Preliminary Diagnosis: Carpal tunnel syndrome

I. What imaging technique is first-line for this diagnosis?

Ultrasound

II. Describe the advantages and disadvantages of this technique for diagnosis of carpal tunnel syndrome.

Advantages

  • Most sensitive and specific modality used to diagnosis carpal tunnel syndrome

  • All structures contained in the carpal tunnel are easily visualized with ultrasound.

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  • May use Doppler to identify vascular structures (e.g., persistent median artery causing carpal tunnel syndrome)

  • Cost-effective imaging method

  • Painless and therefore could be considered in children and patients who refuse electromyography, the gold standard test to diagnosis carpal tunnel syndrome

Disadvantages

  • Operator dependent requiring an examiner who is properly trained

III. What are the contraindications for the first-line imaging technique?

None

IV. What alternative imaging techniques are available?

MRI with postcontrast sequences

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of carpal tunnel syndrome.

MRI with postcontrast sequences
Advantages

  • Superior in demonstrating pathologic changes of soft tissue. It is usually reserved for cases in which the presentation is atypical, such as suspected carpal tunnel mass, recurrent carpal tunnel syndrome after retinacular release, or the possibility of another cause not diagnosed on ultrasound test as bone abnormalities.

Disadvantages

  • Has poor specificity and varying sensitivity

  • Expensive

  • Time-consuming

VI. What are the contraindications for the alternative imaging techniques?

MRI with postcontrast sequences

  • Contraindicated in patients with non-MR-compatible foreign bodies or metallic hardware

  • IV contrast requires that the patient have good renal function.

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