MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MR without and with IV contrast in the setting of chronic hand and wrist pain with clinical concern for CTS. MRI Area of Interest Without IV Contrast MRI can identify enlargement and flattening of the median nerve, bowing of the flexor retinaculum, space occupying lesions, anatomic variants including bifid median nerve and persistent median artery, and tendon pathology in the carpal tunnel [60-62]. When compared with clinical assessment and nerve conduction studies, MRI can diagnose CTS with a high accuracy and stage severity with moderate accuracy [62,63]. There is good correlation between the cross-sectional area of the median nerve as assessed by both US and MRI [63,64]. However, MRI of the wrist is typically not indicated in the setting of suspected CTS [60-62]. Radiographic Arthrography Area of Interest There is no relevant literature to support the use of radiographic arthrography in the setting of chronic hand and wrist pain with clinical concern for CTS. Radiography Wrist Additional Views There is no relevant literature to support the use of additional radiographic views in the setting of chronic hand and wrist pain with clinical concern for CTS. US Area of Interest When compared with clinical assessment and electrophysiologic studies, multiple systematic reviews and meta- analyses have demonstrated US to be highly sensitive and specific for the diagnosis of CTS [65-69]. The measurements and calculations used in the literature for US evaluation of the median nerve are heterogeneous; Chronic Hand and Wrist Pain cross-sectional area measurements of the median nerve at multiple locations in the forearm and wrist and ratios or differences in cross-sectional area comparing the various measurements have been reported.
Chronic Hand and Wrist Pain. MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MR without and with IV contrast in the setting of chronic hand and wrist pain with clinical concern for CTS. MRI Area of Interest Without IV Contrast MRI can identify enlargement and flattening of the median nerve, bowing of the flexor retinaculum, space occupying lesions, anatomic variants including bifid median nerve and persistent median artery, and tendon pathology in the carpal tunnel [60-62]. When compared with clinical assessment and nerve conduction studies, MRI can diagnose CTS with a high accuracy and stage severity with moderate accuracy [62,63]. There is good correlation between the cross-sectional area of the median nerve as assessed by both US and MRI [63,64]. However, MRI of the wrist is typically not indicated in the setting of suspected CTS [60-62]. Radiographic Arthrography Area of Interest There is no relevant literature to support the use of radiographic arthrography in the setting of chronic hand and wrist pain with clinical concern for CTS. Radiography Wrist Additional Views There is no relevant literature to support the use of additional radiographic views in the setting of chronic hand and wrist pain with clinical concern for CTS. US Area of Interest When compared with clinical assessment and electrophysiologic studies, multiple systematic reviews and meta- analyses have demonstrated US to be highly sensitive and specific for the diagnosis of CTS [65-69]. The measurements and calculations used in the literature for US evaluation of the median nerve are heterogeneous; Chronic Hand and Wrist Pain cross-sectional area measurements of the median nerve at multiple locations in the forearm and wrist and ratios or differences in cross-sectional area comparing the various measurements have been reported.