Ultrasound imaging in CTS

The use of high resolution ultrasound imaging to study the median nerve in carpal tunnel syndrome is relatively new. The earliest good quality paper of which I am aware was published less than 25 years ago (Buchberger 1992) and most studies have appeared since 2000. This is partly driven by the technology itself. Only recently have ultrasound scanners been able to produce images of the requisite quality and, perhaps more importantly, only recently have they become cheap enough for this imaging modality to be widely used by non-specialists. We have been carrying out ultrasound studies on some of our patients at Canterbury and at Kings College since 2007 and have examined over 1000 subjects with suspected carpal tunnel syndrome as well as a variety of other nerve disorders.

A ten year history of widespread scientific investigation is still 'early days' and as yet the final role of ultrasound imaging in CTS has not been firmly established. As with most new medical technologies the early adopters of a technique tend to be enthusiastic about it and several authors have claimed that ultrasound can either wholly or partly replace nerve conduction studies in the investigation of CTS (El Miedany 2004, Ziswiler 2005). Such apostolic zeal seems a little premature and often results from a misapprehension or over-simplification of what NCS are for (see the section on nerve conduction studies here). One of the manufacturers, Sonosite, have provided a very useful video introduction to the ultrasonographic anatomy of carpal tunnel syndrome. (This video now seems to have been taken down - I will try to find another)

There are a variety of issues to address:

What to measure and how?

What are the ultrasound changes in carpal tunnel syndrome?

How do the ultrasound images change after treatment?

What does ultrasound tell you about severity and prognosis?

How frequently does ultrasound reveal extra information which alters treatment?

What else can be seen with the ultrasound scanner?

Ultrasound imaging in other peripheral nerve disorders

Although this site is primarily dedicated to carpal tunnel syndrome, as a result of using ultrasound imaging for CTS I have become interested in the use of this technique for other peripheral nerve disorders and I am therefore developing some pages of this site devoted to imaging other nerves.

Revision date - 3rd May 2016

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