Background/Purpose: Carpal Tunnel Syndrome (CTS) is produced by the entrapment of the median nerve (MN) in the carpal tunnel. It is characterized by pain and paresthesia in the territory of MN. It is associated with diabetes mellitus, hypothyroidism, autoimmune diseases, dyslipidemia, and etc. Tinnel and Phalen maneuvers are positive in most of the patients, with a sensitivity of 70 % and 85 %, respectively. CTS diagnosis is clinical; electromyography (EMG ) with conduction velocity is considered the most objective test for the diagnosis, with sensitivity of 86 % and specificity of 95 %, ultrasound has shown an increased cross-sectional area of MN compared with healthy controls. Purpose: Correlate the clinical manifestations of patients with CTS with increased cross-sectional area of the MN and the neurophysiological findings.

Methods: analytical, longitudinal, prospective, study in which patients from the Rheumatology service of the Hospital Docente Padre Billini (HDPB) with clinical diagnosis of  CTS were selected from August to November 2014.  Ultrasound of the Carpal Tunnel was done by two rheumatologists with training in musculoskeletal ultrasound (MSU), half of the sample was evaluated by each, the result was considered pathological if they both agreed. An ultrasound SIEMENS model Acuson X150 with 13 MHz transducer was used in the study. Ultrasound images of longitudinal and transverse carpal tunnel cuts were taken and MN circumference was measured in cross section, considering a normal circumference of the MN of 10mm2. Other variables taken in consideration: sex, age, co morbidities and positive maneuvers. The diagnosis was confirmed by EMG; those patients with no EMG were excluded. The descriptive analysis was done with frequencies and percentages for categorical variables and measures of central tendency and dispersion for the number using SPSS Statistics (v20.x86). The study was approved by the ethics committee.

Results: Of a sample of 62 patients, 52 were included in the study. 51 (98.1%) were females, with a median of age of 55.2 years; 13.5% of the patients were diabetic; 13.5% had hypothyroidism; 9.6%  autoimmune disease; 5.8% suffered dislipaemias; and the remaining 57.7% had no co morbidities. On physical examination, Tinel and Phalen maneuvers were positive with percentages of 90.4% and 75% respectively.  As for the MN diameter, 51 patients (98.1%) had an enlarged MN circumference (>10mm²), 90.4% bilateral. With a median 15.3mm² for the right MN and 13.9mm² for the left MN all the patients had EMG study compatible with the syndrome.  

Conclusion: The ultrasonographic results of patients with CTS in the rheumatology service of the HDPB showed that the cross-sectional diameter of the MN is increased in a high percentage of the patients, and this findings are related with clinical and EMG diagnostics. We conclude that ultrasound is a very useful diagnostic tool as reported in the literature.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-ultrasonographic-and-neurophysiological-correlation-of-patients-with-carpal-tunnel-syndrome-in-santo-domingo-dominican-republic/