Ulnar Nerve Cross-sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-analysis of Ultrasonographic Measurements

Publication date: Available online 6 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ke-Vin Chang, Wei-Ting Wu, Der-Sheng Han, Levent Özçakar
ObjectiveThis meta-analysis aimed to examine the performance of sonographic cross-sectional area (CSA) measurements, in the diagnosis of cubital tunnel syndrome (CuTS).Data sourceElectronic databases, comprising of PubMed and Embase, were searched for the pertinent literature before July 2017.Study selectionFourteen trials comparing the ulnar nerve CSA measurements between participants, with and without CuTS, were included.Data extractionStudy design, participants' demographics, diagnostic reference of CuTS and methods of CSA measurement.Data synthesisAmong different elbow levels, the between-group difference in CSA was the largest at the medial epicondyle [6.0 mm² (95% confidence interval [CI]: 4.5-7.4)]. The pooled mean CSA from the healthy participants was 5.5 mm² (95%CI: 4.4-6.6) at the arm level, 7.4 mm² (95% CI: 6.7-8.1) at the cubital tunnel inlet, 6.6 mm² at the medial epicondyle (95% CI: 5.9-7.2), 7.3 mm² (95%CI: 5.6-9.0) at the cubital tunnel outlet, and 5.5 mm² (95% CI: 4.7-6.3) at the forearm level. The sensitivity, specificity, and diagnostic odds ratios pooled from 5 studies, using 10 mm² as the cut-off point, were 0.85 (95% CI: 0.78-0.90), 0.91 (95% CI: 0.86-0.94), and 53.96 (95% CI: 14.84-196.14), respectively.ConclusionThe ulnar nerve CSA measured by US imaging is useful for the diagnosis of CuTS, and is most significantly different between patients and controls at the medial epicondyle. As the ulnar nerve CSA in normal subjects, at various locations, rarely exceeds 10 mm², this value can be considered as a cut-off point to diagnose ulnar nerve entrapment at the elbow region.



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