Abonnement à la biblothèque: Guest
Portail numérique Bibliothèque numérique eBooks Revues Références et comptes rendus Collections
Critical Reviews™ in Biomedical Engineering
SJR: 0.26 SNIP: 0.375 CiteScore™: 1.4

ISSN Imprimer: 0278-940X
ISSN En ligne: 1943-619X

Volume 48, 2020 Volume 47, 2019 Volume 46, 2018 Volume 45, 2017 Volume 44, 2016 Volume 43, 2015 Volume 42, 2014 Volume 41, 2013 Volume 40, 2012 Volume 39, 2011 Volume 38, 2010 Volume 37, 2009 Volume 36, 2008 Volume 35, 2007 Volume 34, 2006 Volume 33, 2005 Volume 32, 2004 Volume 31, 2003 Volume 30, 2002 Volume 29, 2001 Volume 28, 2000 Volume 27, 1999 Volume 26, 1998 Volume 25, 1997 Volume 24, 1996 Volume 23, 1995

Critical Reviews™ in Biomedical Engineering

DOI: 10.1615/CritRevBiomedEng.2020030827
pages 457-471

Diagnostic and Research Techniques in Carpal Tunnel Syndrome

Amanda Farias Zuniga
Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
Peter J. Keir
McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada


Carpal tunnel syndrome is the most common neuropathy, costing upward of $2B USD annually in North America. Carpal tunnel syndrome is a result of chronic trauma to the median nerve, resulting in nerve damage, decreased conductivity of nerve impulses, and ultimately presents with clinical symptoms such as pain, tingling, numbness, and thumb muscle atrophy in severe cases. Although patient history, symptoms, and a nerve conduction study are the primary diagnosis tools, there are several techniques and tools that may be used to assess carpal tunnel syndrome and characterize the condition. The purpose of this critical review is to discuss the multitude of techniques that can be applied to study carpal tunnel syndrome, including Phalen's and Tinel's tests, nerve conduction study, Semmes-Weinstein monofilaments, laser Doppler flowmetry, pressure catheters, and ultrasound and magnetic resonance imaging. Additionally, this review discusses the reliability, sensitivity, and accuracy of these methods. A combination of these techniques may ultimately improve the accuracy in diagnosing carpal tunnel syndrome, especially in cases where nerve conduction study results are borderline or inconclusive by analyzing other aspects that may differently contribute to the development of carpal tunnel syndrome.


  1. Kamolz LP, Schrogendorfer KF, Rab M, Girsch W, Gruber H, Frey M. The precision of ultrasound imaging and its relevance for carpal tunnel syndrome. Surg Radiol Anat. 2001;23(2):117-21. .

  2. Manktelow RT, Binhammer P, Tomat LR, Bril V, Szalai JP. Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers. J Hand Surg Am. 2004; 29(2):307-17. .

  3. Stapleton MJ. Occupation and carpal tunnel syndrome. ANZ J Surg. 2006;76(6):494-6. .

  4. Giersiepen K, Spallek M, Kao SY, Giersiepen K, Spallek M, Kao SY, Giersiepen K, Spallek M. Carpal tunnel syndrome as an occupational disease. J Am Board Fam Pr [Internet]. 2003;108(6):238-42. .

  5. Newington L, Harris CE, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015;29:440-53. .

  6. Aroori S, Spence RAJ. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17. .

  7. Keir PJ, Farias Zuniga A, Mulla DM, Somasundram KG. Relationships and mechanisms between occupational risk factors and distal upper extremity disorders. Hum Factors. 2019. doi: 10.1177/0018720819860683. .

  8. Harris-Adamson C, Eisen EA, Dale AM, Evanoff B, Hegmann KT, Thiese MS, Kapellusch JM, Garg A, Burt S, Bao S, Silverstein B, Gerr F, Merlino L, Rempel D. Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort. Occup Environ Med. 2013;70(8):529-37. .

  9. Nathan PA, Meadows KD, Istvan JA. Predictors of carpal tunnel syndrome: an 11-year study of industrial workers. J Hand Surg Am. 2002;27A:644-51. .

  10. Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JAC. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol. 2002;113(9):1429-34. .

  11. Diao E, Shao F, Liebenberg E, Rempel DM, Lotz JC. Carpal tunnel pressure alters median nerve function in a dose-dependent manner: a rabbit model for carpal tunnel syndrome. J Orthop Res. 2005;23(1):218-23. .

  12. Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. Ultrasound Med Biol. 2011;37(10):1539-53. .

  13. Evans KD, Volz KR, Hutmire C, Roll SC. Morhphologic characterization of intraneural flow associated with median nerve pathology. J Diagn Med Sonogr. 2012; 28(1):11-9. .

  14. Evans KD, Roll SC, Volz KR, Freimer M. Relationship between intraneural vascular flow measured with sonography and carpal tunnel syndrome diagnosis based on electrodiagnostic testing. J Ultrasound Med. 2012;31:729-36. .

  15. Bilkis S, Loveman DM, Eldridge JA, Ali SA, Kadir A, McConathy W. Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome. Arthritis Care Res. 2012;64(2):287-9. .

  16. Marx RG, Hudak PL, Bombardier C, Graham B, Goldsmith C, Wright JG. The reliability of physical examination for carpal tunnel syndrome. J Hand Surg Br. 1998;23(4):499-502. .

  17. Szabo RM, Gelberman RH, Dimick MP. Sensibility testing in patients with carpal tunnel syndrome. J Bone Jt Surg. 1984;66-A(1):60-4. .

  18. Heckel A, Weiler M, Xia A, Ruetters M, Pham M, Bendszus M, Heiland S, Baeumer P. Peripheral nerve diffusion tensor imaging: assessment of axon and myelin sheath integrity. PLoS One. 2015;10(6):e0130833. .

  19. Gooch CL, Weimer LH. The electrodiagnosis of neuropathy: basic principles and common pitfalls. Neurol Clin. 2007;25(1):1-28. .

  20. Kim DK, Kim BS, Kim MJ, Kim KH, Park BK, Kim DH. Electrophysiologic and ultrasonographic assessment of carpal tunnel syndrome in wheelchair basketball athletes. Ann Rehabil Med. 2017;41(1):58-65. .

  21. Kilmer DD, Davis BA. Electrodiagnosis in carpal tunnel syndrome. Hand Clin. 2002;18(2):243-55. .

  22. Aminoff MJ. Nerve conduction studies. In: Aminoff's electrodiagnosis in clinical neurology. 6th ed. New York: Elsevier; 2012. p. 243. .

  23. Stevens JC. AAEM minimonograph 26: the electro-diagnosis of carpal tunnel syndrome. Muscle Nerve. 1997;20(12):1477-86. .

  24. Padua L, Valente EM, Tonali PA. A useful electrophyisologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve. 1996;19:48-53. .

  25. Chen Y-T, Williams L, Zak MJ, Fredericson M. Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med. 2016;(2):2311-24. .

  26. Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, Zimmermann K, Dillingham TR. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;(54):371-7. .

  27. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology. 2004;43(7):887-95. .

  28. Redmond MD, Rivner M. False positive electrodiagnostic tests in carpal tunnel syndrome. Muscle Nerve. 1988;11:511-7. .

  29. Dillingham TR, Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, Zimmermann K, Yuen SO. Establishing high-quality reference values for nerve conduction studies: a report from the normative data task force of the American Association of Neuromuscular & Electrodiagnostic Medicine. Muscle Nerve. 2016;54(3):366-70. .

  30. Nathan PA, Keniston RC, Meadows KD, Lockwood RS. Predictive value of nerve conduction measurement at the carpal tunnel. Muscle Nerve. 1993;16:1377-82. .

  31. Dyck PJ, Albers JW, Wolfe J, Bolton CF, Walsh N, Klein CJ, Zafft AJ, Russell JW, Thomas K, Davies JL, Carter RE, Melton LJ, Litchy WJ. A trial of proficiency of nerve conduction: greater standardization still needed. Muscle Nerve. 2013;48(3):369-74. .

  32. Salerno DF, Werner RA, Albers JW, Becker MP, Armstrong TJ, Franzblau A. Reliability of nerve conduction studies among active workers. Muscle Nerve. 1999;22:1372-9. .

  33. Arezzo JC, Bolton CF, Boulton A, Casey KL, Dyck PJ, Cornblath D, Fields HL, Hanson P, Greenspan J, Harati Y, Jamal GA, Kenshalo DR, Light AR, O'Brien P, Ochoa J, Zimmerman I. Quantitative sensory testing: a consensus report from the Peripheral Neuropathy Association. Neurology. 1993;43:1050-2. .

  34. Bell-Krotoski JA, Fess E, Figarola J, Hiltz D. Threshold detection and Semmes-Weinstein monofilaments. J Hand Ther. 1995;8(2):155-62. .

  35. Collins S, Visscher P, De Vet HC, Zuurmond WWA, Perez RSGM. Reliability of the Semmes Weinstein monofilaments to measure coetaneous sensibility in the feet of healthy subjects. Disabil Rehabil. 2010;32(24):2019-27. .

  36. Werner RA, Andary M. Carpal tunnel syndrome: patho-physiology and clinical neurophysiology. Clin Neurophysiol. 2002;113(9):1373-81. .

  37. Pagel KJ, Kaul MP, Dryden JD. Lack of utility of Semmes-Weinstein monofilament testing in suspected carpal tunnel syndrome. Am J Phys Med Rehabil. 2002;81(8):597-600. .

  38. Yildirim P, Gunduz OH. What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome? J Phys Ther Sci. 2015;27:3749-53. .

  39. Motomiya M, Funakoshi T, Ishizaka K, Nishida M, Matsui Y, Iwasaki N. Blood flow changes in subsynovial connective tissue on contrast-enhanced ultrasonography in patients with carpal tunnel syndrome before and after surgical decompression. J Ultrasound Med. 2018;37(7):1597-604 .

  40. Gelberman RH, Hergenroeder P, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel: a study of carpal canal pressures. J Bone Jt Surg. 1981;63A(3):380-3. .

  41. Rojviroj S, Sirichativapee W, Kowsuwon W, Wongwiwattananon J, Tamnanthong N, Jeeravipoolvarn P. Pressures in the carpal: a comparison between patients with carpal tunnel syndrome and normal subjects. J Bone Jt Surg. 1990;72B(3):516-8. .

  42. Szabo RM, Chidgey LK. Stress carpal tunnel pressures in patients with carpal tunnel syndrome and normal patients. J Hand Surg Am. 1989 Jul;14(4):624-7. .

  43. Thurston A, Krause B. The possible role of vascular congestion in carpal tunnel syndrome. J Hand Surg. 1988;13B(4):397-9. .

  44. Werner RA, Armstrong TJ, Bir C, Aylard MK. Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clin Biomech. 1997;12(1):44-51. .

  45. Werner C-O, Elmqvist D, Ohlin P. Pressure and nerve lesion in the carpal tunnel. Acta Orthop Scand. 1983;54:312-6. .

  46. Tanzer RC. The carpal tunnel syndrome: aa clinical and anatomical study. J Bone Jt Surg. 1959;41-A(4):626-34. .

  47. Luchetti R, Schoenhuber R, Alfarano M, Deluca S, De Cicco G, Landi A. Carpal tunnel syndrome: correlations between pressure measurement and intraoperative electrophysiological nerve study. Muscle Nerve. 1990;13(12):1164-8. .

  48. Weiss ND, Gordon L, Bloom T, So Y, Rempel DM. Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design. J Bone Jt Surg Am. 1995;77(11):1695-9. .

  49. Seradge H, Jia Y, Owens W. In vivo measurement of carpal tunnel pressure in the functioning hand. J Hand Surg. 1995;20A:855-9. .

  50. Rempel DM, Keir PJ, Smutz WP, Hargens A. Effects of static fingertip loading on carpal tunnel pressure. J Orthop Res. 1997;15(3):422-6. .

  51. Coppieters MW, Schmid AB, Kubler PA, Hodges PW. Description, reliability and validity of a novel method to measure carpal tunnel pressure in patients with carpal tunnel syndrome. Man Ther. 2012;17(6):589-92. .

  52. Okutsu I, Ninomiya S, Yoshida A, Hamanaka I, Kitajima I. Measurement of carpal canal and median nerve pressure in patients with carpal tunnel syndrome. Tech Hand Up Extrem Surg. 2004;8(2):124-8. .

  53. Goss BC, Agee JM. Dynamics of intracarpal tunnel pressure in patients with carpal tunnel syndrome. J Hand Surg Am. 2010;35(2):197-206. .

  54. Uchiyama S, Yasutomi T, Momose T, Nakagawa H, Kamimura M, Kato H. Carpal tunnel pressure measurement during two-portal endoscopic carpal tunnel release. Clin Biomech. 2010;25(9):893-8. .

  55. Bauman TD, Gelberman RH, Mubarak SJ, Garfin SR. The acute carpal tunnel syndrome. Clin Orthop Relat Res. 1981;156(156):151-6. .

  56. Luchetti R, Schoenhuber R, Nathan PA. Correlation of segmental carpal tunnel pressures with changes in hand and wrist positions in patients with carpal tunnel syndrome and controls. J Hand Surg Am. 1998;23B(5):598-602. .

  57. Keir PJ, Wells RP, Ranney D, Lavery W. The effects of tendon load and posture on carpal tunnel pressure. J Hand Surg. 1997;22(A):628-34. .

  58. Keir PJ, Bach JM, Rempel DM. Fingertip loading and carpal tunnel pressure: differences between a pinching and a pressing task. J Orthop Res. 1998;16(1):112-5. .

  59. McGorry RW, Fallentin N, Andersen JH, Keir PJ, Hansen TB, Pransky G, Lin JH. Effect of grip type, wrist motion, and resistance level on pressures within the carpal tunnel of normal wrists. J Orthop Res. 2014;32(4):524-30. .

  60. Gelberman RH, Szabo RM, Mortensen W. Carpal tunnel pressures and wrist position in patients with Colles' fractures. J Trauma. 1984;24(8):747-9. .

  61. Michelson G, Schmauss B, Langhans MJ, Harazny B, Groh MJM. Principle, validity, and reliability of scanning laser Doppler flowmetry. J Glaucoma. 1996;5:99-105. .

  62. Nilsson GE, Otto U, Wahlberg JE. Assessment of skin irritancy in man by laser Doppler flowmetry. Contact Dermatitis. 1982;8:401-6. .

  63. Bircher A, de Boer EM, Agner T, Wahlberg JE, Serup J. Guidelines for measurement of cutaneous blood flow by laser Doppler flowmetry. A report from the Standardization Group of the European Society of Contact Dermatitis. Contact Dermatitis. 1994;30:65-72. .

  64. Yayama T, Kobayashi S, Awara K, Takeno K, Miyazaki T, Kubota M, Negoro K, Baba H. Intraneural blood flow analysis during an intraoperative Phalen's test in carpal tunnel syndrome. J Orthop Res. 2010;28(8):1022-5. .

  65. Soejima O, Iida H, Naito M. Intraoperative assessment of median nerve blood flow during carpal tunnel release with laser Doppler flowmetry. Minim Invasive Neurosurg. 2001;44(4):202-4. .

  66. Walker FO, Cartwright MS, Wiesler ER, Caress J. Ultrasound of nerve and muscle. Clin Neurophysiol. 2004;115(3):495-507. .

  67. Shriki J. Ultrasound physics. Crit Care Clin. 2014;30:1-24. .

  68. McDicken WN, Anderson T. The difference between colour Doppler velocity imaging and power Doppler imaging. Eur J Echocardiogr. 2002;3(3):240-4. .

  69. Joy V, Therimadasamy AK, Chan YC, Wilder-Smith EP. Combined Doppler and B-mode sonography in carpal tunnel syndrome. J Neurol Sci. 2011;308:16-20. .

  70. Mallouhi A, Pultzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of grayscale and color doppler sonography. Am J Roentgenol. 2006;186(5):1240-5. .

  71. Wilson KE, Tat J, Keir PJ. Effects of wrist posture and fin-gertip force on median nerve blood flow velocity. BioMed Res Int. 2017:7156489. .

  72. Chang KV, Wu CH, Yeh TS, Wang TG, Hsiao MY, Chen WS. Application of pulsed-wave Doppler ultrasound to exploration of the peripheral vasomotor response by gender and hand dominance. J Med Ultrason. 2011;38(4):195-202. .

  73. Choo HC, Nosaka K, Peiffer JJ, Ihsan M, Yeo CC, Abbiss CR. Reliability of laser Doppler, near-infrared spectroscopy and Doppler ultrasound for peripheral blood flow measurements during and after exercise in the heat. J Sport Sci. 2017;35(17):1715-23. .

  74. R0e C, Damsgard E, Knardahl S, Damsgard E, Knardahl S, Damsgard E, Knardahl S, Damsgard E, Knardahl S. Reliability of blood flux measurements from the upper trapezius muscle during muscle contractions. Eur J Appl Physiol. 2008;102(5):497-503. .

  75. Herron R, Carter S, Collins A, Leatherwood M. Reliability of skin blood flow measures by laser-Doppler flowmetry. FASEB J. 2015;29(1):Supplement LB675. .

  76. Borire AA, Visser LH, Padua L, Colebatch JG, Huynh W, Simon NG, Kiernan MC, Krishnan AV. Utility of maximum perfusion intensity as an ultrasonographic marker of intraneural blood flow. Muscle Nerve. 2017; 55(1):77-83. .

  77. Ishizaka K, Nishida M, Motomiya M, Satoh M, Inoue M, Kudoh Y, Omotehara S, Horie T, Funakoshi T, Iwasaki N. Reliability of peripheral intraneural microhemodynamics evaluation by using contrast-enhanced ultrasonography. J Med Ultrason. 2014;41(4):481-6. .

  78. Impink BG, Gagnon D, Collinger JL, Boninger ML. Re-peatability of ultrasonographic median nerve measures. Muscle Nerve. 2010;41(6):767-73. .

  79. Edelman RR, Warach S. Magnetic resonance imaging (first of two parts). N Engl J Med. 1993;328(10):708-16. .

  80. Hashemi RH, Bradley WGJ, Lisanti CJ. MRI the Basics. 3rd ed. Philadelphia, PA: Lippincott Williams Wilkins; 2010. .

  81. Allmann KH, Horch R, Uhl M, Gufler H, Altehoefer C, Stark GB, Langer M. MR imaging of the carpal tunnel. Eur J Radiol. 1997;25:141-5. .

  82. Ikeda M, Okada M, Toyama M, Uemura T, Takamatsu K, Nakamura H. Comparison of median nerve cross-sectional area on 3-T MRI in patients with carpal tunnel syndrome. Orthopedics. 2017;40(1):e77-81. .

  83. Koh SH, Kwon BC, Park C, Hwang SY, Lee JW, Kim SS. A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome. Eur J Radiol. 2014;83(11):2065-73. .

  84. Onen MR, Kayalar AE, Ilbas EN, Gokcan R, Gulec I, Na- deri S. The role of wrist magnetic resonance imaging in the differential diagnosis of the carpal tunnel syndrome. Turk Neurosurg. 2015;25(5):701-6. .

  85. Bower JA, Stanisz GJ, Keir PJ. An MRI evaluation of carpal tunnel dimensions in healthy wrists: implications for carpal tunnel syndrome. Clin Biomech. 2006;21(8):816-25. .

  86. Horch RE, Allmann KH, Laubenberger J, Langer M, Stark GB. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery. 1997;41(1):73-6. .

  87. Kobayashi S, Meir A, Baba H, Uchida K, Hayakawa K. Imaging of intraneural edema by using gadolinium-enhanced MR imaging: experimental compression injury. Am J Neuroradiol. 2005;26(4):973-80. .

  88. Keberle M, Jenett M, Kenn W, Reiners K, Peter M, Haerten R, Hahn D. Technical advances in ultrasound and MR imaging of carpal tunnel syndrome. Eur Radiol. 2000;10(7):1043-50. .

  89. Samanci Y, Karagoz Y, Yaman M, Atfi IB, Emre U, Kilifkesmez NO, Qelik SE. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome. Clin Neurol Neurosurg. 2016;150:152-8. .

  90. Bammer R. Basic principles of diffusion-weighted imaging. Eur J Radiol. 2003;45(3):169-84. .

  91. Barcelo C, Faruch M, Lapegue F, Bayol M-A, Sans N. 3-T MRI with diffusion tensor imaging and tractography of the median nerve. Eur Radiol. 2013;23(11):3124-30. .

  92. Klauser AS, Abd Ellah M, Kremser C, Taljanovic M, Schmidle G, Gabl M, Cartes-Zumelzu F, Steiger R, Gizewski ER. Carpal tunnel syndrome assessment with diffusion tensor imaging: value of fractional anisotropy and apparent diffusion coefficient. Eur Radiol. 2018;28(3):1111-7. .

  93. Yildirim A, Bulut HT, Ekmekci B, Surucu GD, Karabiber M. Use of diffusion tensor imaging for nonsurgical treatments of carpal tunnel syndrome. Muscle Nerve. 2014;50(6):950-5. .

  94. Kremkau FW. Sonography: principles and instruments. 9th ed. St. Louis: Elsevier; 2016. .

  95. Filius A, Scheltens M, Bosch HG, Van Doorn PA, Stam HJ, Hovius SER, Amadio PC, Selles RW. Multidimensional ultrasound imaging of the wrist: changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome. J Orthop Res. 2015;33(9):1332-40. .

  96. Shen ZL, Li ZM. Ultrasound assessment of transverse carpal ligament thickness: a validity and reliability study. Ultrasound Med Biol. 2012;38(6):982-8. .

  97. Nacey NC, Pierce JL. Ultrasound imaging of the hand and wrist: fundamentals and new perspectives. Curr Radiol Rep. 2016;4:43. .

  98. Hough A. Peripheral nerve motion measurement with spectral Doppler sonography: a reliability study. J Hand Surg J Br Soc Surg Hand. 2000;25(6):585-9. .

  99. Kociolek AM, Keir PJ. Relative motion between the flexor digitorum superficialis tendon and paratenon in zone V increases with wrist flexion angle. J Orthop Res. 2016;34(7):1248-55. .

  100. Oh S, Belohlavek M, Zhao C, Osamura N, Zobitz ME, An K-N, Amadio PC. Detection of differential gliding characteristics of the flexor digitorum superficialis tendon and subsynovial connective tissue using color doppler sonographic imaging. J Ultrasound Med. 2007;26:149-55 .

  101. Tat J, Kociolek AM, Keir PJ. Repetitive differential finger motion increases shear strain between the flexor tendon and subsynovial connective tissue. J Orthop Res. 2013;31(10):1533-9. .

  102. Sarria L, Cabada T, Cozcolluela R, Martinez-Berganza T, Garcia S. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol. 2000;10(12):1920-5. .

  103. Wang Y, Qiang B, Zhang X, Greenleaf JF, An K-N, Amadio PC, Zhao C. A non-invasive technique for estimating carpal tunnel pressure by measuring shear wave speed in tendon: a feasibility study. J Biomech. 2012;45(16):2927-30. .

  104. Kantarci F, Ustabasioglu FE, Delil S, Olgun DC, Korkmazer B, Dikici AS, Tutar O, Nalbantoglu M, Uzun N, Mihmanli I. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol. 2014;24(2):434-40. .

  105. Yu JS, Habib PA. Normal MR imaging anatomy ofthe wrist and hand. Radiol Clin North Am. 2006;44(4):569-81. .

  106. Wang C-K, Jou I-M, Huang H-W, Chen P-Y, Tsai H-M, Liu Y-S, Lin C-CK. Carpal tunnel syndrome assessed with diffusion tensor imaging: comparison with electrophysiological studies of patients and healthy volunteers. Eur J Radiol. 2012;81(11):3378-83. .

  107. Horng Y, Chang H, Lin K, Guo Y. Accuracy of ultrasonography and magnetic resonance imaging in diagnosing carpal tunnel syndrome using rest and grasp positions of the hands. J Hand Surg. 2012;37A:1591-8. .

  108. Bulut HT, Yildirim A, Ekmekci B, Gunbey HP. The diagnostic and grading value of diffusion tensor imaging in patients with carpal tunnel syndrome. Acad Radiol. 2014;21(6):767-73. .

  109. Mogk JPM, Keir PJ. Evaluation of the carpal tunnel based on 3-D reconstruction from MRI. J Biomech. 2007;40(10):2222-9. .

  110. McDonagh C, Alexander M, Kane D. The role ofultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology. 2015;54(1):9-19. .

  111. Wilson D, Allen GM. Imaging of the carpal tunnel. Semin Musculoskelet Radiol. 2012;16(2):137-45. .

  112. Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am. 2014;96(17):e148. .

  113. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 2008;79(1):63-7. .

  114. Swen WAA, Jacobs JWG, Bussemaker FEAM, De Waard JWD, Bijlsma JWJ. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist. J Rheumatol. 2001;28(1):62-9. .

  115. Kutlar N, Bayrak AO, Bayrak IK, Canbaz S, Turker H. Diagnosing carpal tunnel syndrome with Doppler ultra-sonography: a comparison of ultrasonographic measurements and electrophysiological severity. Neurol Res. 2017;39(2):126-32. .

  116. Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. J Clin Ultrasound. 2009;37:389-93. .

  117. Lee CH, Kim TK, Yoon ES, Dhong ES. Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. Ann Plast Surg. 2005;54(1):20-3. .

  118. Zyluk A, Walaszek I, Szlosser Z. No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome. J Hand Surg Eur Vol. 2014;39(2):161-6. .

  119. Tat J, Kociolek AM, Keir PJ. Validation of color Doppler Sonography for evaluating relative displacement between the flexor tendon and subsynovial connective tissue. J Ultrasound Med. 2015;34(4):679-87. .

  120. Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-bozorg SM, Jajroudi M, Shakiba M, Mazloumi M, Rahmani M. Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method. Radiology. 2011;261(2):499-506. .

  121. Altinok T, Baysal O, Karakas HM, Sigirci A, Alkan A, Kayhan A, Yologlu S. Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome. Clin Radiol. 2004;59(10):916-25. .

  122. Nakamichi K-I, Tachibana S. Cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle Nerve. 2002;26:798-803. .

  123. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, Martinoli C, Loscher WN. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-7. .

  124. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999;173(3):681-684. .

  125. Kuo MH, Leong CP, Cheng YF, Chang HW. Static wrist position associated with least median nerve compression: sonographic evaluation. Am J Phys Med Rehabil. 2001;80(4):256-260. .

  126. Kele H, Verheggen R, Bittermann HJ, Reimers CD. The potential value of ultrasonography in the evaluation of carpal tunnel syndrome. Neurology. 2003;61(3):389-391. .

  127. Yesildag A, Kutluhanb S, Sengula N, Koyuncuoglub HR, Oyara O, Gulerb K, Gulsoya UK. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004;59(10):910-915. .

  128. Ziswiler HR, Reichenbach S, Vogelin E, Bachmann LM, Villiger PM, Juni P. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: a prospective study. Arthritis Rheum. 2005;52(1):304-311. .

  129. Wiesler ER, Chloros GD, Cartwright MS, Smith BP, Rushing J, Walker FO. The use of diagnostic ultrasound in carpal tunnel syndrome. J Hand Surg Am. 2006;31(5):726-732. .

  130. Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am. 2008;33(1):65-71. .

  131. Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A. Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med. 2010;13(6):516-521. .

  132. Azami A, Maleki N, Anari H, Iranparvar Alamdari M, Kalantarhormozi M, Tavosi Z. The diagnostic value of ultra-sound compared with nerve conduction velocity in carpal tunnel syndrome. Int J Rheum Dis. 2014;17(6):612-620. .

  133. Marquardt TL, Gabra JN, Li ZM. Morphological and positional changes of the carpal arch and median nerve during wrist compression. Clin Biomech (Bristol, Avon). 2015;30(3):248-253. .

  134. Toosi KK, Hogaboom NS, Oyster ML, Boninger ML. Computer keyboarding biomechanics and acute changes in median nerve indicative of carpal tunnel syndrome. Clin Biomech (Bristol, Avon). 2015;30(6):546-550. .

  135. Borire AA, Hughes AR, Lueck CJ, Colebatch JG, Krishnan AV. Sonographic differences in carpal tunnel syndrome with normal and abnormal nerve conduction studies. J Clin Neurosci. 2016;34:77-80. .

  136. Tatar IG, Kurt A, Yavasoglu NG, Hekimoglu B. Carpal tunnel syndrome: elastosonographic strain ratio and cross-sectional area evaluation for the diagnosis and disease severity. Med Ultrason. 2016;18(3):305-311. .

  137. Cowley JC, Leonardis J, Lipps DB, Gates DH. The influence of wrist posture, grip type, and grip force on median nerve shape and cross-sectional area. Clin Anat. 2017;30(4):470-478. .

  138. Pinilla I, Martin-Hervas C, Sordo G, Santiago S. The use-fulness of ultrasonography in the diagnosis of carpal tunnel syndrome. J Hand Surg Eur Vol. 2008;33E(4):435-9. .

  139. Erickson M, Lawrence M, Stegink Jansen CW, Coker D, Amadio P, Cleary C. Hand pain and sensory deficits: carpal tunnel syndrome. J Orthop Sports Phys Ther. 2019;49(5):CPG1-85. .

Articles with similar content:

Painful Shoulder Disorders from a Physiotherapeutic View: A Review of Literature
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.11, 1999, issue 3&4
Eva Solem Bertoft
Painful Shoulder Disorders from a Physiotherapeutic Aspects
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.29, 2017, issue 1-4
Eva Solem Bertoft
Rehabilitation of Shoulder Injury in the Throwing Athlete
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.20, 2008, issue 1
William Micheo
A Comprehensive Review of Running Injuries
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.11, 1999, issue 1
Michael Fredericson, A. Gabrielle Bergman
Impact of Inter- and Intramuscular Fat on Muscle Architecture and Capacity
Critical Reviews™ in Biomedical Engineering, Vol.47, 2019, issue 6
Zhenyu Jiang, Kendal Marriott, Monica R. Maly