{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:12:26Z","timestamp":1790820746264,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Evaluate the diagnostic accuracy of median nerve cross\u2010sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic\u2010based (EDX) classification systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of cross\u2010sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all <jats:italic>consolidated<\/jats:italic> and <jats:italic>binary<\/jats:italic> EDX\u2010based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:italic>Binary<\/jats:italic> categorizations of CTS (ie, \u201cNormal\u201d vs \u201cAbsent\u201d) were statistically superior to <jats:italic>consolidated<\/jats:italic> categorizations of CTS severity (ie, \u201cNormal,\u201d \u201cMild,\u201d \u201cModerate,\u201d or \u201cSevere\u201d). <jats:italic>Binary<\/jats:italic> categorizations established consistent CSA cutoff values across all EDX\u2010based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: &lt;7 or &lt;1\u2009mm<jats:sup>2<\/jats:sup> to rule out and &gt;13 or &gt;7\u2009mm<jats:sup>2<\/jats:sup> to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: \u226410 or \u22643\u2009mm<jats:sup>2<\/jats:sup> to rule out and \u226511 or \u22654\u2009mm<jats:sup>2<\/jats:sup> to rule in CTS, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, <jats:italic>binary<\/jats:italic> categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX\u2010based classifications examined.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jum.16486","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T07:20:24Z","timestamp":1716448824000},"page":"1645-1659","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Sonographic Measurement of Median Nerve Cross\u2010Sectional Area to Determine Severity of Carpal Tunnel Syndrome"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7819-7398","authenticated-orcid":false,"given":"Nathan J.","family":"Savage","sequence":"first","affiliation":[{"name":"Department of Physical Therapy Winston\u2010Salem State University  Winston\u2010Salem North Carolina 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