Multimodal Ultrasound Imaging for Pre- and Postoperative Evaluation of Carpal Tunnel Syndrome

To evaluate the value of combining high-frequency ultrasound, sound touch elastography (STE), and ultramicro angiography (UMA) for the diagnosis and short-term postoperative follow-up of carpal tunnel syndrome (CTS) patients.

This prospective study enrolled 50 CTS patients (78 wrists), classified by severity into mild (n = 22), moderate (n = 32), and severe (n = 24) groups, along with 35 healthy volunteers (70 wrists) as controls. All participants underwent multimodal ultrasound examination combining high-frequency ultrasound, STE, and UMA to measure median nerve cross-sectional area (CSA), shear wave velocity (SWV), and color pixel percentage (CPP) within 2 cm proximal to the carpal tunnel inlet. Patients with moderate and severe CTS underwent carpal tunnel release surgery followed by repeat ultrasound evaluation at 3 months postoperatively. Statistical comparisons included the following: (1) ultrasound parameters between preoperative CTS patients and controls; (2) parameter differences across severity subgroups; (3) pre-versus postoperative changes in CTS patients; and (4) diagnostic performance of individual and combined parameters for CTS identification.

Significant elevations in median nerve CSA, SWV, and CPP were observed at the carpal tunnel inlet in the CTS group compared to controls (all P < 0.001). Among CTS patients, CPP demonstrated progressive increases with severity across all subgroups (all P < 0.001). CSA was significantly larger in severe cases than in mild and moderate wrists (P < 0.001), while SWV values were higher in both moderate and severe cases compared to mild CTS (all P < 0.001). Receiver operating characteristic (ROC) analysis indicated that the combination of CSA, SWV, and CPP provided optimal diagnostic accuracy for CTS with area under the curve (AUC) of 0.990, with 96.2% sensitivity and 98.6% specificity. Postoperative assessment at 3 months revealed significant reductions in all three parameters compared to preoperative values (all P < 0.001).

Multimodal ultrasound provides clinical value in carpal tunnel syndrome by supporting early diagnosis and severity stratification, and it may serve as a useful tool for short-term postoperative monitoring.