Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Carpal tunnel syndrome (CTS) is a common neuropathy affecting the median nerve. CTS occurs more frequently in inflammatory arthropathies, such as rheumatoid arthritis (RA). This may relate to the presence of tenosynovitis in the wrist. Patients with tenosynovitis might be better treated conservatively with a diagnostic rheumatological consultation and other non-surgical methods, such as a glucocorticoid injection. However, flexor tenosynovitis at carpal tunnel level is not always easy to detect at clinical examination, but may be detected reliably by ultrasonography (US). Our aim was to determine the presence of tensynovitis detected at US in idiopathic CTS patients referred for surgery and to compare this with the peroperative evaluation and histological findings.
Methods:
The wrists of 34 consecutive idiopathic CTS patients, with an indication for carpal tunnel release, were assessed before surgery with greyscale US (GSUS) and power Doppler US (PDUS) at the volar aspect of the wrist. Flexor tenosynovitis was scored according OMERACT US definitions. During surgery, tenosynovitis was evaluated by the surgeon according to a three-grade tenosynovitis classification system. Biopsy specimens were obtained in 28 patients; tenosynovitis was scored histologically by a pathologist according to a three-grade scoring system.
Results:
US Tenosynovitis was detected in 59% of the patients. Peroperative, surgical tenosynovitis was detected in 88% of the patients. The pathologist found minor tenosynovitis in 17% of the patients, while 79% showed reactive changes. (Table 1) The agreement between the respective modalities is presented in tables 2 and 3.
Conclusion:
In idiopathic CTS patients undergoing surgery, frequently tenosynovial changes are found at US and surgical evaluation, but histology did not confirm this entirely. Tenosynovitis was seen, histologically, in only a minority of all cases. However, reactive changes can be observed in a large number of cases and this could also be the basis of the surgical and ultrasonographic findings. The exact definition of tenosynovitis in these three modalities needs further investigation.
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Table 1 Prevalence of tenosynovitis |
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US |
Surgery |
Histology |
|
TS + |
59% |
46% |
17% |
|
TS +/- |
N.A. |
42% |
79% |
|
TS – |
41% |
12% |
4% |
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– TS: Tenosynovitis – For surgery and histology TS +/- is grade 1 |
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Table 2. Comparison US-Surgery |
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Surgery |
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|
US |
|
TS+ |
TS – |
|
|
TS+ |
17 |
3 |
20 |
|
|
TS- |
13 |
1 |
14 |
|
|
|
30 |
4 |
34 |
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Surgical TS: Grade 1 + grade 2. Histological TS: Grade 2 (expert opinion) |
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Table 3. Comparison US-Histology |
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Histology |
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US |
|
TS+ |
TS – |
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|
TS+ |
4 |
12 |
16 |
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|
TS- |
1 |
11 |
15 |
|
|
|
5 |
23 |
28 |
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Surgical TS: Grade 1 + grade 2. Histological TS: Grade 2 (expert opinion) |
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Disclosure:
D. F. Ten Cate,
None;
N. Glaser,
None;
J. J. Luime,
None;
K. H. Lam,
None;
J. W. G. Jacobs,
None;
R. W. Selles,
None;
J. Hazes,
None;
M. Bertleff,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tenosynovitis-in-carpal-tunnel-syndrome-prevalence-and-comparison-between-ultrasonography-surgery-and-histology/