Article

Suspected carpal tunnel syndrome (CTS) remains the most common
clinical scenario prompting referral for electrodiagnostic (EDx) studies to
identify objective correlates of reported subjective symptoms and clinical
examination findings. Despite much debate and a rapidly expanding literature,
identification of an optimal algorithm for diagnosing focal median mononeuropathy
at the wrist (FMMW) associated with CTS signs and symptoms remains elusive. The
introduction and rapid dissemination of peripheral nerve ultrasound imaging
(PN-USI) of the median nerve has raised new questions regarding the relative
value of structural information from PN-USI versus physiological information from
EDx in the diagnosis of FMMW, as well as the significance of various clinical
signs and symptoms suggestive of CTS. The means by which PN-USI and EDx may be
optimally deployed and integrated in the process of diagnosing FMMW remains to be
clearly delineated. OBJECTIVE: To complete an analytical literature review to
guide the formulation of a clinical diagnostic algorithm (CDA) integrating the
use of PN-USI and EDx for the optimal detection of FMMW in the context of making
a clinical diagnosis of CTS. DATA SOURCES: A structured literature review was
performed on the MEDLINE medical literature database accessed through PubMed.
ANALYSIS: Papers with particular relevance and connection to the goal of
formulating the CDA were selected from the identified studies. Studies
specifically examining the correlations between systematically documented
clinical symptomatology, EDx findings, and PN-USI findings were reviewed for
consistent outcomes that could be incorporated into a CDA to guide the
integration of these two complementary technologies in the diagnostic process.
LIMITATIONS: The formulation of the algorithm was limited to measures with
established validity that can be readily obtained by means of widely accepted
protocols using standard EDx and ultrasound equipment. The formulated algorithm
assumes a consistent association between pathophysiology and anatomical
deformation of the median nerve, which may not occur in certain situations. It
may also not be as accurately applied to patients with CTS with significant
comorbid neuromuscular conditions. CONCLUSIONS: An algorithm has been developed
and presented, and illustrated as a flow chart, based on findings reported in the
relevant reviewed literature in which PN-USI is proposed as a painless and
rapidly performed screening test for FMMW to be completed before subjecting a
patient to a systematic EDx testing process.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS