Article
Ultrasonography of the median nerve in patients with rheumatoid arthritis under suspicion of carpal tunnel syndrome
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Authors
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Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Herne; Ruhr-Universität Bochum, Bochum
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Efthymia Ntasiou
- Ruhr-Universität Bochum, Bochum; St. Josef-Hospital, Bochum
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Christos Krogias
- Ruhr-Universität Bochum, Bochum; St. Josef-Hospital, Bochum
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Ralf Gold
- Ruhr-Universität Bochum, Bochum; St. Josef-Hospital, Bochum
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Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne; Ruhr-Universität Bochum, Bochum
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Michael Sarholz
- St. Marien-Hospital, Vreden
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Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne; Ruhr-Universität Bochum, Bochum
| Published: | September 14, 2021 |
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Outline
Text
Objective: To investigate the performance of nerve greyscale ultrasonography (GS-US) in the diagnosis of Carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA).
Methods: Consecutive patients with active RA under suspicion of CTS presenting to our center were included. Both hands were examined by a neurologist including Electroneurography (ENG) and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG [1], and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm², moderate: 0,14-0,15 cm², severe: > 0,15 cm² CTS [2]] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms [3].
Results: Both hands of 58 patients with active RA (n=116) and suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.
The larger the cross-sectional area (CSA), the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).
In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these patients, clinical complains were more severe than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007) (Figure 1 [Fig. 1]).
Conclusion: In patients with active RA and suspicion of CTS, ultrasound provides additional information about inflammation which is helpful for its diagnosis. Thus, ENG and GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.
Disclosures: None declared
References
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