Ultrasound Findings in Patients with Isolated Cervical Radiculopathy with Carpal Tunnel Syndrome like presentation
Gloria Sanin, BS; John R. Fowler, MD
University of Pittsburgh Medical Center, Pittsburgh, PA
Carpal tunnel syndrome (CTS) and cervical radiculopathy (CR) are two of the most common compression neuropathies of the upper extremity. While the etiology of these two syndromes is a consequence of nerve compression at different levels in the upper extremity, in certain instances, CR can mimic the clinical presentation of CTS, which necessitates precise tools for differentiating these two syndromes in a clinical setting.
Traditionally, electrodiagnostic nerve studies have been used as the gold standard for confirmatory diagnosing of CTS. More recently, it has been shown that ultrasound testing can have high sensitivity and specificity when clinical presentation is used as the reference standard.
Using ultrasound, swelling of the median nerve in CTS can be quantified by obtaining the cross-sectional area and swelling ratio. In the case of isolated CR, where compression of a nerve occurs at the cervical level, swelling of the median nerve at the level of the wrist, a key finding of CTS, is not expected. With our study, we will investigate whether ultrasound testing can be implemented in the diagnosis of isolated CR to reduce and/or replace the use of nerve studies by providing an alternative that is more comfortable, accurate, and cost-effective.
Patients with isolated CR as diagnosed by board certified orthopedic surgeons and PMNR physicians were prospectively enrolled and place in the study group (n=25). The main exclusion criterion were individuals having significant comorbidities, pregnancy, previous neck/carpal tunnel release surgery, pronator teres entrapment, and CTS. All patients enrolled were age matched to individuals with diagnosed CTS as part of the control group. In the clinic setting, ultrasound studies of the wrist were performed to obtain the cross-sectional area (CSA) of the median nerve. Each measurement was performed 3 times and these values were averaged. Based on previous studies, a cross-sectional area of ?10 mm2 was used as indication of median nerve swelling. Additionally, measurements of the median nerve CSA on the unaffected arm were recorded to account for any individual-specific variations in their CSA.
Preliminary results indicate that ultrasound studies may represent a different and superior alternative in the diagnosis of CR in patients whose presentation mimics CTS.
Our data suggests that ultrasound studies can potentially be implemented as a diagnostic tool for CR that is a superior alternative in areas such as cost, accessibility and practicality.
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