Evaluation of wrist radiographic indices in people with Idiopathic carpal tunnel syndrome: a prospective case-control study - 05/12/25

Doi : 10.1016/j.rehab.2025.102068

Nadide KOCA ^1,^{^{a
Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Zekai Tahir Burak Additional Building, Block D, Talatpaşa Boulevard No:82, 06230 Altındağ, Ankara, Turkey},}^⁎ , Nida KOCER NAZLIGÜL ^1,^{^{b
Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, University of Health Sciences, Ankara/Turkey}}

¹ Department of Physical Therapy and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey

^⁎ Corresponding author: Nadide KOCA, M.D., Physical Medicine & Rehabilitation Specialist, Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Zekai Tahir Burak Additional Building, Block D, Talatpaşa Boulevard No:82, 06230 Altındağ, Ankara, Turkey, Phone: 0090 537 684 34 34 Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation Zekai Tahir Burak Additional Building, Block D, Talatpaşa Boulevard No:82 Altındağ Ankara 06230 Turkey

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Highlights

•	Scapholunate instability associates with carpal tunnel syndrome
•	Radiolunate angle correlates with electrophysiological severity
•	Radioscaphoid angle predicts symptom severity in carpal tunnel syndrome
•	Reduced radial inclination increases risk of carpal tunnel syndrome
•	Abnormal ulnar variance raises likelihood of carpal tunnel syndrome

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Abstract

Background

Idiopathic carpal tunnel syndrome (ICTS) is a common condition characterized by compression of the median nerve at the wrist, leading to symptoms like pain, numbness, and weakness.

Objective

This study aims to compare wrist radiographic characteristics of participants with ICTS to those without ICTS and to examine their relationship with carpal tunnel syndrome (CTS) severity and symptomatology.

Methods

This is a prospective case-control study. The study included 136 participants with ICTS and 221 affected hands, along with a control group of 139 participants without ICTS with 240 hands. Within the case group, the electrophysiological severity and symptom severity of CTS were compared with radiographic findings. Ulnar variance (UV), radial inclination (RI), volar tilt (VT), radiolunate angle (RLA), radioscaphoid angle (RSA), scapholunate angle (SLA), wrist anteroposterior diameter (APD), wrist transverse diameter (TD), and carpal height ratio (CHR) were measured on wrist radiographs of both the case and control groups, and the results were statistically compared.

Results

Body mass index (BMI) was significantly higher in the ICTS group (32.01 vs 28.4; P < 0.01). In the ICTS group, RI was significantly lower ( P < 0.05), whereas RLA, RSA, and SLA were significantly higher than in the control group ( P < 0.01 for all). Both positive and negative UV values were significantly elevated in ICTS cases ( P < 0.001). Within the CTS group, RLA showed a positive association with electrophysiological severity, whereas SLA showed a negative association ( P < 0.05 for both). RSA was the only radiographic parameter significantly associated with symptom severity ( P < 0.01).

Conclusion

Decreased RI, increased frequency of both positive and negative UV, and increased SLA, RLA, and RSA were strongly associated with scapholunate dissociation (SLD) in participants with ICTS. Decreased RI and increased positive/negative UV are anatomical risk factors forSLD in people with ICTS. SLD may play a role in the pathogenesis of ICTS .