Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 13;11(12):3374.
doi: 10.3390/jcm11123374.

Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes

Bianka Heiling  1   2 , Leonie I E E Wiedfeld  1 , Nicolle Müller  3 , Niklas J Kobler  1 , Alexander Grimm  4 , Christof Kloos  3 , Hubertus Axer  1
Affiliations

Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes

Bianka Heiling et al. J Clin Med. .

Abstract

In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm2 in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia.

Keywords: carpal tunnel syndrome; diabetes mellitus; nerve conduction study; peripheral nerve ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Nerve conduction studies and peripheral nerve ultrasound of the median nerve at the wrist. (A) Placement of electrodes. (B) Motor nerve conduction study. (C) Sensory nerve conduction study. (D) Normal cross-sectional area (CSA) of the median nerve. (E) Increased CSA of the median nerve. Abbreviations: CMAP, compound motor action potential; CSA, cross-sectional area; DML, distal motor latency; SNAP, sensory nerve action potential.
Figure 2
Figure 2
Nerve conduction studies of the median nerve. (A) Scatter plot of sensory nerve conduction velocity and distal motor latency. (B) Histogram of distal motor latencies. (C) Box plots of distal motor latencies in patients with and without CTS symptoms. (D) Box plots of distal motor latencies in patients with and without diabetic polyneuropathy.
Figure 3
Figure 3
Peripheral nerve ultrasound measurements of the median nerve at the wrist. (A) Histogram of the CSA at the wrist. (B) Histogram of the wrist-to-forearm-ratio. (C) Box plots of median nerve CSA at the wrist in patients with and without CTS symptoms and patients with and without diabetic polyneuropathy. (D) Box plots of wrist-to-forearm-ratio in patients with and without CTS symptoms and patients with and without diabetic polyneuropathy.
Figure 4
Figure 4
Scatterplots of distal motor latencies and peripheral nerve ultrasound measurements. (A) Distal motor latencies and median nerve CSA at the wrist. (B) Distal motor latencies and wrist-to-forearm-ratio.
Figure 5
Figure 5
ROC curve analysis shows that DML, median nerve CSA at the wrist, and wrist-to-forearm-ratio were not suited to distinguish between diabetic patients with and without symptoms for CTS.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zimmerman M., Gottsäter A., Dahlin L.B. Carpal Tunnel Syndrome and Diabetes—A Comprehensive Review. J. Clin. Med. 2022;11:1674. doi: 10.3390/jcm11061674. - DOI - PMC - PubMed
    1. De Krom M.C., Kester A.D., Knipschild P.G., Spaans F. Risk Factors for Carpal Tunnel Syndrome. Am. J. Epidemiol. 1990;132:1102–1110. doi: 10.1093/oxfordjournals.aje.a115753. - DOI - PubMed
    1. Gül Yurdakul F., Bodur H., Öztop Çakmak Ö., Ateş C., Sivas F., Eser F., Yılmaz Taşdelen Ö. On the Severity of Carpal Tunnel Syndrome: Diabetes or Metabolic Syndrome. J. Clin. Neurol. 2015;11:234–240. doi: 10.3988/jcn.2015.11.3.234. - DOI - PMC - PubMed
    1. Chen L.-H., Li C.-Y., Kuo L.-C., Wang L.-Y., Kuo K.N., Jou I.-M., Hou W.-H. Risk of Hand Syndromes in Patients with Diabetes Mellitus: A Population-Based Cohort Study in Taiwan. Medicine. 2015;94:e1575. doi: 10.1097/MD.0000000000001575. - DOI - PMC - PubMed
    1. Doughty C.T., Bowley M.P. Entrapment Neuropathies of the Upper Extremity. Med. Clin. N. Am. 2019;103:357–370. doi: 10.1016/j.mcna.2018.10.012. - DOI - PubMed