Ultrasound, Clinical, and Electrophysiological Findings in Persistent Carpal Tunnel Syndrome

Abstract

Background and purpose: We present the clinical, electrophysiological, and nerve ultrasound findings in cases of persistent carpal tunnel syndrome (PCTS).

Methods: Eighteen PCTS patients underwent evaluation with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), electrophysiology, and nerve ultrasound with a mean of 3.5 months (SD ± 1.4) after open surgery.

Results: PCTS patients showed a mean symptom severity scale score of 3.1 (SD ± 1.1) and functional severity scale score of 3.2 (SD ± 0.9) in BCTSQ. Nerve conduction studies revealed axonal affection of the median nerve in 13/18 patients, ultrasound showed disturbed echogenicity in all patients, a pathological wrist to forearm ratio in 16/18 patients, and cross-sectional area enlargement of the median nerve at the distal wrist crease in 12/18 patients. Ultrasound documented scar tissue formation (in 12/18 patients), incomplete release of retinaculum flexorum (in 4/18 patients), and neuroma of the median nerve (in 2/18 patients) as PCTS cause.

Conclusion: Our data show significant functional disability, axonal nerve damage, and scar tissue formation as common PCTS causes.

Keywords: Boston Carpal Tunnel Questionnaire; Persistent carpal tunnel syndrome; cross-sectional area; electrophysiology; nerve ultrasound.