Ahmed A. Zaher¹, Mohamed AbdelBari Mattar¹,

Mohamed Gomaa², Ashraf Ahmed Zaher²

Departments of Neurosurgery¹, Neurology²; Mansoura University; Egypt

Background: Carpal tunnel syndrome (CTS) is the commonest entrapment syndrome of the upper extremities responsible for considerable patient suffering and governmental cost. Objective: To compare the diagnostic accuracy of various tests used in the diagnosis of CTS and to determine the properties of the most accurate one. Methods: Fifty two cases of clinically established unilateral CTS were subjected to three different investigation modalities before surgical intervention (Electro-diagnostic Studies, MRI and U/S). All patients underwent the open surgical technique for flexor carpal ligament release and they were followed up for a period not less than 12 weeks post-operatively. Results: The study included fifty two patients. The clinical presentations include paresthesia or pain in 52 (100%), Phalen’s signs in 45 (86.5%) and Tinel’s signs in 43 (82.6%). Electro-diagnostic examination was positive in 17 (85%), MRI in 10 (100%), and Ultrasonography in 19 (86.3%). All patients underwent the standard open surgical technique for carpal tunnel release. All surgeons were blinded to the results of investigations done, however not for patient’s symptoms or signs. They all reported positively presence of median nerve compression under the transverse carpal ligament with its relative thickening during its intraoperative exposure. Thirty seven (71.1%) patients reported complete remission of previous symptomatology, while the rest fifteen (28.8%) patients showed marked amelioration of their complaint. Conclusion: Ultrasound is superior to other investigation tools as it provides accurate and rapid diagnosis of CTS with the least cost. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(4): 375-380]

Key Words: Carpal tunnel syndrome, Electro-diagnostic studies, MRI, Ultrasound.