{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:40:42Z","timestamp":1792366842289,"version":"4.4.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While clinical examination for carpal tunnel syndrome (CTS) is the first-line diagnostic method, its accuracy can vary, particularly among clinicians without specialized training. The CTS-6 questionnaire and ultrasound measurement of the median nerve\u2019s cross-sectional area (CSA) are two widely studied diagnostic methods. Combining these tools may provide a more reliable and standardized approach to CTS diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A review was conducted of patients aged 18 years or older screened for CTS from June 2023 to Sept 2023. We combined scores using the formula (CTS-6 score + 2 \u00d7 CSA) based on a previous study by Kimura et al. We then used the Index of Union and positive likelihood ratio (PLR) to analyze the optimal cutoff values for the combined score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 142 hands were analyzed. The combined score had the highest sensitivity, while the CTS-6 alone had the highest specificity. The accuracy of the combined score with a cutoff value of 31.25 was equal to that of the CTS-6 score alone. Per the Index of Union, the optimized cutoff for the combined score was 27.68. Maximizing the PLR, the combined score cutoff was found to be 34.08.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Combining the CTS-6 and median nerve CSA offers the most accurate method for diagnosing CTS. A lower cutoff value (27.68 vs. 31.25) improved the sensitivity of the combined score, demonstrating a strong diagnostic performance for CTS as a screening tool. Alternatively, using the PLR-optimized cutoff (34.08), this becomes a highly specific confirmatory test.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15589447251411545","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T04:58:16Z","timestamp":1769403496000},"page":"1621-1626","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Carpal Tunnel Syndrome Diagnosis: The Combined Use of CTS-6 and Ultrasound Measured Median Nerve CSA"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-6361","authenticated-orcid":false,"given":"Rachel","family":"Hyzny","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacia","family":"Ruse","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Orthopedic Surgery, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Niemann","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Orthopedic Surgery, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Orthopedic Surgery, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3436-6644","authenticated-orcid":false,"given":"Jenna","family":"Dvorsky","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fowler","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Orthopedic Surgery, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2015.04.026"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00432-X"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1558944719856105"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.683807"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90:2587-2593. Accessed September 28 2024. https:\/\/ebhmc.com\/wp-content\/uploads\/2016\/07\/EBHMC-CTS-6.pdf","DOI":"10.2106\/JBJS.G.01362"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1142\/S0218810417500150"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2018.11.010"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2021.08.008"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1637-5"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2015.07.010"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2021.04.022"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2024.01.007"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/3762651"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00719"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2021.09.037"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10571-022-01297-2"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.2.153"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000005816"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2016.03.002"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(96)80164-X"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2022.11.020"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01250"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.159.4.1529845"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/155894471877783"}],"container-title":["HAND"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447251411545","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15589447251411545","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447251411545","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:19:57Z","timestamp":1792365597000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15589447251411545"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,25]]},"references-count":24,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/15589447251411545"],"URL":"https:\/\/doi.org\/10.1177\/15589447251411545","relation":{},"ISSN":["1558-9447","1558-9455"],"issn-type":[{"value":"1558-9447","type":"print"},{"value":"1558-9455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,25]]}}}