Relationship Between Intraneural Hypervascularization of the Median Nerve and Electromyographic Severity Stages in the Diagnosis of Carpal Tunnel Syndrome

TL;DR

This study shows that color Doppler ultrasound can help assess the severity of carpal tunnel syndrome by detecting increased blood flow in the median nerve.

Contribution

The study demonstrates that color Doppler ultrasound is a useful tool for evaluating the severity of carpal tunnel syndrome.

Findings

Color Doppler was positive in 75% of severe carpal tunnel syndrome cases but absent in normal cases.

There was a statistically significant difference in Doppler positivity between non-severe and severe groups (p < 0.001).

Abstract

Background: Ultrasound is increasingly playing a role in the diagnosis of carpal tunnel syndrome (CTS). The interest of the cross-sectional area (CSA) has been widely studied in assessing the severity of CTS. However, few studies have examined the usefulness of colour Doppler in evaluating the severity of CTS.

Objective: This study aims to evaluate the usefulness of colour Doppler ultrasound in assessing the severity of carpal tunnel syndrome compared to electroneuromyography (ENMG).

Methods: This is a cross-sectional study of patients over 18 years of age with typical signs of CTS, conducted over one year. All patients underwent ultrasound, including the measurement of the CSA at the entrance to the carpal tunnel, a colour Doppler, and an electroneuromyographic evaluation within a one-week interval. Using the Rosenbaum and Ochoa severity grading, patients were divided into four groups according to the stage of electrophysiological severity.

Results: Our study included 71 patients with typical signs of CTS, of whom 69 (97.2%) were female. The mean age of patients was 51.94 ± 10 years. CTS was bilateral in 54 patients, with each wrist considered an independent case. A total of 125 wrists were examined by ultrasound and ENMG. Colour Doppler was positive in 24 (19.2%) of the wrists studied. ENMG was normal in five (4%) wrists, 51 (40.8%) wrists were considered mild, 26 (20.8%) moderate, and 43 (34.4%) severe. Colour Doppler was positive in three (12.5%), three (12.5%), and 18 (75%) of the mild, moderate, and severe cases, respectively. None of the patients with normal ENMG had a positive colour Doppler. After analysis, there was a statistically significant difference between the non-severe and severe groups regarding Doppler positivity (p < 0.001).

Conclusion: Our study concludes that colour Doppler ultrasound can predict the severity of CTS, showing a difference between the severity of CTS and the presence of intraneural hypervascularisation of the median nerve in colour Doppler.

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