Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010773. Online ahead of print.
ABSTRACT
BACKGROUND: It remains unclear if physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index (BMI) on CTS severity is not well characterized.
METHODS: Unilateral and bilateral CTS patients were seen from October 2014-February 2021. Obese and non-obese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6 measures were obtained. NCS recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used the Wilcoxon signed-rank testing for paired continuous variables, Mann-Whitney U testing for non-paired continuous variables, and chi-squared for continuous variables with a significance level of p < 0.05.
RESULTS: 109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score (p < 0.0001), CTS-6 score (p < 0.0001), DML (p < 0.0001), and DSL (p < 0.01). Bilateral patients also had higher symptom severity scale (p < 0.01) and DSL (p < 0.001) outcomes compared to unilateral. Obese patients had higher median nerve CSA (p < 0.01), prolonged DML, and DSL (p < 0.0001) values despite similar CTS severity (BCTSQ, CTS-6).
CONCLUSIONS: Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS, BCTSQ). Obesity increases median nerve CSA and prolongs NCS without influencing CTS severity. This information can be utilized when considering which diagnostic testing to order for CTS.
LEVEL OF EVIDENCE: Level 3 Diagnostic.
PMID:37257136 | DOI:10.1097/PRS.0000000000010773
