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January 22/29, 2003

Splinting vs Surgery for Carpal Tunnel SyndromeSplinting vs Surgery for Carpal Tunnel Syndrome

JAMA. 2003;289(4):420-423. doi:10.1001/jama.289.4.420-a

To the Editor: In their study, Dr Gerritsen and colleagues1 confirmed the diagnosis of CTS with electrophysiological testing. It is possible, however, that discrepancies between functional nerve conduction studies and structural imaging techniques may predict response to conservative or surgical treatment. It appears that conventional sonography has less sensitivity than nerve conduction studies (0.70 vs 0.98, respectively), but greater specificity (0.63 vs 0.19, respectively).2 Inclusion of sonographic measurement of the median nerve cross-sectional area performs even better, with sensitivity as high as 89% and a specificity of 83%.3 Higher ultrasound frequencies (≤15 MHz) allow excellent resolution for differentiation of mild nerve alterations.4 Addition of color Doppler sonography could further help in delineation of an underlying inflammatory process.