Ultrasonographic Assessment of Carpal Tunnel Syndrome Severity A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of the study was to investigate the overall estimates of cross-sectional areas of the median nerve measured by ultrasonography in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. Design: MEDLINE (PubMed), Embase (Ovid), and Web of Science were searched for studies reporting the median nerve cross-sectional area measured by ultrasonography for mild, moderate, and severe carpal tunnel syndrome based on electrodiagnostic study. Cross-sectional area values measured at the carpal tunnel inlet were included in the analyses. Results: Overall, 866 citations were retrieved and checked for eligibility. Finally, 16 articles were included for meta-analysis. These studies included a total sample of 2292 wrists including 776 mild, 823 moderate, and 693 severe carpal tunnel syndrome. The pooled analysis revealed a mean cross-sectional area of 11.64 mm2 (95 confidence interval = 11.23-12.05 mm(2), P < 0.001) for mild carpal tunnel syndrome, a mean cross-sectional area of 13.74mm2 (95 confidence interval = 12.59-14.89mm(2), P < 0.001) for moderate carpal tunnel syndrome, and a mean cross-sectional area of 16.80 mm2 (95 confidence interval = 14.50-19.1 mm(2), P < 0.001) for severe carpal tunnel syndrome. Conclusions: This is the first meta-analysis that provides the pooled median nerve cross-sectional area values in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. The values obtained in this study have clinical utility in ultrasonographic assessment of patients with carpal tunnel syndrome.