Golden Standard in Diagnosing Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Introduction: Carpal tunnel syndrome (CTS) is characterized by symptoms like numbness, tingling, and pain due to median nerve compression at the wrist. Electromyography (EMG) has been the gold standard for diagnosis, but studies show ultrasound's comparable accuracy. High-resolution sonography effectively diagnoses CTS, and virtual touch tissue imaging quantification and 2D sonography evaluate median nerve stiffness. Accurate diagnosis is essential for proper management and treatment. This study aims to compare the diagnostic accuracy of ultrasound, EMG, and other potential diagnostic methods in identifying CTS, to determine the most effective diagnostic approach. Methods: For this study, searches were conducted in PubMed/MEDLINE, SCOPUS, and the Europe PMC databases to identify relevant articles. The following keywords were used: "carpal tunnel syndrome," "diagnosis," "ultrasound," "electromyography," "diagnostic accuracy," "sensitivity," and "specificity." Boolean operators (AND, OR) were used to combine these search terms. The primary outcome was the diagnostic accuracy of all modalities in diagnosing CTS. This had to be reported with diagnostic accuracy metrics, such as sensitivity, specificity, and others. In cases where a study did not report these metrics, they were calculated retrospectively. Results: The total cohort consisted of 4704 individuals, while the total number of wrists studied was 5821, with 1725 participants being male. EMG demonstrated a sensitivity of 0.90 (95% CI: 0.84 to 0.95) and a specificity of 0.75 (95% CI: 0.53 to 0.98). Conclusions: Our meta-analysis explores CTS diagnostic accuracy. EMG and ultrasound seem most accurate, but further research and addressing study limitations are needed. Keywords: carpal tunnel syndrome, sensitivity, specificity, electromyography