency ultrasonography provides a better morphological evidence for the median nerve,which supplies imaging basis for diagnosis of CTS.2.High frequency ultrasound can simplify the operation procedures with less damage,which is preferable in the diagnosis of CTS.Part Two The prognostic evaluation of high frequency ultrasonography in carpal tunnel syndromeObjective:To investigate the prognostic evaluation of high frequency ultrasonography in CTSMethods:From May 2014 to May 2016,thirty-two patients(39 hands)with CTS were enrolled and underwent high frequency ultrasound test pre-operatively.The following measurements were evaluated:the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane.The Boston carpal tunnel questionnaire(BCTQ)was used to evaluate the wrist function pre-operatively and 3 months post-operatively.Results:BCTQ score was 13.9±5.3 at 3 months postoperatively,which is lower than 30.7±5.7 preoperatively.Multiple regression analysis showed that BCTQ score was correlated with area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane.ROC curve showed the diagnostic thresholds of a thickness of transverse carpal ligament at the exit of carpal tunnel,flattening of the hook plane and ratio of the median nerve to the inlet and outlet of carpal tunnel were 0.486,4.178 and 1.319.The diagnostic sensitivity was 83.3,85.4 and 88.9,respectively.The corresponding specificity was 75.7,86.2 and 71.4%,respectively.Conclusion:1.The wrist function improves significantly after operation.2 The area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane are the main prognostic factors of CTS.