From morphological alterations to definitive clinical diagnosis - the Ultrasonography investigation’s role in Carpal tunnel syndrome’s diagnostics


  • Zaralieva Aicha UMBAL “Tsaritsa Ioanna - ISUL”, Bulgaria; MC “Sport Med”, Bulgaria
  • Ivanov Martin MC “Sport Med”, Bulgaria
  • Beleva Irina MC “Sport Med”, Bulgaria
📧Corresponding author


Carpal tunnel syndrome (CTS) is a condition which manifests in cases of compression or tension of n.medianus in the wrist area. This condition is the most commonly diagnosed mononeuropathy from compression. EMG is the gold standard for diagnostics of n.medianus injuries. However, recently ultrasonography has proved advantageous, and it is used more often in clinical practice for the dynamic monitoring of patients’ injuries. Great benefits of the US diagnostics are its broad availability and easy differential diagnosis assessment of patients with pain and numbness in the wrist area. It is important to highlight that in US examination the changes in patients’ conditions are almost imminently evident, whereas in EMG diagnostics the alterations become apparent only after a few weeks. Additionally, the ultrasonography is a method for a confirmation of CTS diagnosis after such has been made based on physical examination and presence of symptoms.


carpal tunnel syndrome ultrasonography electromyography anatomical variations

Download pdf


  1. Люцкaнoвa C, Tpoев T, Зapaлиевa A. Cъвpеменни физикaлни метoди зa лечение нa cиндpoмa нa кapпaлния кaнaл. Cъвpеменни медицинcки пpoблеми. 2016, 1, 41-43.
  2. Chammas M, Boretto J, Burmann LM, Ramos RM, dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop (English Ed [Internet]. 2014 Sep; 49 (5): 429- 36. DOI: [PMid:26229841 PMCid:PMC4487499]
  3. Atroshi I, Gummesson C, Johnsson R, McCabe SJ, Ornstein E. Severe carpal tunnel syndrome potentially needing surgical treatment in a general population. J Hand Surg Am [Internet]. 2003 Jul; 28 (4): 639- 44. DOI:
  4. Кocтoвa, B. Пеpифеpни невpoпaтии в пpoфеcиoнaлнaтa пaтoлoгия. 1996.
  5. Graham B, Peljovich A, Afra R, Cho M, Gray R, Stephenson J, Gurman A, MacDermid J, Mlady G, Patel A, Rempel D, Rozental T, Salajegheh M. American Academi of Ortopedic Surgeons. Management ot Carpal Tunnel Syndrome. Evidence-besed Clinical Practice Guideline. Feb 29 2016
  6. Jongs R. Carpal Tunnel Questionnaire. J Physiother [Internet]. 2017 Apr; 63 (2): 119. DOI: [PMid:28325483]
  7. Петpoвa Ю, Mилaнoв И. Canalis carpi syndrome - ЕMГ или еxoгpaфcкa oценкa? Пъpвa нaциoнaлнa кoнфеpенция зa клиничн електpoмиoгpaфия и евoкиpaни пoтенциaли. Tpявнa, 2013.
  8. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve [Internet]. 2011 Oct; 44 (4): 597- 607. DOI: [PMid:21922474]
  9. Mиxaлевa B, Mиxaйлoвa M, Пaвлoв C, Mapинoвa Д, Aнгелoвa M, Филкoвa C. Кapпaл тунел cиндpoм - aнaтoмични вapиaции и теcтoве зa диaгнocтикa. Bapненcки медицинcки фopум. 2017; VI (2): 79-84.
  10. Бaлтoв A. Cтaвнa еxoгpaфия в cъвpеменнaтa pевмaтoлoгия. 2013; 11: 117-120.
  11. Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et al. Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug; 46 (2): 287- 93. DOI: [PMid:22806381]
  12. Köroğlu Ö. Estimating the most accurate sonographic measurement in the diagnosis of carpal tunnel syndrome: Which is the best? Turkish J Phys Med Rehabil [Internet]. 2019 May 31; 65 (2): 177- 83. DOI: [PMid:31453559 PMCid:PMC6706835]
  13. Кapaбинoв B, Геopгиев Г. Cиндpoм нa кapпaлния кaнaл - чеcтo cpещaнo и пoдценявaнo cъcтoяние. MD. 2017; 4: 2-5.
  14. Griffith J. Carpal Tunnel Syndrome. In: Diagnostic Ultrasound: Musculoskeletal [Internet]. Elsevier; 2015.