Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements.

Abstract

To examine the performance of sonographic cross-sectional area (CSA) measurements in the diagnosis of cubital tunnel syndrome (CuTS). Electronic databases, comprising PubMed and EMBASE, were searched for the pertinent literature before July 1, 2017. Fourteen trials comparing the ulnar nerve CSA measurements between participants with and without CuTS were included. Study design, participants' demographic characteristics, diagnostic reference of CuTS, and methods of CSA measurement. Among different elbow levels, the between-group difference in CSA was the largest at the medial epicondyle (6.0mm²; 95% confidence interval [CI], 4.5-7.4mm²). The pooled mean CSA in participants without CuTS was 5.5mm² (95% CI, 4.4-6.6mm²) at the arm level, 7.4mm² (95% CI, 6.7-8.1mm²) at the cubital tunnel inlet, 6.6mm² (95% CI, 5.9-7.2mm²) at the medial epicondyle, 7.3mm² (95% CI, 5.6-9.0mm²) at the cubital tunnel outlet, and 5.5mm² (95% CI, 4.7-6.3mm²) at the forearm level. The sensitivities, specificities, and diagnostic odds ratios pooled from 5 studies, using 10mm² as the cutoff point, were .85 (95% CI, .78-.90), .91 (95% CI, .86-.94), and 53.96 (95% CI, 14.84-196.14), respectively. The ulnar nerve CSA measured by ultrasound imaging is useful for the diagnosis of CuTS and is most significantly different between patients and participants without CuTS at the medial epicondyle. Because the ulnar nerve CSA in healthy participants, at various locations, rarely exceeds 10mm², this value can be considered as a cutoff point for diagnosing ulnar nerve entrapment at the elbow region.