|
1
|
Zaottini F, Pistoia F, Picasso R, Macciò M, Marcenaro G, Grandis M, Benedetti L, Martinoli C. Imaging for inflammatory neuropathies. Best Pract Res Clin Rheumatol 2025:102066. [PMID: 40319002 DOI: 10.1016/j.berh.2025.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 04/16/2025] [Accepted: 04/22/2025] [Indexed: 05/07/2025]
Abstract
Inflammatory neuropathies comprise a heterogeneous group of conditions united by inflammation-mediated damage to peripheral nerves and their vasa nervorum. Although classification, diagnosis and management are largely based on clinical features, electrodiagnostic and laboratory examinations, imaging studies play an important supporting role. Ultrasound and MRI are the two modalities used for imaging peripheral nerves. The two techniques differ in the clinical context of application, the information provided and the diagnostic performance. This narrative review aims to provide guidance on when and how to use ultrasound or MRI in patients with inflammatory neuropathies, highlighting their respective strengths and pitfalls, and how to combine these imaging modalities to enhance their usefulness in the diagnostic-therapeutic management of these far from rare conditions.
Collapse
Affiliation(s)
- Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Division of Radiology, Largo Rosanna Benzi 10, 16132, Genova, Italy; Department of Health Sciences (DISSAL), University of Genova, Via Antonio Pastore 1, 16132, Genova, Italy.
| | - Federico Pistoia
- Department of Health Sciences (DISSAL), University of Genova, Via Antonio Pastore 1, 16132, Genova, Italy.
| | - Riccardo Picasso
- Department of Health Sciences (DISSAL), University of Genova, Via Antonio Pastore 1, 16132, Genova, Italy.
| | - Marta Macciò
- IRCCS Ospedale Policlinico San Martino, Division of Radiology, Largo Rosanna Benzi 10, 16132, Genova, Italy.
| | - Giovanni Marcenaro
- IRCCS Ospedale Policlinico San Martino, Division of Radiology, Largo Rosanna Benzi 10, 16132, Genova, Italy.
| | - Marina Grandis
- IRCCS Ospedale Policlinico San Martino, Division of Neurology, Via Largo Rosanna Benzi 10, 16132, Genova, Italy; Department of Neuroscience (DINOGMI), University of Genova, Genoa, Italy.
| | - Luana Benedetti
- IRCCS Ospedale Policlinico San Martino, Division of Neurology, Via Largo Rosanna Benzi 10, 16132, Genova, Italy.
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Division of Radiology, Largo Rosanna Benzi 10, 16132, Genova, Italy; Department of Health Sciences (DISSAL), University of Genova, Via Antonio Pastore 1, 16132, Genova, Italy.
| |
Collapse
|
|
2
|
Cotteret C, Almazán-Polo J, González-de-la-Flor Á. Shear Wave Elastography of the Sciatic Nerve and Its Relationship with Posterior Chain Flexibility in Healthy Participants: An Observational Study. SENSORS (BASEL, SWITZERLAND) 2025; 25:2885. [PMID: 40363321 PMCID: PMC12074453 DOI: 10.3390/s25092885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2025] [Revised: 04/25/2025] [Accepted: 05/02/2025] [Indexed: 05/15/2025]
Abstract
INTRODUCTION Shear wave elastography (SWE) has been widely used to assess the mechanical properties of peripheral nerves, including the sciatic nerve. However, the relationship between sciatic nerve stiffness and posterior chain flexibility remains unclear. Therefore, we aimed to examine differences in sciatic nerve stiffness and shear wave speed (SWS) based on limb dominance and hamstring flexibility, and to explore their association with posterior chain mobility assessed through AKE and ASLR tests in healthy individuals. METHODS An observational study was conducted on 25 healthy, physically active participants (49 lower limbs). Sciatic nerve stiffness was measured using SWE at a standardized location in the posterior thigh. Posterior chain flexibility was assessed using the Active Knee Extension (AKE) and Active Straight Leg Raise (ASLR) tests. Participants were categorized based on hamstring flexibility, and comparisons were made between dominant and non-dominant limbs. RESULTS Participants with limited hamstring flexibility exhibited significantly higher AKE and ASLR values (p < 0.001) and showed an increased stiffness and SWS towards greater sciatic nerve (p = 0.05), although correlations between SWE values and flexibility tests were not significant. No significant differences were found between dominant and non-dominant limbs in AKE (p = 0.28), ASLR (p = 0.47), SWE (p = 0.38), or SWS (p = 0.34) values. CONCLUSIONS Although no significant correlations were found between SWE parameters and flexibility tests, individuals with limited posterior chain mobility exhibited higher sciatic nerve stiffness in healthy participants.
Collapse
Affiliation(s)
| | - Jaime Almazán-Polo
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, 28670 Villaviciosa de Odón, Spain; (C.C.); (Á.G.-d.-l.-F.)
| | | |
Collapse
|
|
3
|
Lotfi R, Dolatyar B, Zandi N, Tamjid E, Pourjavadi A, Simchi A. Electrically conductive and photocurable MXene-modulated hydrogel conduits for peripheral nerve regeneration: In vitro and in vivo studies. BIOMATERIALS ADVANCES 2025; 170:214197. [PMID: 39889368 DOI: 10.1016/j.bioadv.2025.214197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 01/15/2025] [Accepted: 01/19/2025] [Indexed: 02/03/2025]
Abstract
Electroconductive biomaterials, as advanced nerve guidance conduits (NGCs), have shown great promise to accelerate the rate of peripheral nerve repair and regeneration (PNR) but remain among the greatest challenges in regenerative medicine because of frail recovery. Herein, we introduce injectable nanocomposite nerve conduits based on gelatin methacrylate (GelMa) and MXene nanosheets (MX) for PNR. Microstructural studies determine that the addition of MX increases the mean pore size of GelMa NH from 5.8 ± 1.2 μm to 8.4 ± 1.6 μm for the hydrogel containing 0.25 mg/mL MX, for example, leading to higher swelling and degradation rates. The highest electrical conductivity (∼910 μS/cm) is attained for the GelMa-based nanocomposite composed MX with the concentration of 0.125 mg/mL, for the reason that at higher concentrations, agglomeration of the MXs happens. In vitro investigations, including metabolic activity and live-dead assessments by PC12 cells, reveal the biocompatibility of developed nanocomposite hydrogels (NHs) containing different concentrations of MX nanosheets in the range of 0.025-0.25 mg/mL. Implantation of GelMa-MX conduits in a rat model of peripheral nerve injury (PNI) leads to the impressive recovery of the injured sciatic nerve's sensory, motor, and sensory-motor function. Electrophysiological analysis also indicates a significant increase in compound muscle action potential and nerve conduction velocity with a decrease in terminal latency in animals implanted with GelMa-MX conduits compared to control groups (animals implanted with GelMa and animals without implantation). Moreover, histological analysis exhibits a notable absence of fibrous connective tissue in the regenerated nerve fibers with a substantial increase in more organized myelinated axons. Our results demonstrate that GelMa-MX conduits promote regeneration of the injured sciatic nerve and could be promising for peripheral nerve tissue engineering.
Collapse
Affiliation(s)
- Roya Lotfi
- Institute for Convergence Science & Technology and Department of Materials Science and Engineering, Sharif University of Technology, Tehran 14588-89694, Iran.
| | - Banafsheh Dolatyar
- Developmental Biology Lab., School of Biology, College of Science, University of Tehran, Tehran, Iran.
| | - Nooshin Zandi
- Institute for Convergence Science & Technology and Department of Materials Science and Engineering, Sharif University of Technology, Tehran 14588-89694, Iran.
| | - Elnaz Tamjid
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, P.O. Box 14115-175, Tehran, Iran; Advanced Ceramics, University of Bremen, 28352 Bremen, Germany.
| | - Ali Pourjavadi
- Department of Chemistry, Sharif University of Technology, P.O. Box 11365-9516, Tehran, Iran.
| | - Abdolreza Simchi
- Institute for Convergence Science & Technology and Department of Materials Science and Engineering, Sharif University of Technology, Tehran 14588-89694, Iran; Fraunhofer Institute for Manufacturing Technology and Advanced Materials, 28359 Bremen, Germany.
| |
Collapse
|
|
4
|
Nordenfur T, Caidahl K, Lindberg L, Urban MW, Larsson M. Safety of Shear Wave Elastography as Evidenced From Carotid Artery Strain and Strain Rate Induced by Acoustic Radiation Force Impulse and Arterial Pulsations. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:742-750. [PMID: 39920002 DOI: 10.1016/j.ultrasmedbio.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 12/05/2024] [Accepted: 12/10/2024] [Indexed: 02/09/2025]
Abstract
OBJECTIVE The aim of this study was to investigate the mechanical effects of carotid shear wave elastography (SWE) in vivo as its effects on the arterial wall have not been thoroughly examined. METHODS We evaluated the mechanical effects of carotid SWE in vivo in terms of the radial strain and strain rate to which acoustic radiation force impulses (ARFIs) expose the arterial wall, and compared them with the strain and strain rate induced by arterial pulsation in 13 healthy study subjects (seven individuals 20-35 y of age and six individuals 50-65 y of age). Additionally, we explored whether mechanical effects vary with timing of ARFI and subject age. RESULTS The young cohort was found to have, compared with the old cohort, a higher diastolic ARFI-induced peak strain (p = 0.002) and peak strain rate (p = 0.001), and a lower diastolic ARFI-induced peak negative strain rate (p = 0.013). When comparing cardiac phases, diastolic ARFIs were found to induce a lower peak negative strain rate than systolic ARFIs (p = 0.006). Importantly, ARFI-induced peak strain was lower than that caused by arterial pulsation in both age cohorts (p < 0.0001). The ARFI-induced peak strain rate was slightly higher than that caused by arterial pulsation at rest but lower than published exercise data. The ARFI-induced peak negative strain rate was similar to that caused by arterial pulsation. CONCLUSION Our results indicate that arterial SWE does not expose the arterial wall to any higher strain or strain rate than is experienced during normal arterial pulsation. Further research is required to validate the results in arteries containing vulnerable plaques.
Collapse
Affiliation(s)
- Tim Nordenfur
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Lindberg
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
|
5
|
Gurun E, Ozturk M, Cakir IM, Genc AS, Bozduman O, Sazak HB, Okutan AE. The Efficacy of Shear Wave Elastography in Evaluating Treatment Response to US-Guided Steroid Injection in Patients with Carpal Tunnel Syndrome. Acad Radiol 2025; 32:2815-2821. [PMID: 39788812 DOI: 10.1016/j.acra.2024.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 12/17/2024] [Accepted: 12/19/2024] [Indexed: 01/12/2025]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the efficacy of ultrasound (US)-guided local steroid injection in carpal tunnel syndrome (CTS) using shear wave elastography (SWE). MATERIALS AND METHODS A total of 47 wrists from 41 patients diagnosed with mild to moderate idiopathic CTS, based on clinical and electrophysiological criteria, were enrolled between June and October 2024. All participants underwent US-guided local steroid injection. Pre- and post-injection assessments included measurement of the median nerve's cross-sectional area (CSA) and evaluation of its elasticity through shear wave velocity (m/s) and Young's modulus (kPa). Clinical outcomes were assessed before and 6 weeks after the injection using the Visual Analog Scale (VAS), the Boston Questionnaire-Symptom Severity Scale (BQ-SSS), and the Boston Questionnaire-Functional Status Scale (BQ-FSS). The clinical scores before and after the injection were compared to the corresponding US and SWE measurements. RESULTS Prior to steroid injection, the median nerve CSA was 15.53±4.28mm², shear wave velocity was 4.01±0.27m/s, and Young's modulus was 49.03±6.90kPa. Six weeks following the injection, significant reductions were observed in these parameters, with CSA decreasing to 12.04±2.59mm², shear wave velocity to 3.03±0.22m/s, and Young's modulus to 28.09±4.16kPa (p<0.001 for each). Clinical scores also demonstrated significant improvement, with VAS decreasing from 7.12±1.09 to 2.91±0.86, BQ-SSS from 38.36±4.97 to 21.36±3.50, and BQ-FSS from 23.72±3.81 to 13.27±1.65 (p<0.001 for all). CONCLUSION US-guided steroid injection improves clinical symptoms and reduces the CSA and nerve elasticity in CTS patients six weeks post-treatment.
Collapse
Affiliation(s)
- Enes Gurun
- Department of Radiology, Samsun University Faculty of Medicine, Samsun, Turkey (E.G., M.O., I.M.C., H.B.S.).
| | - Mesut Ozturk
- Department of Radiology, Samsun University Faculty of Medicine, Samsun, Turkey (E.G., M.O., I.M.C., H.B.S.)
| | - Ismet Mirac Cakir
- Department of Radiology, Samsun University Faculty of Medicine, Samsun, Turkey (E.G., M.O., I.M.C., H.B.S.)
| | - Ahmet Serhat Genc
- Department of Orthopedics and Traumatology, Samsun Training And Research Hospital, Samsun, Turkey (A.S.G.)
| | - Omer Bozduman
- Department of Orthopedics and Traumatology, Memorial Antalya Hospital, Antalya, Turkey (O.B.)
| | - Hunkar Burak Sazak
- Department of Radiology, Samsun University Faculty of Medicine, Samsun, Turkey (E.G., M.O., I.M.C., H.B.S.)
| | - Ahmet Emin Okutan
- Department of Orthopedics and Traumatology, Samsun University Faculty of Medicine, Samsun, Turkey (A.E.O.)
| |
Collapse
|
|
6
|
Dag N. Ultrasound and Shear Wave Elastography From Diagnosis to Assessment of Treatment Efficacy in Carpal Tunnel Syndrome. Acad Radiol 2025; 32:2822-2823. [PMID: 40090793 DOI: 10.1016/j.acra.2025.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Accepted: 03/08/2025] [Indexed: 03/18/2025]
Affiliation(s)
- Nurullah Dag
- Inonu University, Department of Radiology, 44280 Malatya, Turkey.
| |
Collapse
|
|
7
|
Nitayarak H, Toleama A, Madiyoh N, Mahae N, Pedpak R, Charntaraviroj P. The effect of computer use on pain, grip strength, and upper limb neural tension in female undergraduate students: A matched-pair study. Work 2025; 81:2139-2147. [PMID: 39973727 DOI: 10.1177/10519815241303333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
BackgroundFemale university students frequently complain of computer-related neck pain after one hour of use, which may cause changes in grip strength and nerve tension in the upper extremity.ObjectiveThe purpose of this study was to compare neck pain intensity, grip strength and upper limb neural tension, before and after an hour of computer use between female students with and without neck pain.MethodThere were 36 female students recruited, which were then divided into the neck pain group (n = 18) and the asymptomatic group (n = 18). Pain intensity, hand grip strength, and neurodynamic testing of the upper extremity were evaluated before and after typing a document on a computer for one hour.ResultsThere was an increase in neck pain, a decrease in grip strength, and an increase in nerve tension of the median, radial, and ulnar nerves after computer use. However, when comparing between groups, the neck pain group had a significantly greater increase in the tension of only the right median and left ulnar nerves compared to the asymptomatic group.ConclusionThe current findings demonstrated that an hour spent on a computer can increase neck pain, reduce grip strength, and produce neural tension of upper extremities. However, female students with neck pain had greater increase tension within the median and ulnar nerves, which may result in upper extremity impairment.
Collapse
Affiliation(s)
- Haifah Nitayarak
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anitya Toleama
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Nurfatee Madiyoh
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Nooreesan Mahae
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Ranuka Pedpak
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Pornpimol Charntaraviroj
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| |
Collapse
|
|
8
|
Cao W, Pomeroy MJ, Liang Z, Gao Y, Shi Y, Tan J, Han F, Wang J, Ma J, Lu H, Abbasi AF, Pickhardt PJ. Lesion Classification by Model-Based Feature Extraction: A Differential Affine Invariant Model of Soft Tissue Elasticity in CT Images. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2025; 38:804-818. [PMID: 39164453 PMCID: PMC11950485 DOI: 10.1007/s10278-024-01178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/29/2024] [Accepted: 06/14/2024] [Indexed: 08/22/2024]
Abstract
The elasticity of soft tissues has been widely considered a characteristic property for differentiation of healthy and lesions and, therefore, motivated the development of several elasticity imaging modalities, for example, ultrasound elastography, magnetic resonance elastography, and optical coherence elastography to directly measure the tissue elasticity. This paper proposes an alternative approach of modeling the elasticity for prior knowledge-based extraction of tissue elastic characteristic features for machine learning (ML) lesion classification using computed tomography (CT) imaging modality. The model describes a dynamic non-rigid (or elastic) soft tissue deformation in differential manifold to mimic the tissues' elasticity under wave fluctuation in vivo. Based on the model, a local deformation invariant is formulated using the 1st and 2nd order derivatives of the lesion volumetric CT image and used to generate elastic feature map of the lesion volume. From the feature map, tissue elastic features are extracted and fed to ML to perform lesion classification. Two pathologically proven image datasets of colon polyps and lung nodules were used to test the modeling strategy. The outcomes reached the score of area under the curve of receiver operating characteristics of 94.2% for the polyps and 87.4% for the nodules, resulting in an average gain of 5 to 20% over several existing state-of-the-art image feature-based lesion classification methods. The gain demonstrates the importance of extracting tissue characteristic features for lesion classification, instead of extracting image features, which can include various image artifacts and may vary for different protocols in image acquisition and different imaging modalities.
Collapse
Affiliation(s)
- Weiguo Cao
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Marc J Pomeroy
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA
- Departments of Radiology and Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Zhengrong Liang
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA.
- Departments of Radiology and Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Yongfeng Gao
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Yongyi Shi
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Jiaxing Tan
- Department of Computer Science, City University of New York, New York, NY, 10314, USA
| | - Fangfang Han
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Centre, Dallas, TX, 75235, USA
| | - Jianhua Ma
- Department of Radiation Oncology, University of Texas Southwestern Medical Centre, Dallas, TX, 75235, USA
| | - Hongbin Lu
- Department of Biomedical Engineering, The Fourth Medical University, Xi'an, China
| | - Almas F Abbasi
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Perry J Pickhardt
- Department of Radiology, School of Medicine, University of Wisconsin, Madison, WI, 53792, USA
| |
Collapse
|
|
9
|
Hirono T, Vieira TM, Botter A, Watanabe K. Hip posture affects the firing properties of motor units in the tibialis anterior muscle. J Neurophysiol 2025; 133:1074-1082. [PMID: 40038067 DOI: 10.1152/jn.00448.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/25/2024] [Accepted: 02/27/2025] [Indexed: 03/06/2025] Open
Abstract
In this study, we contend the firing properties of motor units change due to nonphysiological sources. We specifically ask whether changes in the fibular nerve length, without a concurrent change in tibialis anterior architecture, affect motor unit firing and recruitment strategies. We tested this hypothesis based on high-density surface electromyograms (EMGs) collected from the tibialis anterior of 18 healthy young adults for two hip postures, flexed and extended. To control for changes in peripheral nerve length, conduction time between electrical stimulation and generation of compound action potentials in extensor digitorum brevis was measured for the two hip postures during rest. Motor units were decomposed from EMGs obtained during sustained isometric dorsiflexion at 10% of the maximal voluntary contraction (MVC), and during ramp isometric contractions up to 20% MVC. Individual motor unit firings were identified and tracked between the two postures. Nerve conduction time was significantly shorter in hip flexed than in hip extended posture (P < 0.01), suggesting that peripheral nerve was stretched in the flexed hip posture. MVC torque was not different between flexed and extended postures (P = 0.254). Motor unit firing rates during sustained contraction at 10% of MVC, and during ramp-up contraction to 20% of MVC were significantly lower during flexed hip posture than during extended hip posture (P < 0.05). Hip flexion posture, which likely result in a stretching of the fibular nerve, was observed to reduce the average firing rate of active motor units during relatively low contractions.NEW & NOTEWORTHY Peripheral nerve condition can affect motor unit activations. Sciatic and fibular nerves are stretched by ankle dorsiflexion, knee extension, and hip flexion. Hip flexion posture, which likely result in a stretching of the fibular nerve, was observed to reduce the average firing rate of active motor units during relatively low contraction. Proximal joint posture, which does not directly influence muscle architecture, should be considered to interpret neural input properties.
Collapse
Affiliation(s)
- Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, Turin, Italy
| | - Alberto Botter
- Laboratorio di Ingegneria del Sistema Neuromuscolare (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, Turin, Italy
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| |
Collapse
|
|
10
|
Balogh D, Kociolek AM. The Median Nerve Displays Adaptive Characteristics When Exposed to Repeated Pinch Grip Efforts of Varying Rates of Force Development: An Ultrasonic Investigation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025; 44:727-738. [PMID: 39692085 PMCID: PMC11892086 DOI: 10.1002/jum.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/14/2024] [Accepted: 12/03/2024] [Indexed: 12/19/2024]
Abstract
OBJECTIVES Repeated gripping with high grip forces and high rates of grip force development are risk factors for carpal tunnel syndrome. As the nerve's adaptive ability is crucial to prevent disease progression, we investigated how these risk factors influence median nerve deformation and displacement over the time course of a repeated pinch grip task. METHODS Seventeen healthy participants performed a repeated grip task against a load cell while their carpal tunnel was scanned with ultrasound. The grip task involved pulp-pinching three consecutive times from 0 to 40% maximal voluntary exertion (MVE), performed at three different rates of force development (RFD): 40% MVE/1 second; 2 seconds; and 5 seconds. Ultrasound images were analyzed at 10% MVE intervals. Nerve circularity, width, height, and cross-sectional area were measured to assess deformation. Median nerve displacement was assessed by its change in position relative to the flexor digitorum superficialis tendon of the third digit (FD) in both radioulnar and palmodorsal axes. RESULTS Linear mixed modeling indicated that median nerve deformation increased, becoming more circular, with each repeated pulp-pinch (P < .01) and with grip force magnitude (P < .01). However, a faster RFD decreased nerve deformation (P < .01). Furthermore, the nerve displaced ulnarly during pulp-pinching, with greater displacement during the fastest (ie, 40% MVE/1 second) RFD (P < .01). CONCLUSIONS The median nerve deformed and displaced in response to pulp-pinching; however, faster rates of force development hindered this adaptive response. This likely reflects the viscoelastic properties of the healthy nerve and subsynovial connective tissue, highlighting the importance of tissue compliance in preventing nerve compression.
Collapse
Affiliation(s)
- Denise Balogh
- Canadian Center for Rural and Agricultural HealthUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Aaron M. Kociolek
- School of Physical and Health EducationNipissing UniversityNorth BayOntarioCanada
| |
Collapse
|
|
11
|
Kim J, Kim MW, Kim JM. Enhanced diagnosis and severity assessment of carpal tunnel syndrome using combined shear wave elastography and cross-sectional area analysis: A prospective case-control study. PLoS One 2025; 20:e0320011. [PMID: 40127092 PMCID: PMC11932468 DOI: 10.1371/journal.pone.0320011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 02/12/2025] [Indexed: 03/26/2025] Open
Abstract
Carpal tunnel syndrome (CTS) is a prevalent neuropathy resulting from median nerve compression, typically diagnosed through electrodiagnostic studies. Shear wave elastography (SWE) has emerged as an essential imaging technique, especially in evaluating tissue elasticity, which could enhance the diagnosis and severity assessment of CTS. This study aimed to examine the combined effect of the median nerve's cross-sectional area (CSA) and elasticity assessed through SWE in diagnosing CTS and evaluating its severity. A total of 50 participants were involved in this prospective study, with 99 wrists analyzed (51 affected by CTS and 48 normal controls). Measurements of both CSA and elasticity were taken at the carpal tunnel inlet. The findings indicated that CSA and elasticity were considerably higher in CTS patients than in the controls. The combined parameter of CSA × elasticity outperformed other measures for differentiating between normal and CTS cases (Area Under the Curve 0.91, sensitivity 0.90, specificity 0.83, cutoff 753.7 kPa·mm²). This combined metric also showed potential for distinguishing CTS severity levels, particularly between mild and severe cases. Although CSA and elasticity alone had limitations in severity classification, their combined values illustrated significant distinctions across severity levels. Integrating SWE with CSA notably improves diagnostic accuracy for CTS and shows potential for severity grading. This approach offers a more detailed evaluation of the structural and mechanical changes in the median nerve, potentially enhancing both the diagnosis and management of CTS.
Collapse
Affiliation(s)
- Jaewon Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
|
12
|
Grönfors H, Mäkelä K, Himanen SL. Shear Wave Velocity of the Thenar Muscle Is Associated With the Neurophysiologic Severity of Carpal Tunnel Syndrome. J Clin Neurophysiol 2025:00004691-990000000-00213. [PMID: 40102207 DOI: 10.1097/wnp.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025] Open
Abstract
PURPOSE Aim of the study was to examine the associations between abductor pollicis brevis (APB) muscle stiffness evaluated by shear wave elastography and electrodiagnostic study findings in patients with carpal tunnel syndrome. The association between shear wave elastography and APB muscle echogenicity was also examined. METHODS This prospective study included patients who were referred to electrodiagnostic studies because of upper limb symptoms. The electrodiagnostic studies consisted of nerve conduction studies and needle-electromyography. Abductor pollicis brevis muscle shear wave velocity was measured, and muscle echogenicity assessed using the Heckmatt grading scale. RESULTS In total, 97 hands were included in the nerve conduction studies. Of these, 53 APB muscles were further examined with needle-electromyography. Shear wave velocity correlated positively with the neurophysiologic severity of carpal tunnel syndrome (r = 0.449, P = 0.028, N = 26). Mean shear wave velocity was faster in the APB muscles with neurogenic findings (mean 2.72 m/second, ±SD 0.36) than muscles with normal findings (2.48 m/second, ±SD 0.34, P = 0.036). In receiver operating characteristic analysis, the best shear wave velocity cutoff value was 2.66 m/second. With this cutoff value, the sensitivity was 0.692, while the 1-specificity was 0.233. Only seven APB muscles showed increased echogenicity. CONCLUSIONS Shear wave velocity of APB muscle is positively associated with the neurophysiologic severity of carpal tunnel syndrome. Carpal tunnel syndrome-related axonal damage also seems to increase shear wave velocity in APB muscle; however, according to the receiver operating characteristic analysis, the method is not yet suitable for clinical use to define muscle denervation. The findings of this study show that shear wave elastography has potential as an additional clinical tool in the diagnostics of carpal tunnel syndrome.
Collapse
Affiliation(s)
- Henri Grönfors
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; and
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; and
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| |
Collapse
|
|
13
|
Rugel CL, Thompson SD, Franz CK, Heckman CJ, Lavasani M, Lee SSM. Stress and stiffness as predictors of shear wave velocity in peripheral nerve. PLoS One 2025; 20:e0319439. [PMID: 40067855 PMCID: PMC11896041 DOI: 10.1371/journal.pone.0319439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/01/2025] [Indexed: 03/15/2025] Open
Abstract
Shear wave elastography (SWE) is a promising non-invasive indicator for diagnosing peripheral neuropathy. Emerging validation studies using ultrasound-based measures of shear wave velocity (SWV) in other biological tissues, such as muscle, demonstrate there is a concern of whether SWE is an accurate measure of tensile stress or stiffness. Distinguishing between these two parameters and their relationship with SWV is crucial if SWE is to be used as a biomarker for peripheral neuropathies, where changes in mechanical properties are known to occur. In this study, we use cat sciatic nerves to first evaluate SWV in situ at knee positions known to reduce (90° flexion) or increase (180° extension) stress, and then excise nerves to directly quantify the relationships between SWV, stress, and stiffness with ex vivo tensile testing. Our ex vivo findings show that although SWV can be predicted using either stress or stiffness, stress explains more variability in sciatic nerve SWV. However, while stress remains the better predictor of SWV ex vivo, within the SWV range established in situ, stiffness improves its accuracy at estimating SWV, especially when also accounting for factors related to nerve viscoelasticity. Therefore, if SWE is to be used in clinical settings as an indicator of nerve stiffness in peripheral neuropathy, it is essential to standardize parameters such as limb positioning and nerve preloading, which could potentially mask pathological changes in nerve stiffness.
Collapse
Affiliation(s)
- Chelsea L. Rugel
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Seth D. Thompson
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Colin K. Franz
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - C. J. Heckman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Mitra Lavasani
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Sabrina S. M. Lee
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
|
14
|
Zou Q, Guo X, Ni X, Chen X, Xu C, Yin Y, Huang C. Ultrasound-based grading of carpal tunnel syndrome: a comparative study of cross-sectional area and shear wave elastography at different wrist joint angles. Br J Radiol 2025; 98:58-67. [PMID: 39288303 DOI: 10.1093/bjr/tqae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 08/17/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) is a prevalent neuropathy where accurate diagnosis is crucial for effective treatment planning. This study introduces a novel approach for CTS grading using ultrasound, specifically through the analysis of the cross-sectional area (CSA) and shear wave elastography (SWE) of the median nerve in various wrist positions. METHODS Our research involved subjects from outpatient clinics, diagnosed with CTS through nerve conduction studies (NCS), and a control group of healthy individuals. High-frequency ultrasound and SWE measurements were conducted in 3 wrist positions: straight, 45° extension, and 45° flexion. RESULTS The key findings revealed significant differences in median nerve CSA and SWE values between the CTS and control groups across all wrist positions, with notable variances in SWE values correlating with wrist positioning. SWE demonstrated enhanced sensitivity and specificity in distinguishing between mild, moderate, and severe CTS, especially at 45° wrist flexion. In contrast, CSA measurements were limited in differentiating between the varying severity stages of CTS. CONCLUSIONS The study concludes that SWE, particularly at 45° wrist flexion, provides a more precise diagnostic benchmark for CTS severity grading than CSA. This advancement in non-invasive diagnostic methodology not only aids in accurate CTS grading but also has significant implications in formulating tailored treatment strategies, potentially reducing the reliance on more invasive diagnostic methods like NCS. ADVANCES IN KNOWLEDGE This study marks a significant advancement in the ultrasound diagnosis of CTS. It particularly highlights the importance of applying SWE technology across various wrist joint angles, offering a new diagnostic benchmark. This discovery provides data support and additional insights for achieving an early consensus on ultrasound-based grading diagnosis of CTS.
Collapse
Affiliation(s)
- Qijiu Zou
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xiaoli Guo
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xuejun Ni
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xiaoyang Chen
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Cheng Xu
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Yifei Yin
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Chen Huang
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| |
Collapse
|
|
15
|
Tomažin T, Pušnik L, Albano D, Jengojan SA, Snoj Ž. Multiparametric Ultrasound Assessment of Carpal Tunnel Syndrome: Beyond Nerve Cross-sectional Area. Semin Musculoskelet Radiol 2024; 28:661-671. [PMID: 39561748 DOI: 10.1055/s-0044-1790561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Carpal tunnel syndrome (CTS), the most common mononeuropathy, results from compression of the median nerve within the fibro-osseous carpal tunnel. Diagnosis is typically based on clinical evaluation and confirmed by nerve conduction studies. However, ultrasound (US) has emerged as a valuable noninvasive adjunct for CTS confirmation, offering potential advantages over electrodiagnostic testing in terms of patient comfort and diagnostic accuracy. This review begins with a concise summary of carpal tunnel anatomy and CTS pathophysiology as a foundation for exploring the diverse applications of US in CTS evaluation. B-mode US assessment is presented with a focus on cross-sectional imaging and dynamic evaluations, including the transverse translocation and longitudinal gliding of the median nerve. We also review current methods for assessing vascularization in CTS and explore the usefulness of elastography in CTS evaluation. The advantages and limitations of each US method are elucidated, highlighting their practical utility in clinical practice.
Collapse
Affiliation(s)
- Tjaša Tomažin
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Suren Armeni Jengojan
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Žiga Snoj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
16
|
Prakash A, Vinutha H, Janardhan DC, Mouna RM, Sushmitha PS, Sajjan S, Samanvitha H. Diagnostic efficacy of high-frequency Grey-scale ultrasonography and Sono-elastography in grading the severity of carpal tunnel syndrome in comparison to nerve conduction studies. Skeletal Radiol 2024; 53:2399-2408. [PMID: 38526811 DOI: 10.1007/s00256-024-04662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To correlate the cross-sectional area (CSA) and elasticity of the median nerve (MN) measured at carpal tunnel inlet between healthy controls and various degrees of carpal tunnel syndrome (CTS) graded as per nerve conduction studies (NCS). MATERIALS AND METHODS A total of 53 patients (with 81 wrists) presenting with clinical symptoms characteristic of CTS, having their diagnosis confirmed and severity graded by NCS, and 48 healthy controls (with 96 wrists) were included in the study. All the study participants underwent wrist ultrasound which included initial Grey-scale USG followed by strain and shear wave elastography. The CSA and elasticity (in terms of strain ratio and shear modulus) of MN were measured at the carpal tunnel inlet. Statistical analysis was performed using the Mann-Whitney U test to compare between the two groups and for subgroup analysis of cases. The diagnostic performance of each variable was evaluated using the receiver operating characteristic curves. RESULTS The mean CSA was 9.20 ± 1.64, 11.48 ± 1.05, 14.83 ± 1.19 and 19.87 ± 2.68 mm2, the mean shear modulus was 17.93 ± 2.81, 23.59 ± 2.63, 32.99 ± 4.14 and 54.26 ± 9.24 kPa and the mean strain ratio was 5.26 ± 0.68, 5.56 ± 0.70, 7.03 ± 0.47 and 8.81 ± 0.94 in control, mild, moderate and severe grades of CTS, respectively (p < 0.001). CONCLUSION The combined utility of Grey-scale USG and Elastography may serve as a painless and cost-effective alternative to NCS in grading the severity of CTS.
Collapse
Affiliation(s)
- Arjun Prakash
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - H Vinutha
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
| | - D C Janardhan
- Department of Neurology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - R Mohit Mouna
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - P S Sushmitha
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Shantkumar Sajjan
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - H Samanvitha
- Department of Radiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| |
Collapse
|
|
17
|
Wolny T, Glibov K, Wieczorek M, Gnat R, Linek P. Changes in Ultrasound Parameters of the Median Nerve at Different Positions of the Radiocarpal Joint in Patients with Carpal Tunnel Syndrome. SENSORS (BASEL, SWITZERLAND) 2024; 24:4487. [PMID: 39065886 PMCID: PMC11281217 DOI: 10.3390/s24144487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position.
Collapse
Affiliation(s)
- Tomasz Wolny
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Katarzyna Glibov
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Military Medical Academy, Memorial Teaching H of The Medical University of Lodz—Central Veterans Hospital, 90-419 Lodz, Poland;
| | - Michał Wieczorek
- Department of Neurological Rehabilitation, The Health Center in Mikołów Ltd., 43-190 Mikołów, Poland;
| | - Rafał Gnat
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| |
Collapse
|
|
18
|
Zhang H, Elfar JC, Kwoh CK, Li ZM. Shear wave elastography of transverse carpal ligament increased with simulated carpal tunnel pressure. J Orthop Surg Res 2024; 19:389. [PMID: 38956611 PMCID: PMC11221182 DOI: 10.1186/s13018-024-04874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model. METHODS Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL. RESULTS SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996). CONCLUSION The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome.
Collapse
Affiliation(s)
- Hui Zhang
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA
| | - John C Elfar
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA
| | - C Kent Kwoh
- Arthritis Center, University of Arizona, Tucson, AZ, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.
- Arthritis Center, University of Arizona, Tucson, AZ, USA.
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA.
| |
Collapse
|
|
19
|
Martikkala L, Pemmari A, Himanen SL, Mäkelä K. Median Nerve Shear Wave Elastography Is Associated With the Neurophysiological Severity of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1253-1263. [PMID: 38516753 DOI: 10.1002/jum.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This study examines the associations between the median nerve (MN) shear wave elastography (SWE), the MN cross-sectional area (CSA), patient's symptoms, and the neurophysiological severity of carpal tunnel syndrome (CTS). The most appropriate site to perform SWE was also tested. METHODS This prospective study comprised 86 wrists of 47 consecutive patients who volunteered for MN ultrasound after an electrodiagnostic study. The neurophysiological severity of CTS was assessed according to the results of a nerve conduction study (NCS). The MN CSA was measured at the carpal tunnel inlet (wCSA) and the forearm (fCSA). SWE was performed on the MN in a longitudinal orientation at the wrist crease (wSWE), at the forearm (fSWE), and within the carpal tunnel (tSWE). RESULTS The wCSA and wSWE correlated positively with the neurophysiological severity of CTS (r = .619, P < .001; r = .582, P < .001, respectively). The optimal cut-off values to discriminate the groups with normal NCS and with findings indicating CTS were 10.5 mm2 for the wCSA and 4.12 m/s for the wSWE. With these cut-off values, wCSA had a sensitivity of 80% and specificity of 87% and wSWE a sensitivity of 88% and specificity of 76%. Neither tSWE nor fSWE correlated with the neurophysiological severity of CTS or differed between NCS negative and positive groups (P = .429, P = .736, respectively). CONCLUSION Shear wave velocity in the MN at the carpal tunnel inlet increases in CTS and correlates to the neurophysiological CTS severity equivalently to CSA measured at the same site.
Collapse
Affiliation(s)
- Lauri Martikkala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Pemmari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| |
Collapse
|
|
20
|
El-Maghraby AM, Almalki YE, Basha MAA, Nada MG, El Ahwany F, Alduraibi SK, Alshehri SHS, Aldhilan AS, Almushayti ZA, Alduraibi AK, Aboualkheir M, Attia O, Amer MM, Basha AMA, Eladl IM. Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study. Orthop Res Rev 2024; 16:111-123. [PMID: 38741666 PMCID: PMC11090190 DOI: 10.2147/orr.s459993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28-57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results CSAu and CSAu-CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.
Collapse
Affiliation(s)
- Ahmed Mohamed El-Maghraby
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, 61441, Kingdom of Saudi Arabia
| | | | - Mohamad Gamal Nada
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Fatma El Ahwany
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Shaker Hassan S Alshehri
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Mervat Aboualkheir
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah, 42361Kingdom of Saudi Arabia
| | - Osama Attia
- Department of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Mona M Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | - Ibrahim M Eladl
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| |
Collapse
|
|
21
|
Neto T, Johannsson J, Andrade RJ. Using ultrasound shear wave elastography to characterize peripheral nerve mechanics: a systematic review on the normative reference values in healthy individuals. Ultrasonography 2024; 43:169-178. [PMID: 38544459 PMCID: PMC11079506 DOI: 10.14366/usg.23211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 05/09/2024] Open
Abstract
Ultrasound shear wave elastography (SWE) is an emerging non-invasive imaging technique for peripheral nerve evaluation. Shear wave velocity (SWV), a surrogate measure of stiffness, holds promise as a biomarker for various peripheral nerve disorders. However, to maximize its clinical and biomechanical value, it is important to fully understand the factors that influence nerve SWV measurements. This systematic review aimed to identify the normal range of SWV for healthy sciatic and tibial nerves and to reveal the factors potentially affecting nerve SWV. An electronic search yielded 17 studies eligible for inclusion, involving 548 healthy individuals (age range, 17 to 72 years). Despite very good reliability metrics, the reported SWV values differed considerably across studies for the sciatic (1.9-9.9 m/s) and tibial (2.3-9.1 m/s) nerves. Factors such as measurement proximity to joint regions, limb postures inducing nerve axial stretching, and transducer alignment with nerve fiber orientation were associated with increased SWV. These findings suggest regional-specific nerve mechanical properties, non-linear elastic behaviour, and marked mechanical anisotropy. The impact of age and sex remains unclear and warrants further investigation. These results emphasize the importance of considering these factors when assessing and interpreting nerve SWE. While increased SWV has been linked to pathological changes affecting nerve tissue mechanics, the significant variability observed in healthy nerves highlights the need for standardized SWE assessment protocols. Developing guidelines for enhanced clinical utility and achieving a comprehensive understanding of the factors that influence nerve SWE assessments are critical in advancing the field.
Collapse
Affiliation(s)
- Tiago Neto
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Johanna Johannsson
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Ricardo J. Andrade
- Nantes University, Movement - Interactions - Performance, MIP, UR 4334, 44000, Nantes, France
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| |
Collapse
|
|
22
|
Dąbrowska A, Paluch Ł, Walecka I, Żelewska M, Noszczyk B. Elastography of nerves in the wrists of cyclists. Pol J Radiol 2024; 89:e204-e210. [PMID: 38783911 PMCID: PMC11112416 DOI: 10.5114/pjr.2024.139040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/19/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose This study aimed to investigate changes in the elasticity of the median and ulnar nerves in cyclists. Material and methods The study included 30 cyclists and 2 non-biking reference groups that included 32 healthy volunteers and 32 individuals with ulnar nerve entrapment neuropathies. All participants underwent physical, ultrasonographic, and elastographic examinations including assessment of nerve cross-sectional area (CSA) and stiffness (SWE). The cyclists' group was tested before and after a 2-hour workout. Results The values of ulnar nerve CSA and stiffness in Guyon's canal in resting cyclists were 5.30 ± 1.51 mm2 and 49.05 ± 11.18 kPa, respectively. These values were significantly higher than in the healthy volunteers, but not higher than in the nerve entrapment group. Median nerve CSA and stiffness at rest were 9.10 ± 2.61 mm2 and 38.54 ± 14.87 kPa, respectively. Both values were higher than respective values in the healthy group. Cycling induced an increase in all these parameters, although the increase in nerve stiffness was more noticeable than in CSA. Conclusions The elasticity of the median and ulnar nerve in cyclists remains within normal limits, questioning the belief that cyclists are at risk of nerve palsy in Guyon's canal. However, cycling workout does exert compression, resulting in transient oedema of both nerves. The dynamics of changes was more noticeable in SWE examination than in conventional ultrasound, which may depend on SWE sensitivity.
Collapse
Affiliation(s)
- Agnieszka Dąbrowska
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Łukasz Paluch
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Irena Walecka
- Department of Dermatology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the MSWiA, Warsaw, Poland
| | - Marta Żelewska
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Bartłomiej Noszczyk
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| |
Collapse
|
|
23
|
Xu R, Ren L, Zhang X, Qian Z, Wu J, Liu J, Li Y, Ren L. Non-invasive in vivo study of morphology and mechanical properties of the median nerve. Front Bioeng Biotechnol 2024; 12:1329960. [PMID: 38665817 PMCID: PMC11043530 DOI: 10.3389/fbioe.2024.1329960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The current literature studied the median nerve (MN) at specific locations during joint motions. As only a few particular parts of the nerve are depicted, the relevant information available is limited. This experiment investigated the morphological and biomechanical properties of the MN. The effects of the shoulder and wrist motions on MN were explored as well. Eight young healthy female individuals were tested with two-dimensional ultrasound and shear wave elastography (SWE). The morphological and biomechanical properties were examined in limb position 1, with the wrist at the neutral position, the elbow extended at 180°, and the shoulder abducted at 60°. In addition, the experiment assessed the differences among the wrist, forearm, elbow, and upper arm with Friedman's test and Bonferroni post hoc analysis. Two groups of limb positions were designed to explore the effects of shoulder movements (shoulder abducted at 90° and 120°) and wrist movements (wrist extended at 45° and flexed at 45°) on the thickness and Young's modulus. Differences among the distributions of five limb positions were tested as well. The ICC3, 1 values for thickness and Young's modulus were 0.976 and 0.996, respectively. There were differences among the MN thicknesses of four arm locations in limb position 1, while Young's modulus was higher at the elbow and wrist than at the forearm and upper arm. Compared to limb position 1, only limb position 4 had an effect on MN thickness at the wrist. Both shoulder and wrist motions affected MN Young's modulus, and the stiffness variations at typical locations all showed a downward trend proximally in all. The distributions of MN thickness and Young's modulus showed fold line patterns but differed at the wrist and the pronator teres. The MN in the wrist is more susceptible to limb positions, and Young's modulus is sensitive to nerve changes and is more promising for the early diagnosis of neuropathy.
Collapse
Affiliation(s)
- Ruixia Xu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Xiao Zhang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, China
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Jianan Wu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Jing Liu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Ying Li
- Editorial Department of Journal of Bionic Engineering, Jilin University, Changchun, China
| | - Luquan Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| |
Collapse
|
|
24
|
Tezcan EA, Levendoglu F, Durmaz MS, Batur EB, Gezer IA, Erol K. Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis. Ir J Med Sci 2024; 193:977-985. [PMID: 37670102 DOI: 10.1007/s11845-023-03512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.
Collapse
Affiliation(s)
- Ezgi Akyildiz Tezcan
- Department of Physical Medicine and Rehabilitation, Cumra State Hospital, Konya, 42500, Turkey.
| | - Funda Levendoglu
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Ilknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Kemal Erol
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| |
Collapse
|
|
25
|
Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
Collapse
Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
| |
Collapse
|
|
26
|
Demir G, Aksoy F, Buğdaycı O, Kaptanoğlu AF. Elastography findings in acne scar patients who were treated with microneedling. Int J Dermatol 2024; 63:330-336. [PMID: 38143318 DOI: 10.1111/ijd.16948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Acne scar (AS) is a frequent sequela in patients with acne. In addition to advanced treatment methods, microneedling (MN) is still used as an effective option in the treatment of AS. However, similar to most diseases in dermatology, there is no objective tool to determine the severity of AS and to evaluate the treatment outcome. OBJECTIVES In the current study, we aimed to evaluate skin elasticity in AS patients who have undergone MN therapy. Furthermore, other purposes were to determine the relationships between the history of isotretinoin use, demographic data, and changes in skin elasticity. METHODS In order to evaluate the skin elasticity of 20 patients with AS, shear wave elastography (SWE) was performed before and after MN treatment. The physician's clinical assessment was evaluated with quantitative AS severity scale. In order to show that SWE is a consistent method, three repeated measurements were performed on 24 healthy participants. RESULTS A significant increase was found between the shear-wave velocity (SWV) values that were measured baseline and after treatment in the patient group (P = 0.033). In the control group, there was no significant difference between the three repeated measurements (P > 0.05). A statistically significant decrease was also detected in the AS severity scores (P < 0.005). CONCLUSIONS In AS patients who underwent MN treatment, a significant increase was found in skin elasticity compared to the baseline. We argued that SWE is a method that can be useful to evaluate skin elasticity before and after similar cosmetic procedures and dermatological diseases.
Collapse
Affiliation(s)
- Gizem Demir
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Furkan Aksoy
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Onur Buğdaycı
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aslı F Kaptanoğlu
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
|
27
|
Harinesan N, Silsby M, Simon NG. Carpal tunnel syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:61-88. [PMID: 38697747 DOI: 10.1016/b978-0-323-90108-6.00005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Median neuropathy at the wrist, commonly referred to as carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. It is caused by chronic compression of the median nerve at the wrist within the space-limited carpal tunnel. Risk factors that contribute to the etiology of compression include female gender, obesity, work-related factors, and underlying medical conditions, such as hypothyroidism, pregnancy, and amyloidosis. The diagnosis is made on clinical grounds, although these can be confounded by anatomical variations. Electrodiagnostic studies, which are specific and sensitive in diagnosing CTS, support the diagnosis; however, a subgroup may present with normal results. The advent of imaging techniques, including ultrasound and MRI, further assists the diagnostic process. The management of CTS is divided into the nonsurgical approaches that include hand therapy, splinting and corticosteroid injection, and surgical decompression of the carpal tunnel. Although several surgical techniques have been developed, no one method is more effective than the other. Each of these management approaches are effective at providing symptom relief and are utilized at different severities of the condition. There is, however, a lack of consensus on standardized diagnostic criteria, as well as when and to whom to refer patients for surgery.
Collapse
Affiliation(s)
- Nimalan Harinesan
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Silsby
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
| |
Collapse
|
|
28
|
Karakaya MA, Darcin K, Ince I, Yenigun Y, Kasali K, Dostbil A. Evaluation of brachial plexus stiffness in different arm and head positions by sonoelastography. Medicine (Baltimore) 2023; 102:e35559. [PMID: 37832128 PMCID: PMC10578761 DOI: 10.1097/md.0000000000035559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Intraoperative positioning-related nerve injuries, particularly those affecting the brachial plexus, are concerning complications believed to arise from stretching and/or compression of peripheral nerves. Although sonoelastography, a new ultrasound technology, is emerging as a valuable tool in the musculoskeletal system, its utility in evaluating peripheral nerves remains unclear. This study aimed to utilize sonoelastography to assess the brachial plexus during surgery, specifically investigating changes in its stiffness values in relation to different head and arm positions. In this prospective cohort study, bilateral brachial plexuses of 8 volunteers in 3 different positions were enrolled. Using a high-frequency linear probe, the stiffness of the brachial plexus was quantitatively measured in kilopascals (kPa) under 3 different positions: neutral, head rotated, and head rotated with arm hyperabducted. Intra-class agreement was evaluated. The stiffness of the brachial plexus was 7.39 kPa in the neutral position (NP), 10.28 kPa with head rotation, and 17.24 kPa when the head was turned, and the ipsilateral arm was hyperabducted. Significant increases were observed in stiffness values when the head was turned, whether ipsilaterally or contralaterally, and during hyperabduction of the arm while the head was turned (for all P < .001). Strong intra-class correlations were found for the measurements of stiffness values (ICC = 0.988-0.989; P < .001; Cronbach Alpha = 0.987-0.989). Sonoelastography revealed significant increases in the stiffness of the brachial plexus with various head rotations and arm positions compared to the neutral state. These findings suggest that sonoelastography could potentially serve as a valuable tool for assessing the risk of brachial plexus injury during surgery and for guiding optimal patient positioning. Further research with larger sample sizes is needed to establish definitive clinical applications.
Collapse
Affiliation(s)
| | - Kamil Darcin
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Ilker Ince
- Department of Anesthesiology and Perioperative Medicine, Penn State University, Milton S Hershey Medical Center, Pennsylvania, USA
| | - Yilmaz Yenigun
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Kamber Kasali
- Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University Hospital, Erzurum, Turkey
| |
Collapse
|
|
29
|
Khademi S, Kordi Yoosefinejad A, Motealleh A, Rezaei I, Abbasi L, Jalli R. The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome. J Bodyw Mov Ther 2023; 36:62-68. [PMID: 37949601 DOI: 10.1016/j.jbmt.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS. MATERIAL AND METHODS It was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18-65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow. RESULTS Median nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant. CONCLUSION One session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.
Collapse
Affiliation(s)
- Sahar Khademi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Rezaei
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
|
30
|
Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason 2023; 23:e313-e327. [PMID: 38020515 PMCID: PMC10668945 DOI: 10.15557/jou.2023.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.
Collapse
Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | | - Julia Michalek
- Department of Radiology, Northwestern Memorial Hospital, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | |
Collapse
|
|
31
|
Roll SC, Takata SC, Yao B, Kysh L, Mack WJ. Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023; 39:492-506. [PMID: 37654772 PMCID: PMC10468154 DOI: 10.1177/87564793231176009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Methods Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. Results The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. Conclusion A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.
Collapse
Affiliation(s)
- Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sandy C. Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Wendy J. Mack
- Division of Population and Public Health, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
|
32
|
Zhang Z, Wang H, Ding X, He S. Immersion ultrasound improves the repeatability of shear-wave elastography for measuring median nerve elasticity. J Orthop Surg Res 2023; 18:618. [PMID: 37612692 PMCID: PMC10464027 DOI: 10.1186/s13018-023-04097-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To study the factors that influence the measurement of median nerve elasticity, to provide a more reproducible test for the assessment of median nerve elasticity using shear wave elasticity (SWE), and to reduce operator empirical dependence. To compare the repeatability of the median nerve elasticity measurement using immersion SWE with that using contact SWE, analyze the factors affecting SWE measurement, and provide a more repeatable method for doctors without SWE operation experience. METHODS Two doctors without SWE operation experience measured the median nerve mean elastic modulus (Emean) at the same position and at different time points on the right wrist of 58 healthy volunteers using immersion and contact ultrasound methods. The intraobserver and interobserver repeatability of measurements was assessed using the interclass correlation coefficient (ICC), while the repeatability was assessed using the Bland-Altman diagram. RESULTS The intraobserver and interobserver repeatability of the median nerve elasticity measured via contact SWE by inexperienced operators were classified as good, with ICCs of 0.633 (95% CI 0.380-0.783) and 0.552 (95% CI 0.243-0.735), respectively. The intraobserver and interobserver repeatability of the median nerve elasticity measured by immersion SWE were very good, with ICCs of 0.975 (95% CI 0.958-0.985) and 0.942 (95% CI 0.902-0.966), respectively. The intraobserver and interobserver Bland-Altman diagram of median nerve elasticity measured by immersion SWE showed that 98% of the points fell within the 95% limits of agreement. The intraobserver and interobserver Bland-Altman diagram of median nerve elasticity measured by contact SWE showed that 94% of the points fell within the 95% limits of agreement. CONCLUSION Immersion ultrasound can improve the repeatability of median nerve elasticity measurements by inexperienced operators.
Collapse
Affiliation(s)
- Zhijun Zhang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Hui Wang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Xiaoya Ding
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Shu He
- Medical Affairs Department, The Fifth People's Hospital of Chongqing, Chongqing, 400030, China.
| |
Collapse
|
|
33
|
Bennett OM, Sears ED. The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5067. [PMID: 37404780 PMCID: PMC10317486 DOI: 10.1097/gox.0000000000005067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023]
Abstract
Lack of a reliable reference standard for carpal tunnel syndrome (CTS) diagnosis could impact the diagnostic test characteristics. This systematic review sought to evaluate differences in the accuracy of CTS diagnostic modalities based on the reference standard used. Methods A systematic review was performed following PRISMA guidelines to investigate diagnostic modalities used in CTS. A literature search of Embase, PubMed, and Cochrane Reviews was conducted for the years of 2010-2021 for primary data, and 113 studies met final inclusion criteria. Studies were stratified based on the reference standard utilized and diagnostic modality assessed, and the weighted means of the sensitivities and specificities were calculated. Results Thirty-five studies used clinical diagnosis alone as a reference standard, and 78 studies used electrodiagnostic study (EDS). The specificity for MRI and ultrasound (US) were substantially lower when EDS was used as the reference standard. MRI was the test most affected by the reference standard used, showing increased sensitivity when using EDS as the reference compared to clinical diagnosis (77.1% versus 60.9%) and decreased specificity (87.6% versus 99.2%). Regardless of the reference standard used, all tests had anticipated false-positive and/or false-negative rates of at least 10%. Conclusions Testing characteristics vary greatly based on the choice of reference standard, with the sensitivity of MRI most affected. Regardless of reference standard used, EDS, US, and MRI each had false-positive and/or false-negative rates too great to be appropriate for use as a screening examination.
Collapse
Affiliation(s)
| | - Erika D Sears
- From the University of Michigan Medical School, Ann Arbor, Mich
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich
| |
Collapse
|
|
34
|
Shang S, Yan W, Guo Y, Guo H, Chen R, Cong S, Huang C. The normal value and influencing factors of shear wave elastography in healthy tibial nerves: A cross-sectional study. Health Sci Rep 2023; 6:e1412. [PMID: 37441130 PMCID: PMC10334271 DOI: 10.1002/hsr2.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Background and Aims Shear wave elastography is a potential method for evaluating peripheral neuropathy, but lacking reference values. The aim of this study was to measure tibial nerve stiffness in healthy individuals using shear wave elastography and to investigate the influencing factors of tibial nerve stiffness. Methods Shear wave elastography of bilateral tibial nerves was performed in 50 healthy individuals 4 cm proximal to the medial malleolus. Mean shear modulus data of tibial nerves were obtained and recorded. Intra- and interobserver agreement were assessed using intraclass correlation coefficients. Differences among groups (grouped by laterality, sex, age, and body mass index) were analyzed with independent-samples t-tests and paired t-tests. Effect size (Cohen's d) was also calculated. Results The intra-and interobserver agreement were moderate (intraclass correlation coefficient, 0.700-0.747) for all participants, and was poor (intraclass correlation coefficient, 0.265-0.088) in very thin people (body mass index <18.5 kg/m2). The shear wave elastography measurements of the tibial nerve did not show a significant difference between legs, sexes, or different age groups. Higher values of tibial nerve stiffness were found in thinner participants. Conclusions Shear wave elastography is a method to evaluate the stiffness of peripheral nerves. The measurement results were likely influenced by body mass index of the participants.
Collapse
Affiliation(s)
- Shiyao Shang
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Wenxiao Yan
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Yuping Guo
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Hantao Guo
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Rumin Chen
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Shuzhen Cong
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| | - Chunwang Huang
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouPeople's Republic of China
| |
Collapse
|
|
35
|
Jerban S, Barrère V, Andre M, Chang EY, Shah SB. Quantitative Ultrasound Techniques Used for Peripheral Nerve Assessment. Diagnostics (Basel) 2023; 13:956. [PMID: 36900101 PMCID: PMC10000911 DOI: 10.3390/diagnostics13050956] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
AIM This review article describes quantitative ultrasound (QUS) techniques and summarizes their strengths and limitations when applied to peripheral nerves. METHODS A systematic review was conducted on publications after 1990 in Google Scholar, Scopus, and PubMed databases. The search terms "peripheral nerve", "quantitative ultrasound", and "elastography ultrasound" were used to identify studies related to this investigation. RESULTS Based on this literature review, QUS investigations performed on peripheral nerves can be categorized into three main groups: (1) B-mode echogenicity measurements, which are affected by a variety of post-processing algorithms applied during image formation and in subsequent B-mode images; (2) ultrasound (US) elastography, which examines tissue stiffness or elasticity through modalities such as strain ultrasonography or shear wave elastography (SWE). With strain ultrasonography, induced tissue strain, caused by internal or external compression stimuli that distort the tissue, is measured by tracking detectable speckles in the B-mode images. In SWE, the propagation speed of shear waves, generated by externally applied mechanical vibrations or internal US "push pulse" stimuli, is measured to estimate tissue elasticity; (3) the characterization of raw backscattered ultrasound radiofrequency (RF) signals, which provide fundamental ultrasonic tissue parameters, such as the acoustic attenuation and backscattered coefficients, that reflect tissue composition and microstructural properties. CONCLUSIONS QUS techniques allow the objective evaluation of peripheral nerves and reduce operator- or system-associated biases that can influence qualitative B-mode imaging. The application of QUS techniques to peripheral nerves, including their strengths and limitations, were described and discussed in this review to enhance clinical translation.
Collapse
Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
| | - Victor Barrère
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
| | - Michael Andre
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Sameer B. Shah
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA
- Department of Bioengineering, University of California, San Diego, CA 92093, USA
| |
Collapse
|
|
36
|
Shin KJ, Yi J, Hahn S. Shear-wave elastography evaluation of thenar muscle in carpal tunnel syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:510-517. [PMID: 36201602 DOI: 10.1002/jcu.23359] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE We aim to evaluate the shear wave velocity (SWV) of the thenar muscle as an adjunct diagnostic tool for carpal tunnel syndrome (CTS). METHODS Ninety-two wrists with CTS and 30 control wrists without CTS underwent ultrasonographic evaluation of thenar muscle and median nerve including shear-wave elastography. Cross sectional area (CSA) of medial nerve and SWV of thenar muscle and median nerve were evaluated. CTS patients were assessed for Boston CTS, Padua CTS, modified Hirani grading scores, and nerve conduction study (NCS). SWVs, CSA, and NCS parameters were compared between two groups. RESULTS The SWVs of thenar muscle and median nerve (p < 0.001, respectively), and CSA of median nerve (p < 0.001) were more significantly greater in patients with CTS than in controls. The SWV of median nerve was moderately correlated with CSA of median nerve (r = 0.35, p < 0.001) and modified Hirani CTS score (r = 0.35, p < 0.001). The SWV of thenar muscle was inversely correlated with modified Hirani CTS score (r = -0.21, p = 0.04). CONCLUSION The SWV of thenar muscle and median nerve of CTS were significantly increased compared to that of control, and significantly negatively correlated with NCS parameters (modified Hirani CTS score). SWVs may be used as an adjunct diagnostic tool for CTS.
Collapse
Affiliation(s)
- Kyong Jin Shin
- Department of Neurology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jisook Yi
- Department of Radiology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
|
37
|
Li ZM, Jordan DB. Carpal tunnel mechanics and its relevance to carpal tunnel syndrome. Hum Mov Sci 2023; 87:103044. [PMID: 36442295 PMCID: PMC9839559 DOI: 10.1016/j.humov.2022.103044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
The carpal tunnel is an elaborate biomechanical structure whose pathomechanics plays an essential role in the development of carpal tunnel syndrome. The purpose of this article is to review the movement related biomechanics of the carpal tunnel together with its anatomical and morphological features, and to describe the pathomechanics and pathophysiology associated with carpal tunnel syndrome. Topics of discussion include biomechanics of the median nerve, flexor tendons, subsynovial tissue, transverse carpal ligament, carpal tunnel pressure, and morphological properties, as well as mechanisms for biomechanical improvement and physiological restoration. It is our hope that the biomechanical knowledge of the carpal tunnel will improve the understanding and management of carpal tunnel syndrome.
Collapse
Affiliation(s)
- Zong-Ming Li
- Hand Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America.
| | - David B Jordan
- Hand Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America
| |
Collapse
|
|
38
|
Sernik RA, Pereira RFB, Cerri GG, Damasceno RS, Bastos BB, Leão RV. Shear wave elastography is a valuable tool for diagnosing and grading carpal tunnel syndrome. Skeletal Radiol 2023; 52:67-72. [PMID: 35920932 DOI: 10.1007/s00256-022-04143-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). MATERIALS AND METHODS The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. RESULTS The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37 m/s and 19.4 ± 5.8 kPa) than in controls (1.91 ± 0.24 m/s and 11.1 ± 3.0 kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39 m/s and 22.4 ± 7.1 kPa) than in the mild CTS group (2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13 m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6 kPa, with 87% and 82% sensitivity and specificity. CONCLUSION MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.
Collapse
Affiliation(s)
- Renato Antonio Sernik
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | | | - Giovanni Guido Cerri
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | | | - Breno Braga Bastos
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
| | - Renata Vidal Leão
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil.
| |
Collapse
|
|
39
|
Wang C, Wang H, Zhou Y, Zhang S, Huang M. Evaluation of the clinical value of shear wave elastography for early detection and diagnosis of diabetic peripheral neuropathy: a controlled preliminary prospective clinical study. BMC Musculoskelet Disord 2022; 23:1120. [PMID: 36550450 PMCID: PMC9773497 DOI: 10.1186/s12891-022-06085-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aims to analyze the clinical application value of shear wave elastography (SWE) technique for early diagnosis of diabetic peripheral neuropathy (DPN). METHODS Diabetic patients hospitalized in the Department of Endocrinology of the First Affiliated Hospital of Anhui Medical University from August 2021 to February 2022 were enrolled as DPN group (n=38) and non-DPN group (n=35) based on the neurophysiological examination results. 30 healthy subjects were recruited as the control group during the same period. Ultrasound examination of the tibial nerve and related laboratory tests were examined and collected for the total 103 study subjects. Statistical analysis of the collected data, and the receiver operating characteristic(ROC) curve for determination of the optimal cut-off values of mean stiffness of tibial nerve to detect DPN, with determination of area under curve (AUC), specificity, sensitivity, and Youden index.P value < 0.05 is considered statistically significant. RESULTS Gender, age and BMI differences among three groups were insignificant (P>0.05). The difference of serological indicators between DPN and non-DPN groups was also not found (P>0.05), whereas longer duration of diabetes was observed in DPN group as compared to non-DPN group. As to the ultra-sound relevant parameters, the cross-sectional area and elastic modulus of the tibial nerve in both lower extremities among these three groups were not significantly different (Oneway ANOVA analysis) although the differences were indeed observed if we compared DPN group exclusively with non-DPN group, or compared non-DPN group with healthy group, or compared DPN group with healthy group (t test). Additionally, the mean elasticity (Emean) cut-off value for the diagnosis of DPN was preferably taken as 67.55 kPa. CONCLUSION SWE has unique advantages in early detection and diagnosis of DPN, which deserve further research.
Collapse
Affiliation(s)
- Can Wang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Huiqin Wang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, Dongcheng branch of The First Affiliated Hospital of Anhui Medical University(Feidong Peoples Hospital), Hefei, 231699 China
| | - Yi Zhou
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Shiqi Zhang
- grid.412679.f0000 0004 1771 3402Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Meng Huang
- grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China ,grid.412679.f0000 0004 1771 3402Department of Ultrasound Medicine, Dongcheng branch of The First Affiliated Hospital of Anhui Medical University(Feidong Peoples Hospital), Hefei, 231699 China
| |
Collapse
|
|
40
|
Wu H, Zhao HJ, Xue WL, Wang YC, Zhang WY, Wang XL. Ultrasound and elastography role in pre- and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome. Front Neurol 2022; 13:1079737. [PMID: 36588903 PMCID: PMC9800593 DOI: 10.3389/fneur.2022.1079737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Carpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery. Methods First, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery. Results The cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls (p < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS (p < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity. Conclusions and discussion Conventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.
Collapse
|
|
41
|
Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, Bianco A. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness. SPORTS MEDICINE - OPEN 2022; 8:71. [PMID: 35657537 PMCID: PMC9166919 DOI: 10.1186/s40798-022-00462-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
AbstractStiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.
Collapse
|
|
42
|
López-de-Celis C, Izquierdo-Nebreda P, González-Rueda V, Cadellans-Arróniz A, Rodríguez-Sanz J, Bueno-Gracia E, Pérez-Bellmunt A. Short-Term Effects of Three Types of Hamstring Stretching on Length, Neurodynamic Response, and Perceived Sense of Effort-A Randomised Cross-Over Trial. Life (Basel) 2022; 12:life12101666. [PMID: 36295102 PMCID: PMC9605153 DOI: 10.3390/life12101666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Stretching techniques for hamstring muscles have been described both to increase muscle length and to evaluate nerve mechanosensitivity. Aim: We sought to evaluate the short-term effects of three types of hamstring stretching on hamstring length and report the type of response (neural or muscular) produced by ankle dorsiflexion and perceived sense of effort in asymptomatic subjects. Methods: A randomised cross-over clinical trial was conducted. A total of 35 subjects were recruited (15 women, 20 men; mean age 24.60 ± 6.49 years). Straight leg raises (SLR), passive knee extensions (PKE), and maximal hip flexion (MHF) were performed on dominant and non-dominant limbs. In addition, the intensity of the applied force, the type and location of the response to structural differentiation, and the perceived sensation of effort were assessed. Results: All stretching techniques increased hamstring length with no differences between limbs in the time*stretch interaction (p < 0.05). The perceived sensation of effort was similar between all types of stretching except MHF between limbs (p = 0.047). The type of response was mostly musculoskeletal for MHF and the area of more neural response was the posterior knee with SLR stretch. Conclusions: All stretching techniques increased hamstring length. The highest percentage of neural responses was observed in the SLR stretching, which produced a greater increase in overall flexibility.
Collapse
Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Anatomy Group, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Correspondence: (C.L.-d.-C.); (J.R.-S.); Tel.: +34-93-504-20-00 (J.R.-S.)
| | - Pedro Izquierdo-Nebreda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Anatomy Group, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Aïda Cadellans-Arróniz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Anatomy Group, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
- Correspondence: (C.L.-d.-C.); (J.R.-S.); Tel.: +34-93-504-20-00 (J.R.-S.)
| | - Elena Bueno-Gracia
- Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Anatomy Group, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
| |
Collapse
|
|
43
|
Farias Zuniga A, Keir PJ. Thirty Minutes of Sub-diastolic Blood Flow Occlusion Alters Carpal Tunnel Tissue Function and Mechanics. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1110-1121. [PMID: 35300878 DOI: 10.1016/j.ultrasmedbio.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
There is evidence that carpal tunnel syndrome (CTS) development is driven by vascular factors, specifically those resulting from ischemia and edema. The purpose of this study was to investigate the vascular hypothesis of CTS development by quantifying the temporal effects of 30 min of sub-diastolic brachial blood flow occlusion on median nerve edema, intraneural blood flow velocity, nerve function as measured through nerve conduction study (NCS), tendon-connective tissue mechanics and carpal tunnel tissue stiffness. Forty healthy volunteers underwent 30 min of sub-diastolic brachial occlusion while an NCS and ultrasound examination were performed consecutively every 5 min. Motor latency (p < 0.001), sensory conduction velocity (p < 0.001), sensory amplitude (p = 0.04), nerve blood flow (p < 0.001), peak relative flexor digitorum superficialis tendon-sub-synovial connective tissue displacement (p = 0.02) and shear strain (p = 0.04) were significantly affected by partial ischemia. Our results highlight the dependency of carpal tunnel tissue function on adequate blood flow.
Collapse
Affiliation(s)
- Amanda Farias Zuniga
- McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Keir
- McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
|
44
|
Gürün E, Akdulum İ, Akyüz M, Oktar SÖ. Shear wave elastography evaluation of brachial plexus in multiple sclerosis. Acta Radiol 2022; 63:520-526. [PMID: 33730859 DOI: 10.1177/02841851211002828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized by inflammation involving the peripheral nerves. Shear wave elastography (SWE) is potentially a method of choice for detecting peripheral nerve involvement. PURPOSE To compare the degree of thickening and nerve elasticity of brachial plexus (BP) nerve roots and evaluate the usefulness of sonoelastography in patients with clinically diagnosed MS without brachial plexopathy. MATERIAL AND METHODS Thirty-two patients with MS and 32 controls were included in the study. Bilateral C5, C6, and C7 mean nerve root diameters, and mean elasticity values in kiloPascal (kPa) were measured in the patient and control groups. The relationship between the age, height, and weight values and nerve diameter-elasticity values of the patient and control groups was compared. RESULTS The elasticity values of the C5 and C6 nerve roots were increased, and the nerve root thickness was decreased in the MS group compared to that in the control (P < 0.05). There was no difference between the C7 mean nerve root elasticity (kPa) and diameter measurements in the patient and control groups (P > 0.05). CONCLUSION Our study showed an increase in the BP nerve root elasticity values (kPa) in patients with MS compared to that of the control group and a decrease in diameter values thought to be related to the possible chronic atrophic process. The results are consistent with the demyelinating process of the peripheral nervous system (PNS) due to MS.
Collapse
Affiliation(s)
- Enes Gürün
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - İsmail Akdulum
- Department of Radiology, Gazi University, Ankara, Turkey
| | - Melih Akyüz
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: Rush University Medical Center, Chicago, IL, USA
| | | |
Collapse
|
|
45
|
Spatial variation in mechanical properties along the sciatic and tibial nerves: an ultrasound shear wave elastography study. J Biomech 2022; 136:111075. [DOI: 10.1016/j.jbiomech.2022.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
|
|
46
|
Chiba E, Hamamoto K, Kanai E, Oyama-Manabe N, Omoto K. A preliminary animal study on the prediction of nerve block success using ultrasonographic parameters. Sci Rep 2022; 12:3119. [PMID: 35210487 PMCID: PMC8873395 DOI: 10.1038/s41598-022-06986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the diagnostic value of ultrasonographic parameters as an indicator for predicting regional nerve block success. Ultrasound-guided sciatic nerve block was performed in seven dogs using either 2% mepivacaine (nerve-block group) or saline (sham-block group). The cross-sectional area (CSA), nerve blood flow (NBF), and shear wave velocity (SWV) of the sciatic nerve (SWVN), SWV of the biceps femoris muscle (SWVM), and their ratio (SWVNMR) were measured at 0, 30, 60, and 90 min after the nerve block as well as the change rate of each parameter from the baseline. A receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic value of each parameter in the prediction of nerve block success. No significant changes were observed in the CSA or NBF in association with the nerve block. The SWVN and SWVNMR in the nerve-block group were significantly higher than those in the sham-block group at 90 min and at 30, 60, and 90 min, respectively (p < 0.05). The change rates of SWVN and SWVNMR in the nerve-block group were significantly higher than those in the sham-block group at all time points (p < 0.05). The ROC curve analysis showed that SWVN had a moderate diagnostic accuracy (area under the curve [AUC], 0.779), whereas SWVNMR and change rates of SWVN and SWVNMR had a high diagnostic accuracy (AUC, 0.947, 0.998, and 1.000, respectively). Ultrasonographic evaluation of the SWVN and SWVNMR could be used as indicators for predicting nerve block success.
Collapse
Affiliation(s)
- Emiko Chiba
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Eiichi Kanai
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| |
Collapse
|
|
47
|
Abstract
Over the past decade, ultrasound elastography has emerged as a new technique for measuring soft tissue properties. Real-time, noninvasive, and quantitative evaluations of tissue stiffness have improved and aid in the assessment of normal and pathological conditions. Specifically, its use has substantially increased in the evaluation of muscle, tendon, and ligament properties. In this review, the authors describe the principles of elastography and present different techniques including strain elastography and shear-wave elastography; discuss their applications for assessing soft tissues in the hand before, during, and postsurgeries; present the strengths and limitations of their measurement capabilities; and describe directions for future research.
Collapse
Affiliation(s)
- Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, College of Engineering and Integrated Design, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Kai-Nan An
- Mayo Clinic College of Medicine, 200 First Street, S.W, Rochester, MN 55905, USA
| |
Collapse
|
|
48
|
Shear-Wave-Elastography in Neurofibromatosis Type I. Diagnostics (Basel) 2022; 12:diagnostics12020360. [PMID: 35204451 PMCID: PMC8871512 DOI: 10.3390/diagnostics12020360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023] Open
Abstract
Ultrasound shear wave elastography (SWE) is an increasingly used imaging modality that expands clinical ultrasound by measuring the elasticity of various tissues, such as the altered elasticity of tumors. Peripheral nerve tumors are rare, have been well-characterized by B-mode-ultrasound, but have not yet been investigated with SWE. Given the lack of studies, a first step would be to investigate homogeneous peripheral nerve tumors (PNTs), histologically neurofibromas or schwannomas, which can occur in multiple in neurofibromatosis type 1 and 2 (NF1 and 2), respectively. Hence, we measured shear wave velocity (SWV) in 30 PNTs of 11 patients with NF1 within the median nerve. The SWV in PNTs ranged between 2.8 ± 0.8 m/s and correlated with their width and approximate volume but not with their length or height. Furthermore, we determined the extent to which PNTs alter the SWV of the median nerve for three positions of the wrist joint: neutral (zero-degree), individual maximal flexion and maximal extension. Here, SWV was decreased in NF1 patients compared to age- and sex-matched controls (p = 0.029) during maximal wrist extension. We speculate that the presence of PNTs may have a biomechanical impact on peripheral nerves which has not been demonstrated yet.
Collapse
|
|
49
|
An exploratory study of two-dimensional shear-wave elastography in the diagnosis of acute compartment syndrome. BMC Surg 2021; 21:418. [PMID: 34911499 PMCID: PMC8672541 DOI: 10.1186/s12893-021-01420-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Two-dimensional shear-wave elastography (2D-SWE) is an ultrasound elastography technique that uses shear waves to quantitatively measure tissue stiffness and it has recently been developed as a safe, real-time, and noninvasive imaging technique. The purpose of this study was to investigate the value of 2D-SWE in the diagnosis and treatment of acute compartment syndrome (ACS). Methods 2D-SWE was used to measure the elasticity values of the main muscles in the superficial compartments of the calf in 212 healthy volunteers, and the difference in the muscle elasticity values between different gender and age groups were analyzed. Nine patients with clinical suspicion of ACS were included in this study and 2D-SWE was used to measure the elasticity values of the muscles on the affected and unaffected sides, and a comparative analysis was performed. Results The mean elasticity values of the tibialis anterior (TA), peroneus longus (PL), and gastrocnemius medialis (GA) muscles in the relaxed state of the 212 healthy volunteers were 25.4 ± 3.2 kPa, 15.7 ± 1.5 kPa, and 12.1 ± 2.1 kPa, respectively. No statistically significant differences was observed in the elasticity values of the same muscle under the state of relaxation in different gender and age groups (p > 0.05). A statistically significant difference in the elasticity values of the muscle between the affected and unaffected sides in the fasciotomy group (p < 0.05, n = 5) was observed. In contrast, no difference in the elasticity values of the muscle between the affected and unaffected sides in the conservative group (p > 0.05, n = 4) was observed. There was a statistically significant difference in the elasticity values of the muscle on the affected side in the two treatment groups (p < 0.05). Conclusions When the ACS occurs, the muscle elasticity of the affected limb increases significantly. 2D-SWE is expected to be a new noninvasive technique for the assessment of ACS and may provide a potential basis for clinical diagnosis and treatment.
Collapse
|
|
50
|
Do Y, Lall PS, Lee H. Assessing the Effects of Aging on Muscle Stiffness Using Shear Wave Elastography and Myotonometer. Healthcare (Basel) 2021; 9:healthcare9121733. [PMID: 34946459 PMCID: PMC8700831 DOI: 10.3390/healthcare9121733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/05/2022] Open
Abstract
The current study investigated the differences in muscle stiffness between older and young adults at rest and during contraction. We also evaluated the differences in muscle stiffness assessments using a myotonometer (MyotonPRO) and shear wave elastography (SWE). Twenty-two older adults (mean age, 66.6 ± 1.6 years) and 23 young adults (mean age, 66.6 ± 1.6 years) participated in this study. Muscle stiffness of the tibialis anterior (TA) and medial gastrocnemius (MG) muscles at rest and during contraction were measured using SWE and the MyotonPRO. The stiffness increase rate (SIR) was also calculated to determine the absolute stiffness difference. The mean muscle stiffness of the TA and MG muscles was significantly lower in older adults than in young adults at rest and during contraction (p < 0.05). Similarly, the SIR values of the TA and MG were significantly lower in older adults than in young adults (p < 0.05). Our results indicate that both instruments could be used to quantify muscle stiffness changes and serve as a cornerstone for assessing aging-related losses in muscle function. Stiffness measures may help exercise professionals to develop an in-depth understanding of muscle impairment at the tissue level.
Collapse
Affiliation(s)
| | | | - Haneul Lee
- Correspondence: ; Tel.: +(82)-32-820-4335; Fax: +(82)-32-820-4420
| |
Collapse
|