Some authors have advocated for the use of US as the confirmatory test of choice or as a complementary test for the suspected diagnosis of CTS due to the ability to identify space occupying lesions, anatomic variants including bifid median nerve and persistent median artery, and tendon pathology in the carpal tunnel and the false-positive rate of electrodiagnostic studies [70-73]. Despite evidence supporting the diagnostic capabilities of US in the setting of CTS, there is disagreement among hand surgeons regarding the necessity of diagnostic tests [73,74]. The 2016 American Academy of Orthopedic Surgeons guidelines reports limited evidence supports not routinely using US for the diagnosis of CTS [60]. Variant 6: Adult. Chronic hand or wrist pain. Radiographs normal or show nonspecific arthritis. Suspect tendon injury, tenosynovitis, or tendon pathology. Next imaging study. Bone Scan Area of Interest There is no relevant literature to support the use of bone scan in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT with IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT without and with IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest Without IV Contrast There is no relevant literature to support the use of CT without IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology.
Chronic Hand and Wrist Pain. Some authors have advocated for the use of US as the confirmatory test of choice or as a complementary test for the suspected diagnosis of CTS due to the ability to identify space occupying lesions, anatomic variants including bifid median nerve and persistent median artery, and tendon pathology in the carpal tunnel and the false-positive rate of electrodiagnostic studies [70-73]. Despite evidence supporting the diagnostic capabilities of US in the setting of CTS, there is disagreement among hand surgeons regarding the necessity of diagnostic tests [73,74]. The 2016 American Academy of Orthopedic Surgeons guidelines reports limited evidence supports not routinely using US for the diagnosis of CTS [60]. Variant 6: Adult. Chronic hand or wrist pain. Radiographs normal or show nonspecific arthritis. Suspect tendon injury, tenosynovitis, or tendon pathology. Next imaging study. Bone Scan Area of Interest There is no relevant literature to support the use of bone scan in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT with IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT without and with IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology. CT Area of Interest Without IV Contrast There is no relevant literature to support the use of CT without IV contrast in the setting of chronic hand and wrist pain with clinical concern for tendon injury, tenosynovitis, or tendon pathology.