Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?

Abstract

Purpose Diabetes mellitus (DM) and carpal tunnel syndrome (CTS) are common pathologies. The diagnosis of CTS can be facilitated by the use of an ultrasound-based wrist-to-forearm ratio (WFR) of the nerve diameter. However, the applicability of WFR in DM-patients is not yet clear.

Materials and Methods 233 wrists of 153 patients were examined. Cross-sectional areas (CSA) of the median nerve were obtained using a linear array probe. The WFR was calculated.

Results Diabetics with CTS had significantly lower WFR values than non-diabetics with CTS (p = 0.002). There was no difference between the WFR of diabetics with and without CTS (p = 0.06). The diagnostic accuracy between diabetics with and without CTS was low for measurements of WFR (ROC AUC = 0.630, 95 % CI 0.541 – 0.715, p = 0.011).

Conclusion Our findings suggest that the WFR has a low diagnostic accuracy in diabetic patients with CTS and should be used with caution in those patients.

Key Points 

• The diagnostic accuracy of WFR is low in patients with DM

• WFR should not be used in patients with DM

• The sonographic evaluation of the median nerve in patients with DM should focus on morphological changes

Citation Format

• Steinkohl F, Loizides A, Gruber L et al. Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?. Fortschr Röntgenstr 2019; 191: 117 – 121

Zusammenfassung

Ziel Diabetes mellitus (DM) und das Karpaltunnelsyndrom (CTS) sind häufige Erkrankungen. Die sonografische Diagnose des CTS basiert auf der Wrist-to-Forearm-Ratio (WFR). Kann man aber die WFR bei Patienten mit DM anwenden?

Material und Methoden Es wurden 233 Handgelenke von 153 Patienten untersucht. Die Querschnittsfläche (CSA) des Nervus medianus wurde mit einem Linearschallkopf erhoben. Die WFR wurde errechnet.

Ergebnisse Patienten mit DM und CTS hatten signifikant niedrigere WFR-Werte als Patienten ohne DM mit CTS (p = 0,002). Es gab keinen Unterschied zwischen der WFR von Patienten mit DM und ohne CTS und von Patienten mit DM und mit CTS (p = 0,06). Die diagnostische Genauigkeit zwischen Patienten mit DM und mit CTS und Patienten mit DM und ohne CTS war mit der WFR niedrig (ROC AUC = 0,630, 95 % CI 0,541 – 0,715, p = 0,011).

Schlussfolgerung Die Ergebnisse dieser Arbeit legen nahe, dass die WFR bei Patienten mit DM und CTS eine niedrige diagnostische Genauigkeit hat. Daher sollte sie bei diesen Patienten nur mit Vorsicht verwendet werden.

Kernaussagen 

• Die diagnostische Genauigkeit der WFR ist bei Diabetikern niedrig

• Die WFR sollte bei Patienten mit DM nicht verwendet werden

• Die sonografische Beurteilung des Nervus medianus sollte bei Patienten mit DM den Schwerpunkt auf morphologische Veränderungen legen

Key words

Carpal Tunnel Syndrome - Diabetes Mellitus - ultrasound - Wrist-to-Forearm-Ratio - median nerve

• Reference

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