B-Mode and Power Doppler Assessment As Predictors for Short and Long-Term Clinical Outcome in Cts Patients with or without Surgical Treatment

Alexander Marschall¹, Anja Ficjian¹, Martin Stradner¹, Rusmir Husic¹, Dorothea Zauner², Werner Seel³, Nicole E. Simmet³, Alexander Klammer¹, P Heizer⁴, Kerstin Brickmann¹, Judith Gertler¹, Florentine Fürst¹, René Thonhofer¹, Josef Hermann², Winfried B. Graninger⁵, Stefan Quasthoff⁴ and Christian Dejaco¹, ¹Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria, ²Internal Medicine, Medizinische Universitätsklinik, Graz, Austria, ³Neurology, Medical University Graz, Graz, Austria, ⁴Department of Neurology, Medical University Graz, Graz, Austria, ⁵Internal Medicine/Rheumatology, Medical University Graz, Graz, Austria

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Carpal tunnel syndrome, outcomes, Preoperative, prognostic factors and ultrasound

Session Information

Date: Sunday, November 8, 2015

Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: To investigate the prognostic value of baseline B-mode and Power Doppler (PD) ultrasound assessment of the median nerve in CTS patients with or without surgical treatment, regarding their short and long-term clinical outcomes.

Methods: Prospective study on 135 patients with suspected CTS, undergoing baseline and two follow-up visits after 3 and 28 months. Clinical, neurophysiological (NCS) and sonographic evaluation was performed at each visit. Cross-sectional Areas (CSA) were sonographically measured at 4 levels at forearm and wrist, and CSA wrist-to-forearm ratios were calculated. PD-signals were subjectively graded from 0-3. Clinical outcomeswere evaluated using the Boston-Questionnaire, DASH-Questionnaire, as well aspatient’s assessment of pain and physicians’ global assessment according to visual analogue scales (painVAS, physVAS). We conducted multivariate logistic regression models to determine the predictive values of baseline CSA and PD assessments.

Results: Short-term Follow-up visit was completed by 111 Patients and 105 Patients were available for long-term follow-up. At 3 months, 121 wrists (in 80 Patients) have received the final diagnosis of CTS. 13 and 10 CTS Patients showed improvement regarding their BQ at short-term and long-term follow-up, respectively. According to regression analysis, we found that CSA, measured at the level of the Carpal Tunnel inlet, predicted short-term clinical improvement (≥25% according to BQ) in the subgroup of CTS patients undergoing carpal tunnel surgery (OR 1.842, p < 0.05), but not in patients treated conservatively (p=0.804). CSA or PD assessmentsdid not predict short-term improvement of painVAS, physVAS or DASH, and none of the ultrasound parameters was useful for the prediction of long-term clinical outcomes.

Conclusion: Ultrasound assessment of the median nerve CSA is of limited value to predict short-term clinical outcomes of CTS patients undergoing carpal tunnel release, whereas long-term outcomes are not predicted by sonography results.

Disclosure: A. Marschall, None; A. Ficjian, None; M. Stradner, None; R. Husic, None; D. Zauner, None; W. Seel, None; N. E. Simmet, None; A. Klammer, None; P. Heizer, None; K. Brickmann, None; J. Gertler, None; F. Fürst, None; R. Thonhofer, None; J. Hermann, None; W. B. Graninger, None; S. Quasthoff, None; C. Dejaco, None.

To cite this abstract in AMA style:

Marschall A, Ficjian A, Stradner M, Husic R, Zauner D, Seel W, Simmet NE, Klammer A, Heizer P, Brickmann K, Gertler J, Fürst F, Thonhofer R, Hermann J, Graninger WB, Quasthoff S, Dejaco C. B-Mode and Power Doppler Assessment As Predictors for Short and Long-Term Clinical Outcome in Cts Patients with or without Surgical Treatment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/b-mode-and-power-doppler-assessment-as-predictors-for-short-and-long-term-clinical-outcome-in-cts-patients-with-or-without-surgical-treatment/. Accessed .

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