Can ultrasound imaging be used for the diagnosis of carpal tunnel syndrome in diabetic patients? A systemic review and network meta-analysis



High-resolution ultrasound (US) becomes a reliable tool for diagnosing carpal tunnel syndrome (CTS), but whether it can be applied to patients with preexisting diabetes mellitus (DM) remains unclear.


We searched PubMed and Embase and systemically reviewed studies exploring the median nerve CSAs at the wrist level by US imaging. Nine studies enrolling at least one subgroup comprising patients with both DM and CTS were included for network meta-analysis. The primary outcome was the inter-group difference of the wrist-level median nerve CSA.


The median nerve size at the wrist level was larger in patients with only CTS than in patients with only DM [CSA difference = 3.14 mm2, 95% confidence interval (CI) 1.92–4.35]. Patients with DM and CTS had a slightly enlarged median nerve CSA than did patients with only CTS, but the difference was not statistically significant (0.52 mm2, 95% CI − 0.54 to 1.59). According to rank probabilities, median nerve CSAs in patients with DM and CTS were likely to be ranked as the largest, followed by patients with only CTS, patients with only DM, and healthy controls. Furthermore, median nerve CSAs seemed smaller in patients with than without diabetic polyneuropathy.


Although DM causes swelling of the median nerve at the wrist level, patients with CTS have a larger CSA regardless of preexisting DM. The add-on effect of DM on median nerve CSAs in patients with CTS is limited. Diabetic polyneuropathy tends to result in less swollen median nerves in the CTS population.

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Carpal tunnel syndrome


Cross-sectional area


Confidence interval


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The current research project was supported by (1) National Taiwan University Hospital, Bei-Hu Branch; (2) Ministry of Science and Technology (MOST 106-2314-B-002-180-MY3); (3) Taiwan Society of Ultrasound in Medicine.

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Correspondence to Ke-Vin Chang.

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Ethical standard statement

This article is a meta-analysis with all analyses based on previous published studies, thus no ethical approval and patient consent are required.

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Fig. S1 Summary of quality assessment for the included studies: low risk of bias in green, high risk of bias in red, and unclear risk of bias in yellow. (TIF 3480 KB)

Fig. S2 Quality assessment graph: low risk of bias in green, high risk of bias in red, and unclear risk of bias in yellow. (TIF 1135 KB)

Fig. S3 Network graph for comparison of median nerve sizes at the wrist level in different subgroups. DM, diabetes mellitus; CTS, carpal tunnel syndrome. (TIF 2074 KB)

Fig. S4 Cumulative ranking probabilities for different subgroups based on cross-sectional area (CSA) of the median nerve. DM, diabetes mellitus; CTS, carpal tunnel syndrome. (TIF 2412 KB)

Fig. S5 Inconsistency plot comparing the results from direct and indirect comparisons in the network meta-analysis. IF, inconsistency factor; A, Normal; B, patients with only diabetes mellitus (DM); C, patients with only carpal tunnel syndrome (CTS); D, patients with CTS and DM. (TIF 1845 KB)

Fig. S6 Funnel plot for the comparisons of the median nerve cross-sectional area between different subgroups. A, Normal; B, patients with only diabetes mellitus (DM); C, patients with only carpal tunnel syndrome (CTS); D, patients with CTS with DM. (TIF 2705 KB)

Fig. S7 Egger’s test for the comparison of median nerve cross-sectional areas between different subgroups. (TIF 2412 KB)

Supplementary material 8 (DOC 35 KB)

Supplementary material 9 (DOCX 17 KB)

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Chen, I., Chang, K., Lou, Y. et al. Can ultrasound imaging be used for the diagnosis of carpal tunnel syndrome in diabetic patients? A systemic review and network meta-analysis. J Neurol 267, 1887–1895 (2020).

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  • Median nerve
  • Wrist
  • Diabetes mellitus
  • Sonography
  • Electromyography