Clinical neurophysiology practice · 2026
The wrist/palm forearm ratio is less reliable in diabetic patients with carpal tunnel syndrome than in non-diabetic patients.
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Tóth Marianna, Arányi Zsuzsanna
Аннотация
OBJECTIVE: This prospective study aimed to compare ultrasonographic parameters in diabetic and non-diabetic carpal tunnel syndrome and to analyze whether the findings are related to the presence of associated polyneuropathy.
METHODS: The cross-sectional areas (CSAs) of the median nerve were measured at three sites using high-resolution ultrasound in 63 patients with diabetes mellitus and carpal tunnel syndrome (73 hands), 146 non-diabetic patients with carpal tunnel syndrome (163 hands), and 50 controls (50 hands). The diabetic group included 13 patients with type 1 (15 hands) and 50 with type 2 diabetes (58 hands); of these, 43 also had polyneuropathy. Electrophysiological testing was performed to confirm carpal tunnel syndrome, determine its severity, and assess for polyneuropathy.
RESULTS: Wrist/palm cross-sectional areas (CSA-I, CSA-O) did not differ between the diabetic and non-diabetic groups. Wrist/palm-forearm ratio (WFR/PFR) was lower (p = 0.007), while forearm CSA was larger (p = 0.002) in diabetic patients compared to non-diabetic individuals, particularly in patients with type 2 diabetes and moderately severe carpal tunnel syndrome. WFR was lower in the diabetic subgroup with polyneuropathy than in the subgroup without polyneuropathy. Sensitivity, positive predictive value, and accuracy of the WFR/PFR were lower in diabetic than non-diabetic patients; however, these differences decreased when CSA-I/CSA-O values were combined with WFR/PFR.
CONCLUSIONS: The wrist/palm-forearm ratio is less reliable for diagnosing carpal tunnel syndrome in diabetic than non-diabetic patients, particularly in moderately severe carpal tunnel syndrome and type 2 diabetes.
SIGNIFICANCE: It is to consider multiple parameters when performing ultrasound-based diagnosis of diabetes-related compressive neuropathies.
METHODS: The cross-sectional areas (CSAs) of the median nerve were measured at three sites using high-resolution ultrasound in 63 patients with diabetes mellitus and carpal tunnel syndrome (73 hands), 146 non-diabetic patients with carpal tunnel syndrome (163 hands), and 50 controls (50 hands). The diabetic group included 13 patients with type 1 (15 hands) and 50 with type 2 diabetes (58 hands); of these, 43 also had polyneuropathy. Electrophysiological testing was performed to confirm carpal tunnel syndrome, determine its severity, and assess for polyneuropathy.
RESULTS: Wrist/palm cross-sectional areas (CSA-I, CSA-O) did not differ between the diabetic and non-diabetic groups. Wrist/palm-forearm ratio (WFR/PFR) was lower (p = 0.007), while forearm CSA was larger (p = 0.002) in diabetic patients compared to non-diabetic individuals, particularly in patients with type 2 diabetes and moderately severe carpal tunnel syndrome. WFR was lower in the diabetic subgroup with polyneuropathy than in the subgroup without polyneuropathy. Sensitivity, positive predictive value, and accuracy of the WFR/PFR were lower in diabetic than non-diabetic patients; however, these differences decreased when CSA-I/CSA-O values were combined with WFR/PFR.
CONCLUSIONS: The wrist/palm-forearm ratio is less reliable for diagnosing carpal tunnel syndrome in diabetic than non-diabetic patients, particularly in moderately severe carpal tunnel syndrome and type 2 diabetes.
SIGNIFICANCE: It is to consider multiple parameters when performing ultrasound-based diagnosis of diabetes-related compressive neuropathies.