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Carpal Tunnel Syndrome (CTS)NCT06841809

Analysis of Radiographic Indices in Carpal Tunnel Syndrome

An observational study of Carpal Tunnel Syndrome (CTS) and Wrist, run by Ankara Training and Research Hospital at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The aim of this study was to compare wrist radiographic indices in patients with idiopathic carpal tunnel syndrome (CTS) with normal cases. The investigators believe that the investigators can contribute to the development of new treatment strategies by determining the radiographic features that contribute to the… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Carpal Tunnel Syndrome (CTS), Wrist, X-Ray
How many people
275 participants
Where
1 siteTurkey (Türkiye)
Study dates
16 Feb 2025to 1 Jul 2025
How long will I take part?
1 Day
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The case group will consist of patients referred to the EMG clinic and diagnosed with carpal tunnel syndrome (CTS). All of these patients will undergo bilateral EMG. The control group was randomly selected from patients with hand and wrist complaints, who were matched with the study group in terms of age and gender, and who had hand complaints other than CTS.

Who may be able to join

  • Not having had any previous surgical procedures on the hand or wrist
  • Not having had a major hand or wrist trauma
  • No structural disorders in the bone structure

Who cannot join

  • Being under 18 years of age
  • History of major hand-wrist trauma or surgery
  • Acromegaly
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • GUT arthritis
  • Psoriatic arthritis

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Ankara Training and Research Hospital, University of Health Sciences, Department of Physical Therapy and Rehabilitation

    Ankara, Altindag, 06230

Other trials in Turkey (Türkiye)

About this study

Official title: The Role of Radiographic Indices in the Evaluation of Hand and Wrist Pathologies in Patients With Carpal Tunnel Syndrome

The aim of this study was to compare wrist radiographic indices in patients with idiopathic carpal tunnel syndrome (CTS) with normal cases. The investigators believe that the investigators can contribute to the development of new treatment strategies by determining the radiographic features that contribute to the development of CTS.

Read the detailed description

Carpal tunnel syndrome (CTS) is the most common mononeuropathy of the upper extremity. It occurs as a result of compression of the median nerve in the carpal tunnel during its course in the wrist. Clinical symptoms are characterized by numbness and tingling in the first 3 fingers and the radial half of the 4th finger, which are compatible with the distribution of the median nerve. Electrophysiologically, it is classified as mild, moderate and severe. As the disease duration increases, atrophy and weakness may develop in the thenar muscles. The incidence is 4-5% worldwide and is more common in women between the ages of 40-60.

Pathophysiology consists of mechanical compression, increased pressure, ischemia in the median nerve and local metabolic changes.

Among the risk factors, occupations that require repeated flexion and extension of the wrist constitute environmental risk factors. Extension can increase the tunnel pressure by 10 times, while flexion can increase it by more than 8 times. Systemic risk factors for CTS are pregnancy, menopause, obesity, renal failure, hypothyroidism, oral contraceptive use, and congestive heart failure.

Diabetes, alcoholism, vitamin deficiency or toxicity, and exposure to toxins are neuropathic risk factors. Localized risk factors include mass lesions that compress the tunnel, arthritis, and radius distal end fractures.

Despite these risk factors, most cases of CTS are still classified as idiopathic.

CTS often develops in the late period after radius distal end fractures. The mechanism here is multifactorial and includes malunion, chronically inflamed synovium, volar callus, and scar tissue. However, in late CTS cases developing after Colles fractures, it has been determined that carpal alignment is greatly affected by the displacement of the radius.

This finding has drawn the attention of researchers to the radiographic features of the distal radius and carpal bone in the etiopathogenesis of idiopathic CTS.

There are several studies conducted on wrist radiographic features in idiopathic CTS.

In a case-control study evaluating the radiographic parameters of 94 wrists of 62 idiopathic carpal tunnel syndrome patients and 94 asymptomatic wrists of 94 controls, radial inclination, volar inclination, ulnar variance and transverse and anteroposterior diameters were measured on posteroanterior and lateral radiographs of the wrist. The measurements were made by two evaluators and the average of the measurements of the two was taken. At the end of this study, a significant difference was found only in ulnar variance and it was reported that positive ulnar variance may be an index to be considered in CTS.

In another study, wrist radiographs of 75 idiopathic CTS patients who underwent carpal tunnel release surgery were compared with the radiographs of 87 normal control group participants. Radial inclination, volar inclination, ulnar variance, radiolunate angle (RLA) and lunate-radius axis distance were measured. Data were measured using two independent raters and the average of these measurements was taken. RLA and lunate-radius axis distance were found to be significant between the two groups. The researchers concluded that excessive dorsiflexion and volar displacement of the lunate can be considered as CTS risk factors.

In another study conducted on female patients with CTS, radiographs of 55 CTS hands of 40 female patients were compared with healthy control subjects. Capitate length, Carpal height, Palm length, Scaphoid-Pisiform Width Index (SPWI) and Palmar ratio values were found to be lower in the patient group. The researchers reported that the carpal bone configuration affects the proximal part of the carpal tunnel and may affect the compression of the median nerve in female patients.

The purpose of this study; to compare the radiographic features of the wrist of patients with idiopathic CTS with the radiographic features of normal control cases. For this purpose, the investigators examined the radiographic features of the distal radius and the scaphoid and lunate bones, which are the two bones that articulate with it and also participate in the posterior proximal floor of the carpal tunnel. The investigators also evaluated whether radiographic features are related to the severity of CTS and symptom severity. The investigators believe that the results to be obtained will contribute to treatment strategies. This study is the first to investigate the relationship between the radioscaphoid angle (RSA), scapholunate angle (SLA) and radiographic indices and symptoms in idiopathic carpal tunnel syndrome (CTS).

Keywords
Carpal Tunnel Syndrome (CTS), wrist, X-Ray
Medical subject headings
Carpal Tunnel Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT06841809
Study groupRoleWhat they receive
CasePatients referred to the EMG clinic and diagnosed with carpal tunnel syndrome were selected. All of these patients underwent bilateral EMG.
ControlThe control group was randomly selected from patients who applied with other hand and wrist complaints during the same period and who had wrist radiographs, and who were matched with the study group in terms of age and gender.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Measurement of Radiographic Indices

    Radio-lunate Angle (RLA): The distance between the tangential line connecting the two distal poles of the lunate root and the line drawn perpendicular to the central medullary canal of the distal radius.

    Measured: up to 12 weeks

Secondary outcomes (10)
  1. Boston Carpal Tunnel Syndrome Questionnaire

    The Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) is specifically designed for people with carpal tunnel syndrome (CTS) and provides insight into symptoms and severity when performing specific actions. Normal 24-hour periods are measured over the past 2 weeks.

    The BCTSQ consists of two separate scales: the Symptom Severity Scale (SSS), which consists of 11 questions, and the Functional Status Scale (FSS), which consists of 8 items and requires participants to rate the difficulty of each item on a five-point scale. A final score is calculated for each scale (the sum of individual scores divided by the number of items) and ranges from 1 to 5, with a higher score indicating more severe disability.

    Measured: up to 12 weeks

  2. Electromyography Examination

    Electromyography (EMG), which is electromyography, is a diagnostic method used to determine the health status of muscles and motor neurons that control muscles.

    Upper extremity nerve conduction studies were performed using supramaximal percutaneous stimulation with a constant current stimulator and surface electrode recording.

    Mild CTS: The difference between the median sensory response distal latency and the ulnar sensory response distal latency is > 1 msec or the difference between the median-ulnar nerve peak latencies recorded at the 4th finger is > 0.5 msec Moderate CTS: In addition to the above, the distal latency of the median motor nerve is prolonged (> 4.0 msec) Severe CTS: Frequently low/absent sensory potential amplitude and decreased motor response amplitude (< 5.0 mV) or delayed latency (> 5.5 msec).

    Measured: up to 12 weeks

  3. Measurement of Radiographic Indices

    Radial Inclination (RE): The angle between a line connecting the radial styloid tip and the ulnar aspect of the distal radius and a second line perpendicular to the longitudinal axis of the radius.

    Measured: up to 12 weeks

  4. Measurement of Radiographic Indices

    Volar Inclination (VE): The angle of the distal radial surface relative to the vertical shaft line. It is evaluated on the lateral radiograph.

    Measured: up to 12 weeks

  5. Measurement of Radiographic Indices

    Carpal Height Ratio (CHR): It is found by measuring the height of the carpal bones vertically and dividing it by the length of the 3rd metacarpal.

    Measured: up to 12 weeks

  6. Measurement of Radiographic Indices

    Wrist Anteroposterior Diameter (APD): The distance between the volar and dorsal edges of the distal radius.

    Measured: up to 12 weeks

  7. Measurement of Radiographic Indices

    Transfers Diameter (TC): The distance between the radial edge of the radius and the ulnar edge of the ulna at the level of the radiocarpal joint.

    Measured: up to 12 weeks

  8. Measurement of Radiographic Indices

    Ulnar Variance (UV): The vertical distance between the articular surface of the ulna head and the lunate facet of the distal radius.

    Measured: up to 12 weeks

  9. Measurement of Radiographic Indices

    Radio-scaphoid Angle (RSA): The angle between the tangential line connecting the palmar proximal and distal edges of the scaphoid and the line drawn to the central medullary canal of the distal radius.

    Measured: up to 12 weeks

  10. Measurement of Radiographic Indices

    Scapholunate Angle (SLA): The angle between the longitudinal axes of the lunate and scaphoid on a lateral radiograph.

    Measured: up to 12 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2025
  2. Study start16 Feb 2025
  3. Primary completion1 May 2025
  4. Study completion1 Jul 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
275 participants (actual)
Target duration
1 Day
IDs, dates and publications
ClinicalTrials.gov ID
NCT06841809
Sponsor's protocol ID
AnkaraTRH-FTR-NK-03
Status last verified
May 2025
First submitted
16 Feb 2025
Last updated
31 Jul 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Uysal T, Ramoglu SI, Basciftci FA, Sari Z. Chronologic age and skeletal maturation of the cervical vertebrae and hand-wrist: is there a relationship? Am J Orthod Dentofacial Orthop. 2006 Nov;130(5):622-8. doi: 10.1016/j.ajodo.2005.01.031.

    PubMed 17110259
  • Ferreira Branco D, Bouvet C, Hamard M, Beaulieu JY, Poletti PA, Boudabbous S. Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging. Eur J Radiol. 2022 Sep;154:110417. doi: 10.1016/j.ejrad.2022.110417. Epub 2022 Jun 22.

    PubMed 35772337
  • Garcia-Elias M, An KN, Amadio PC, Cooney WP, Linscheid RL. Reliability of carpal angle determinations. J Hand Surg Am. 1989 Nov;14(6):1017-21. doi: 10.1016/s0363-5023(89)80053-x.

    PubMed 2584642
  • Okan N, Caboglu F, Mertoglu T, Durakbasa O, Gorgec M. [The measurement of wrist kinematics in children 4 to 16 years old and the comparison of the scapholunate distance with adult values]. Acta Orthop Traumatol Turc. 2004;38(1):30-3. Turkish.

    PubMed 15054295
  • Wang YC, Tseng YC, Chang HY, Wang YJ, Chen CJ, Wu DY. Gender differences in carpal height ratio in a taiwanese population. J Hand Surg Am. 2010 Feb;35(2):252-5. doi: 10.1016/j.jhsa.2009.11.010.

    PubMed 20141895
  • Vaezi T, Hassankhani GG, Ebrahimzadeh MH, Moradi A. Evaluation of Normal Ranges of Wrist Radiologic Indexes in Mashhad Population. Arch Bone Jt Surg. 2017 Nov;5(6):451-458.

    PubMed 29299502
  • Ar Altamimi A, Gharaibeh MA, Shokor MA, Dawod MS, Alswerki MN, Al-Odat OM, Elkhaldi RH. Association between carpal height ratio and ulnar variance in normal wrist radiography. BMC Musculoskelet Disord. 2024 Jul 9;25(1):524. doi: 10.1186/s12891-024-07647-z.

    PubMed 38982384
  • Taillac H, Holzgrefe R, Hao KA, Hones KM, Wright TW, King JJ, Satteson E, Matthias RC. Intercarpal Angles on Hand Versus Wrist Films: Are Hand Radiographs Sufficient for Assessing Intercarpal Angles? J Hand Surg Am. 2024 Dec;49(12):1273.e1-1273.e6. doi: 10.1016/j.jhsa.2023.04.012. Epub 2023 May 27.

    PubMed 37245153
  • Sarhan MY, Altamimi AA, Gharaibeh MA, Akel A, Abu Shokor M, Salem OA, Balbisi B, Abu-Jeyyab M. Evaluation of Normal Ranges of Wrist Radiologic Indexes in Jordanian Population. Orthop Rev (Pavia). 2024 Aug 3;16:120049. doi: 10.52965/001c.120049. eCollection 2024.

    PubMed 39105053
  • Koca N, Nazligul NK. Evaluation of wrist radiographic indices in people with idiopathic carpal tunnel syndrome: a prospective cross-sectional study. Ann Phys Rehabil Med. 2026 Mar;69(2):102068. doi: 10.1016/j.rehab.2025.102068. Epub 2026 Jan 8.

    PubMed 41512671

Questions about this trial

What is this clinical trial studying?

An observational study of Carpal Tunnel Syndrome (CTS) and Wrist, run by Ankara Training and Research Hospital at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Measurement of Radiographic Indices (time frame: up to 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06841809, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Jul 2025.

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