The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study

ObjectivesTo investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).MethodsProspective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.ResultsShort-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.ConclusionsUltrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.研究目的：探讨正中神经B型超声及能量多普勒（Power Doppler, PD）超声对腕管综合征（carpal tunnel syndrome, CTS）患者短期与长期临床结局的预测价值。 研究方法：本研究为前瞻性研究，纳入135例疑似腕管综合征患者，分别于基线期、短期随访（3个月）及长期随访（15~36个月）时完成3次评估。基线期采用超声于前臂及腕部的4个解剖层面测量正中神经横截面积（cross-sectional area, CSA），并对PD信号进行半定量分级（0~3分）。每次随访均通过波士顿问卷（Boston Questionnaire, BQ）、DASH问卷评估临床结局，同时采用视觉模拟评分量表分别记录患者疼痛评估结果（painVAS）及医师整体评估结果（physVAS）。采用多因素logistic回归模型分析基线期CSA及PD信号对临床结局的预测价值。 研究结果：最终共有111例（82.2%）患者获得短期随访数据，105例（77.8%）患者获得长期随访数据。最终确诊为腕管综合征的患者共84例，累及125只腕关节。回归分析结果显示，在接受腕管手术治疗的CTS患者中，腕管入口处测量的CSA可依据BQ评分预测其短期临床改善情况（比值比OR=1.8，P=0.05），但该相关性未在保守治疗患者中体现。无论是CSA还是PD超声评估，均无法预测painVAS、physVAS或DASH评分的短期改善情况；且上述超声参数均无法有效预测长期临床结局。 结论：腕管入口处正中神经的超声评估可预测接受腕管松解术的CTS患者的短期临床改善情况，但长期临床结局与超声检查结果无关联。