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Sonography of the Median Nerve in Carpal Tunnel Syndrome with Diabetic Neuropathy

Kim, Li-Na, MD; Kwon, Hee-Kyu, MD, PhD; Moon, Hyun-Im, MD; Pyun, Sung-Bum, MD, PhD; Lee, Hang-Jae, MD

American Journal of Physical Medicine & Rehabilitation: October 2014 - Volume 93 - Issue 10 - p 897–907
doi: 10.1097/PHM.0000000000000084
CME Article . 2014 Series . Number 6
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CME

Objective The aim of this study was to determine the criteria for ultrasonographic measurement of the cross-sectional area (CSA) of the median nerve and differential diagnosis of patients with carpal tunnel syndrome (CTS) with or without diabetic polyneuropathy (DPN).

Design One hundred eighty-seven patients were divided into five groups: healthy controls, CTS, diabetes with CTS but without DPN, DPN only, and both DPN and CTS. The CSAs of the median nerve were measured at four levels, and cutoff values to diagnose CTS with DPN were obtained.

Results All the CSAs were larger in the DPN group compared with those in the control group. The CSAs of the median nerve at the wrist revealed no significant differences among the groups with CTS; however, these groups demonstrated larger CSAs at the wrist and a higher wrist/forearm ratio compared with the DPN only group. The cutoff value for the CSA at the wrist that yielded the highest sensitivity and specificity was 11.6 mm.

Conclusions The CSA of the median nerve at the wrist and the wrist/forearm ratio could be useful for diagnosing the comorbidity of CTS with DPN.

From the Department of Physical Medicine & Rehabilitation, Sahmyook Medical Center, Seoul, Republic of Korea (L-NK); Department of Physical Medicine & Rehabilitation, College of Medicine, Korea University, Seoul, Republic of Korea (H-KK, H-IM, S-BP); and Department of Physical Medicine & Rehabilitation, College of Medicine, Bundang CHA Medical Center, Sungnam City, Gyeonggi Province, Republic of Korea (H-JL).

All correspondence and requests for reprints should be addressed to: Hee-Kyu Kwon, MD, PhD, Department of Physical Medicine & Rehabilitation, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea.

Supported by Korea University Grant. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins