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Gupta I, Sharma S, Gupta K, Bagarhatta M, Mannan N, Gupta P, Jhanwar V, Gupta D, Yadav J. Comparing the efficacy of multiple quantitative and qualitative ultrasound parameters for the diagnosis of carpal tunnel syndrome. J Ultrasound 2025; 28:43-52. [PMID: 39414755 PMCID: PMC11947341 DOI: 10.1007/s40477-024-00959-9] [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: 07/07/2024] [Accepted: 08/28/2024] [Indexed: 10/18/2024] Open
Abstract
PURPOSE Carpal tunnel syndrome (CTS) is a compression neuropathy causing significant morbidity. Over the years, ultrasound has been evaluated as an alternative to nerve conduction study (NCS) for diagnosing CTS, however, there is no consensus as to which ultrasound parameter is the best. Our study aimed to determine and compare the efficacy of various ultrasound-based variables for diagnosis of CTS. METHODS 80 patients with clinical suspicion of CTS underwent ultrasound examination with calculation of cross-sectional area (CSA), delta CSA, wrist forearm ratio (WFR), palmer bowing (PB), flattening ratio (FR), flexor retinaculum thickness (FT), and evaluation of echogenicity and vascularity of median nerve. NCS was taken as the gold standard and the diagnostic efficacy of all these variables was compared, followed by receiver operator curve (ROC) analysis. RESULTS Delta CSA had the highest accuracy (91.25%), followed by CSAc (80%), WFR (78.75%), and PB (73.75%). Youden's index and sensitivity were highest for delta CSA (0.783 and 96.15% respectively), while specificity was highest for FT (89.29%). The highest area under the curve was noted for delta CSA (97.1%), followed by WFR (AUC = 87.4%) and CSAc (AUC = 86.0%). CONCLUSION Delta CSA was found to be the best ultrasound parameter for diagnosis of CTS, followed by CSAc, WFR, and PB, and can be used as an alternative to NCS. Using ROC analysis this study also predicted the best cut-off values for these parameters which could improve their diagnostic accuracy and further research is needed to confirm these findings.
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Affiliation(s)
- Isha Gupta
- Department of Radio-Diagnosis, SMS Medical College and Attached Group of Hospitals, Jaipur, India.
| | - Shashank Sharma
- Department of Radio-Diagnosis, SMS Medical College and Attached Group of Hospitals, Jaipur, India
| | - Kshitij Gupta
- Rajasthan University of Health Sciences, Jaipur, India
| | - Meenu Bagarhatta
- Department of Interventional Radiology, SMS Medical College and Attached Group of Hospitals, Jaipur, India
| | - Naima Mannan
- Department of Radio-Diagnosis, SMS Medical College and Attached Group of Hospitals, Jaipur, India
| | - Parul Gupta
- Department of Radio-Diagnosis, SMS Medical College and Attached Group of Hospitals, Jaipur, India
| | - Vikas Jhanwar
- Department of Radio-Diagnosis, SMS Medical College and Attached Group of Hospitals, Jaipur, India
| | - Deepak Gupta
- Department of Statistics, Rajasthan University, Jaipur, India
| | - Jitendra Yadav
- SMS Medical College and Attached Group of Hospitals, Jaipur, India
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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.
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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
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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.
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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
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Huang CH, Liu KC, Cheng JW, Hsu SC, Chen CK. Carpal Tunnel Syndrome in Elite Female Tug-of-War Athletes: Prevalence and Risk Factor Analysis. Diagnostics (Basel) 2024; 14:2120. [PMID: 39410525 PMCID: PMC11476192 DOI: 10.3390/diagnostics14192120] [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: 08/07/2024] [Revised: 09/16/2024] [Accepted: 09/20/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Tug-of-War (TOW) games involve repetitive hand movements and vigorous force, raising the risk of peripheral neuropathy in the upper extremities. The prevalence of carpal tunnel syndrome (CTS) in TOW athletes remains unclear. We hypothesize that elite female TOW athletes have a higher prevalence of CTS than the general population. Methods: Twenty-nine female TOW athletes were recruited from a national team and participated in the study. CTS was clinically diagnosed by history taking and physical examination. Nerve conduction studies (NCS) were additionally performed to confirm CTS. Results: Twelve athletes were clinically diagnosed with CTS; however, only nine were confirmed by NCS. Ten athletes were diagnosed with subclinical CTS by NCS, while seven were classified as truly-non-CTS by both clinical assessment and NCS. The prevalence of CTS and subclinical CTS among the athletes was found to be 33.3% and 37.0%, respectively, significantly higher than 2.7% in the general population by electrodiagnosis. The body weight (p = 0.025) of the athletes with CTS and subclinical CTS was significantly different from those of the athletes without CTS. Conclusions: Our observations revealed a higher prevalence of CTS among elite female TOW athletes, with body weight being a risk factor. The forceful grasping and pulling of the rope may contribute to the development of CTS.
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Affiliation(s)
- Chiang-Hui Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-H.H.); (K.-C.L.); (S.-C.H.)
| | - Kuo-Cheng Liu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-H.H.); (K.-C.L.); (S.-C.H.)
- Department of Physical Medicine and Rehabilitation, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), TuCheng, New Taipei City 236, Taiwan
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Management, Chang Gung University, Taoyuan 333, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ju-Wen Cheng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan 333, Taiwan;
| | - Shao-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-H.H.); (K.-C.L.); (S.-C.H.)
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-H.H.); (K.-C.L.); (S.-C.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Center of Comprehensive Sports Medicine, Chang Gung Memorial Hospital at Taoyuan, Taoyuan 333, Taiwan
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Rayegani SM, Bayat M. Sonographic evaluation of median nerve cross-sectional area in a normal Iranian population: A cross-sectional study. Health Sci Rep 2023; 6:e1393. [PMID: 37396558 PMCID: PMC10308346 DOI: 10.1002/hsr2.1393] [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: 03/10/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Considering disagreements on the normal range of median nerve cross-sectional area (MNCSA) and insufficient data in the Iranian population, this study aimed to measure normal MNCSA. Methods In this cross-sectional study, bilateral upper limbs of 99 subjects were assessed by sonography, and MNCSA was measured at three levels: forearm, carpal tunnel inlet (CTI), and carpal tunnel outlet (CTO). The association between MNCSA and demographic factors was assessed. Results Mean MNCSA was 6.33 mm2 at the forearm, 9.41 mm2 at CTI, and 10.67 mm2 at CTO. MNCSA was significantly higher in males (6.78 vs. 5.94 mm2 at the forearm, 9.98 vs. 8.92 mm2 at CTI, and 11.24 vs. 10.84 mm2 at CTO in males and females, respectively) and taller (>170 cm) subjects in all three levels (6.69 vs. 6.03 mm2 at the forearm, 9.80 vs. 9.02 mm2 at CTI, and 11.27 vs. 10.12 mm2 at CTO in taller and shorter subjects, respectively). MNCSA was not significantly associated with wrist ratio (WR) or body mass index (BMI). Conclusion The normal MNCSA range in the Iranian population is 6.31 mm2 (forearm) to 10.74 mm2 (CTO). MNCSA is significantly higher in males and taller subjects but is not associated with BMI and WR.
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Affiliation(s)
- Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Masume Bayat
- Physical Medicine and Rehabilitation Research CenterShahid Beheshti University of Medical SciencesTehranIran
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Aloi NF, Cluts LM, Fowler JR. Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies. Hand (N Y) 2023; 18:765-771. [PMID: 34991383 PMCID: PMC10336820 DOI: 10.1177/15589447211066349] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity (P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.
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Uz C, Umay E. Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality. Acta Orthop Belg 2023; 89:167-172. [PMID: 37295003 DOI: 10.52628/89.1.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The study aimed to investigate the relationship between the proximal and distal cross-sectional area (CSA) of the median nerve and wrist skin thickness measured by ultrasound in patients with carpal tunnel syndrome (CTS), demographics, disease characteristics, electrophysiological measurements, symptom severity, functionality, and symptom severity. 98 patients with electrophysiological diagnoses of CTS in the dominant hand were included in the study. Proximal and distal CSAs of the median nerve and wrist skin thickness were measured ultrasonographically. Demographic and disease characteristics of the patients were recorded. Patients were evaluated with the Historical-Objective scale (Hi- Ob) for clinical staging, the Functional status scale (FSS) for functional status, and the Boston symptom severity scale (BSSS) for symptom severity. Ultrasonographic findings were correlated with demographic and disease characteristics, electrophysiological findings, Hi-Ob scala, Functional status scale (FSS), and Boston symptom severity scale (BSSS). Proximal median nerve CSA median was 11.0 (7.0-14.0) mm2, distal median nerve CSA median was 10.5 (5.0-18.0) mm2, and wrist skin thickness was measured 1.10 (0.6-1.40) mm. Median nerve CSAs were positively correlated with the CTS stage and FSS, negatively correlated with the sensory nerve action potential of the median nerve (SNAP) and the compound muscle action potential of the median nerve (CMAP) ( p<0.05). Wrist skin thickness was positively correlated with disease characteristics, including the presence of paresthesia and loss of dexterity and FSS and BSSS levels. Ultrasonographic measurements in CTS are associated with functionality rather than demographics. Especially the increase in wrist skin thickness leads to an increase in symptom severity.
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Asghar A, Naaz S, Ansari S, Kumar A, Singh V. The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis. Morphologie 2023; 107:99-115. [PMID: 35697557 DOI: 10.1016/j.morpho.2022.05.005] [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: 04/27/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED The cross-section area is a crucial parameter to assess peripheral neuropathy. The ultrasonographic evaluation of cross-section area of median nerve is a low-cost and readily available tool for diagnosis and assessment. However, the intra-nerve dimensional variability and its normative reference value in a healthy subject are missing. The current meta-analysis aims to capture the median nerve cross-section area for healthy subjects and generate a comprehensive ultrasonographic reference data set for each population. METHODS The full text of manuscripts were collected after short-listing the abstracts collected from search strategy. A quality assurance tool was used to capture the risk of bias of each study after reviewing the included manuscripts. The pooled estimate of cross-section area was stratified according to anatomical landmarks, sex, and ancestry. RESULTS A total of 97 observational studies dealt with 6679 wrists of healthy subjects were included. The pooled estimate of the cross-section area of median nerve at carpal tunnel inlet was 8.54mm2 [95% CI: 8.34-8.74mm2]. The same pooled estimate at carpal tunnel outlet was 8.03mm2 [95% CI: 7.46-8.60mm2]. Both these pooled estimates have significant correlation with mean age of population. Age and sex were two primary predictors of the cross-section of median nerve. The flattening ratio, circularity, and wrist-forearm ratio of median nerve were also computed. CONCLUSION These normative data could serve as a reference for assessing median nerve pathologies, including carpal tunnel syndrome. The ethnic variation of pooled estimate and heterogeneity will guide clinician set up the reference value for diagnostic criteria.
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Affiliation(s)
- A Asghar
- Department of Anatomy, AIIMS Patna, Patna, Bihar 801505, India.
| | - S Naaz
- Department of Anaesthesiology, AIIMS Patna, Patna, Bihar 801505, India
| | - S Ansari
- Consultant Radiologist, Paras HMRI, Hospital Patna, Patna, Bihar, India
| | - A Kumar
- Department of Anatomy, AIIMS Patna, Patna, Bihar 801505, India
| | - V Singh
- Speciality Registrar (Orthopaedics), Homerton University Hospital, London, UK
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Daliri M, Ebrahimnejad M, Najafi S, Aminzadeh B, Emadzadeh M, Moradi E, Moradi A. Magnetic Resonance Imaging and Sonographic Features before and after Surgery in Carpal Tunnel Syndrome: Association with Clinical Findings. Clin Orthop Surg 2022; 14:603-612. [PMID: 36518939 PMCID: PMC9715927 DOI: 10.4055/cios22031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/23/2022] [Accepted: 05/15/2022] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The interest in ultrasonography (US) and magnetic resonance imaging (MRI) assessment of the patients with carpal tunnel syndrome (CTS) is growing. This paper aimed to find the correlation of postoperative changes in these modalities' parameters with clinical outcomes. METHODS Boston CTS questionnaire-symptom severity (BQ-SS), Boston CTS questionnaire-functional status (BQ-FS), and visual analog scale (VAS) questionnaires (for pain, paresthesia, and grip weakness assessment) were used to evaluate clinical outcomes. Various imaging parameters of the median nerve and carpal tunnel were evaluated using US and MRI at two levels of the hook of the hamate (distal) and the pisiform (proximal) once preoperatively and then 3 months postoperatively. Corresponding US and MRI parameter measures were compared, and correlational analysis was performed between alteration of imaging findings and changes in clinical parameters postoperatively. RESULTS Patients' functional status (BQ-FS score) was positively correlated with the nerve width both in US and MRI at the proximal level (r = 0.457 and r = 0.453, respectively) and also with the MRI nerve circumference at the distal level (r = -0.482). Correlation between paresthesia and the nerve width was notable in MRI at the distal hook of the hamate level (r = -0.403). Grip weakness VAS score was correlated with the nerve width-to-height ratio (WHR) in US at the distal level (r = 0.432). CONCLUSIONS Changes in US and MRI parameters of the median nerve width, circumference, and WHR were associated with clinical changes in patients with CTS after surgery.
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Affiliation(s)
- Mahla Daliri
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Samane Najafi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Moradi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison. Diagnostics (Basel) 2022; 12:diagnostics12102433. [PMID: 36292122 PMCID: PMC9600501 DOI: 10.3390/diagnostics12102433] [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: 08/19/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.
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Öten E, Uğur L. 3D volumetric evaluation of the diagnosis and severity of carpal tunnel syndrome using MRI. J Clin Neurosci 2022; 97:82-86. [DOI: 10.1016/j.jocn.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
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ElSadek A, Fathy M, AbdElMoneim A. High-resolution neuromuscular ultrasound-based diagnosis of carpal tunnel syndrome in a sample of Egyptian population. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome is the commonest entrapment neuropathy. The cut-off point of cross-sectional area to diagnose carpal tunnel syndrome may vary among populations. The objective of this study was to determine the best cut-off point of median nerve cross-sectional area to diagnose carpal tunnel syndrome among Egyptian population and to compare the difference of median nerve cross-sectional area in diabetic patients versus healthy individuals.
Results
Mean cross-sectional area was 7.78 ± 1.260 mm2 among healthy individuals and 8 ± 1.018 mm2 among diabetics. Cut-off cross-sectional area of median nerve above which compression is anticipated is 9.5 mm2.
Conclusion
Ultrasound can be used to diagnose carpal tunnel syndrome by measuring the median nerve cross-sectional area.
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Martikkala L, Mäkelä K, Himanen SL. Reduction in median nerve cross-sectional area at the forearm correlates with axon loss in carpal tunnel syndrome. Clin Neurophysiol Pract 2021; 6:209-214. [PMID: 34377874 PMCID: PMC8327490 DOI: 10.1016/j.cnp.2021.06.001] [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: 05/23/2020] [Revised: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022] Open
Abstract
The median nerve CSA at the forearm is smaller when CTS is involved with axon loss. WFR of the median nerve is highest when CTS causes slight axon loss. Axon loss of the median nerve in CTS hampers the diagnostic value of wCSA and WFR. Objective To explore the relationship between axon loss and measured cross-sectional areas of the median nerve (MN) in severe carpal tunnel syndrome (CTS). Methods In this retrospective study of 158 examined wrists, we compared axon loss to the ultrasound parameters MN cross-sectional area at the wrist (wCSA), MN cross-sectional area at the forearm (fCSA) and wrist-to-forearm ratio (WFR), in patients with moderate to extreme CTS. Axon loss was evaluated by needle electromyography (EMG) of the abductor pollicis brevis muscle (spontaneous activity and reduction of interference pattern). Results Both the spontaneous activity and interference pattern reduction correlated negatively to fCSA (r = −0.189, p = 0.035; r = −0.210, p = 0.019; respectively). In moderate CTS, both the spontaneous activity and interference pattern reduction correlated positively to WFR (r = 0.231, p = 0.048; r = 0.232, p = 0.047; respectively). The WFR was highest when slight spontaneous activity was detected. Neither wCSA nor WFR correlated with axon loss in severe and extreme CTS. Conclusions The fCSA is smaller when axon loss in CTS is more prominent. The WFR is highest when CTS is associated with slight axon loss of the MN. Significance CTS might cause retrograde axonal atrophy detected as small fCSA. Prominent axon loss in CTS may reduce the diagnostic value of WFR.
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Key Words
- APB, abductor pollicis brevis
- CTS, carpal tunnel syndrome
- Carpal tunnel syndrome
- EDX, electrodiagnostic studies
- EMG, needle electromyography
- HRUS, high-resolution ultrasound
- IP, interference pattern
- MN, median nerve
- NCS, nerve conduction studies
- Needle electromyography
- RAA, retrograde axonal atrophy
- Retrograde axonal atrophy
- Ultrasound
- WFR, wrist-to-forearm ratio
- fCSA, median nerve cross-sectional area at the forearm
- wCSA, median nerve cross-sectional area at the wrist
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Affiliation(s)
- Lauri Martikkala
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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14
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Moon H, Lee BJ, Park D. Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome. Sci Rep 2020; 10:15607. [PMID: 32973181 PMCID: PMC7515891 DOI: 10.1038/s41598-020-72757-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.
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Affiliation(s)
- Hyunseok Moon
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunghwndo-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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15
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Linehan C, Childs J, Quinton AE, Aziz A. Ultrasound parameters to identify and diagnose carpal tunnel syndrome. A review of the literature. Australas J Ultrasound Med 2020; 23:194-206. [PMID: 34760599 DOI: 10.1002/ajum.12219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut-off values. Currently, an effective parameter and cut-off value are still debated. The aim of this review is to determine if these parameters have sufficient rigour to allow their use in clinical practice. Twenty-one studies using sonographic parameters to identify carpal tunnel syndrome in comparison with electrodiagnostic testing (EDx) were selected for review. Methodological differences were found between studies in the use of EDx criteria, scanning and recruitment protocols, with participant biometrics often not reported. Parameters including the cross-sectional area of the median nerve at the level of the pisiform bone in addition to the wrist-to-forearm difference demonstrated high diagnostic utility for set cut-off values. Doppler techniques and mobility are promising, and further research is required to understand the effectiveness of these techniques.
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Affiliation(s)
- Callum Linehan
- Medical Imaging Department Ultrasound Mid North Coast Diagnostic Imaging Forster New South Wales Australia
| | - Jessie Childs
- School of Health Sciences University of South Australia Adelaide South Australia Australia
| | - Ann E Quinton
- School of Health Medical and Applied Science Central Queensland University Sydney New South Wales Australia.,Sydney Medical School Nepean University of Sydney Sydney New South Wales Australia
| | - Aamer Aziz
- School of Health Medical and Applied Sciences Central Queensland University Mackay Queensland Australia
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17
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Abstract
PURPOSE Electrodiagnostic studies do not differentiate severe lesions of the median nerve in the distal forearm from those within the carpal tunnel when compound muscle action potential over the abductor pollicis brevis and sensory nerve action potential are absent; needle electromyography showing denervation confined to the abductor pollicis brevis is presumed to suggest localization to the carpal tunnel, although the lesion may be in the forearm. Under these circumstances, the patient may undergo carpal tunnel release without benefit. This retrospective study looked at patients with clinical picture of severe carpal tunnel syndrome who had no compound muscle action potential or sensory nerve action potential on median nerve stimulation; the goal was to determine how often ultrasonic imaging pointed to a location other than the carpal tunnel. METHODS Patients with clinical picture of severe carpal tunnel syndrome with no sensory nerve action potential and no compound muscle action potential over the abductor pollicis brevis and second lumbrical underwent ultrasonic imaging; criteria for localization to the carpal tunnel included significant increase in the cross-sectional area of the median nerve at the carpal tunnel inlet and increase in the wrist/forearm cross-sectional area ratio. RESULTS In 42 of 46 cases, entrapment at the carpal tunnel was confirmed by ultrasonography; in four patients, other causes were located proximal to the carpal tunnel. CONCLUSIONS Ultrasonic imaging is useful not only for confirming entrapment of the median nerve at the carpal tunnel in patients with nonlocalizing electrodiagnostic studies but also in detecting pathology in the forearm, which may mimic severe carpal tunnel syndrome.
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18
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Tony AA, Tony EA, Selim YA, Saad E. Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abeer A. Tony
- Departments of Neurology, Faculty of Medicine, Aswan University, Aswan, Egypt
| | | | | | - Ehab Saad
- Rheumatology and Rehablitation, South-Vally University, Qena, Egypt
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Torres-Costoso A, Martínez-Vizcaíno V, Álvarez-Bueno C, Ferri-Morales A, Cavero-Redondo I. Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:758-765.e10. [DOI: 10.1016/j.apmr.2017.08.489] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/07/2023]
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20
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Gonzalez-Suarez CB, Buenavente LD, Cua RCA, Fidel MBC, Cabrera JTC, Regala CFG. Inter-Rater and Intra-Rater Reliability of Sonographic Median Nerve and Wrist Measurements. J Med Ultrasound 2018; 26:14-23. [PMID: 30065508 PMCID: PMC6029182 DOI: 10.4103/jmu.jmu_2_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Electrophysiologic studies have been considered the “gold standard” in diagnosing carpal tunnel syndrome (CTS); however, reports of false-negative results, as well as discomfort for the patient during the procedure has paved the use of ultrasound, being a painless and cost-efficient tool, as an alternative means for its diagnosis. Various ultrasound parameters assessing the median nerve and wrist dimensions have been described, but description of landmarks to assess these in a reliable manner has been lacking. Methodology: A systematic search of different databases yielded data regarding ultrasound parameters for CTS diagnosis, the landmarks used, and presence of reliability testing. Based on this, three sonologists discussed the external and sonographic landmarks that will be used in measuring the median nerve measurements, bowing of the flexor retinaculum and the carpal tunnel dimensions. A pilot test with two consecutive healthy participants using the discussed ultrasound parameters was carried out, and results were subjected to inter- and intra-rater reliability testing. Modifications were accordingly made on the acquisition of ultrasound image using external landmarks. The reliability testing proper was done with ten consecutive healthy participants. Results: Based on the systematic review and the pilot study, external landmarks were used to locate the median nerve in the forearm, carpal tunnel inlet and outlet. For the forearm measurement, it was taken 10 cm proximal from the distal palmar crease. The distal palmar crease was the external landmark used for the carpal tunnel inlet, while for the carpal tunnel outlet; it was measured 1 cm distal to the distal palmar crease. Instead of using the inner edge of the hook of hamate and trapezium, the apices of these bones were used as the landmarks in measuring the carpal tunnel outlet dimensions. There was excellent intra-rater reliability (mid-forearm, carpal tunnel inlet and outlet) except for the following: cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet and outlet; and bowing of the flexor retinaculum. All the parameters had an excellent inter-rater reliability measured at the three levels (intraclass correlation [ICC]: Of 0.77–0.99) except for CSA of the median nerve at the levels of the forearm (fair-to-good with ICC of 0.71) and the carpal tunnel inlet (fair-to-good reliability of ICC: 0.43). Conclusion: There was an improved inter- and intra-rater reliability when external landmarks were used instead of sonographic landmarks.
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Affiliation(s)
- Consuelo B Gonzalez-Suarez
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Surgery, University of Santo Tomas, San Pablo, Laguna, Philippines.,Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines.,SPC Medical Center, San Pablo, Laguna, Philippines
| | - Lorraine D Buenavente
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Ronald Christopher A Cua
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Maria Belinda C Fidel
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines.,Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
| | - Jan-Tyrone C Cabrera
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Carina Fatima G Regala
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
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Lee CH, Choi H, Yoon JS, Kang S. Carpal Tunnel Syndrome Assessment With Ultrasonography: A Comparison Between Non-diabetic and Diabetic Patients. Ann Rehabil Med 2018; 42:85-91. [PMID: 29560328 PMCID: PMC5852234 DOI: 10.5535/arm.2018.42.1.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/19/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the diagnostic value of cross-sectional area (CSA) and wrist to forearm ratio (WFR) in patients with electro-diagnosed carpal tunnel syndrome (CTS) with or without diabetes mellitus (DM). Methods We retrospectively studied 256 CTS wrists and 77 healthy wrists in a single center between January 1, 2008 and January 1, 2013. The CSA and WFR were calculated for each wrist. Patients were classified into four groups according to the presence of DM and CTS: group 1, non-DM and non-CTS patients; group 2, non-DM and CTS patients; group 3, DM and non-CTS patients; and group 4, DM and CTS patients. To determine the optimal cut-off value, receiver operating characteristic (ROC) curve analysis was performed. Results The CSA and WFR were significantly different among the groups (p<0.001). The ROC curve analysis of non-DM patients revealed CSA ≥10.0 mm2 and WFR ≥1.52 as the most powerful diagnostic values of CTS. The ROC curve analysis revealed CSA ≥12.5 mm2 and WFR ≥1.87 as the most powerful diagnostic values of CTS. Conclusion Ultrasonographic assessment for the diagnosis of CTS requires a particular cut-off value for diabetic patients. Based on the ROC analysis results, improved accurate diagnosis is possible if WFR can be applied regardless of presence or absence of DM.
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Affiliation(s)
- Chung Ho Lee
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Hanboram Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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22
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Dehghan F, Haghighat S, Ramezanian H, Karami M, Rezaei MR. Ultrasonography Predictive Factors of Response to Local Steroid Injection in Patients with Carpal Tunnel Syndrome. Adv Biomed Res 2018. [PMID: 29531920 PMCID: PMC5841001 DOI: 10.4103/2277-9175.225591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: The aim of this study is to determine the predictive value of ultrasonography for results of local steroid injection in patients with carpal tunnel syndrome (CTS). Materials and Methods: This prospective cohort study was conducted during a 1-year period in outpatient clinics of rehabilitation and physical medicine including 35 patients with moderate and severe CTS who receive ultrasonography-guided local steroid injection. The Boston self-assessment questionnaire and electrodiagnosis parameters were recorded at baseline, 1 month, and 3 months after therapy. We also recorded the baseline ultrasonography parameters to determine the predictors of outcome. Results: The sensory severity score and functional status scale along with electrodiagnosis parameters decreased significantly at 1 month (P < 0.001) and remained unchanged after 3 months. Volar bulging was negatively associated with sensory nerve action potential latency (r = −0.392; P = 0.020). Cross-sectional area (CSA) of maximal swelling (MS; r = 0.409; P = 0.015), CSA at 2-cm of MS (r = 0.563; P < 0.001), and CSA at 12-cm of MS (r = 0.521; P = 0.001) correlated positively with compound muscle action potential (CMAP) amplitude while maximal swelling/12-cm MS ratio (r = −0.439; P = 0.008) and maximal swelling/2-cm MS ratio (r = −0.342; P = 0.045) correlated negatively. CSA at 12-cm of MS also correlated positively with CMAP amplitude nerve conduction velocity (r = 0.436; P = 0.010). Conclusion: Volar bulging, CSA of maximal swelling, CSA of MS at 2-cm, and CSA of MS at 12-cm are among the ultrasonographic predictors of response to local steroid injection in patients with CTS.
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Affiliation(s)
- Farnaz Dehghan
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shila Haghighat
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadiseh Ramezanian
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Karami
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Arslan H, Yavuz A, İlgen F, Aycan A, Ozgokce M, Akdeniz H, Batur A. The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome. J Med Ultrason (2001) 2018; 45:453-459. [PMID: 29330689 DOI: 10.1007/s10396-017-0857-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). METHODS Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. RESULTS Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9 years, range 23-73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. CONCLUSION The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.
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Affiliation(s)
- Harun Arslan
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey.
| | - Alpaslan Yavuz
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Ferda İlgen
- Department of Neurology, Van Training and Research Hospital, Van, Turkey
| | - Abdurrahman Aycan
- Department of Neurosurgery, Medical Faculty, Van Yuzuncu Yil University, Van, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Hüseyin Akdeniz
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
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The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7420648. [PMID: 28676832 PMCID: PMC5476875 DOI: 10.1155/2017/7420648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
Introduction The aim of this study was to explore the acupuncture effect on the cross-sectional area (CSA) of the median nerve at the wrist in patients with carpal tunnel syndrome (CTS) and, additionally, to identify whether clinical, electrophysiological, and ultrasonographic changes show any association. Methods Forty-five limbs of 27 female patients were randomly divided into two groups (acupuncture and control). All patients used night wrist splint. The patients in the acupuncture group received additional acupuncture therapy. Visual analog scale (VAS), Duruöz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve CSAs were noted before and after the treatment in both groups. Results VAS, DHI, Quick DASH scores, and electrophysiological measurements were improved in both groups. The median nerve CSA significantly decreased in the acupuncture group, whereas there was no change in the control group. Conclusion After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.
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25
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Moon HI, Kwon HK, Lee A, Lee SK, Pyun SB. Sonography of Carpal Tunnel Syndrome According to Pathophysiologic Type: Conduction Block Versus Axonal Degeneration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:993-998. [PMID: 28258652 DOI: 10.7863/ultra.16.05019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate sonographic findings according to the pathophysiologic type in patients with carpal tunnel syndrome. METHODS We retrospectively reviewed the records of 80 patients (148 hands) with carpal tunnel syndrome. Patients were classified into 3 groups according to electrophysiologic findings: (1) conduction block and conduction delay; (2) axonal degeneration; and (3) mixed. We used sonographic evaluations to assess the cross-sectional area at the distal wrist crease and the distal forearm and the wrist-to-forearm ratio of the median nerve. RESULTS Patients with axonal degeneration had significantly larger cross-sectional areas and wrist-to-forearm ratios than those with a conduction block (P < .05). The increased wrist-to-forearm ratio correlated with a reduced amplitude of the sensory nerve action potential, which reflects the degree of axonal degeneration. CONCLUSIONS The cross-sectional area and wrist-to-forearm ratio were associated with the pathophysiologic type of carpal tunnel syndrome, with larger nerve swellings seen in patients with axonal degeneration compared with those with demyelinating lesions. In addition to helping in the localization of the nerve lesion, sonography may indicate the type of nerve lesion.
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Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Bundang-gu, Korea
| | - Hee Kyu Kwon
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Ahry Lee
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Se Kwang Lee
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
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Park D. Ultrasonography of the Transverse Movement and Deformation of the Median Nerve and Its Relationships With Electrophysiological Severity in the Early Stages of Carpal Tunnel Syndrome. PM R 2017; 9:1085-1094. [DOI: 10.1016/j.pmrj.2017.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/09/2017] [Accepted: 03/28/2017] [Indexed: 01/27/2023]
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Oh WT, Kang HJ, Koh IH, Jang JY, Choi YR. Morphologic change of nerve and symptom relief are similar after mini-incision and endoscopic carpal tunnel release: a randomized trial. BMC Musculoskelet Disord 2017; 18:65. [PMID: 28158978 PMCID: PMC5291967 DOI: 10.1186/s12891-017-1438-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The symptoms in carpal tunnel syndrome (CTS) can be ameliorated by open and endoscopic release of the transverse carpal ligament. It is unknown whether a mini-incision or endoscopic carpal tunnel release more effectively reverses the pathological changes that are observed in the median nerve in patients with CTS and these morphologic changes correlates with the subjective outcomes after carpal tunnel release. We hypothesized that (1) at 24 weeks after surgery, the subjective outcomes of mini-incision release and endoscopic release would not differ in patients with CTS; and (2) the ultrasonographic (US) morphology of the median nerve reverses similarly after mini-incision and endoscopic release; (3) the subjective outcomes correlates with these morphologic changes. METHODS Between November 2011 and January 2013, 67 patients with CTS in their dominant wrist were randomized to either mini-incision (n = 32) or endoscopic (n = 35) release. Each patient was assessed by both the Boston Carpal Tunnel Questionnaire (BCTQ) and the Disabilities of the Arm, Shoulder, and Hand (DASH) pre-operatively and 24 weeks' post-operation. An US examination was conducted at both time points to measure the cross-sectional area (CSA) at the inlet, middle, and outlet (CSA-I, CSA-M and CSA-O) and the flattening ratio (FR) at the middle and outlet (FR-M and FR-O) of the median nerve. RESULTS The post-operative mean BCTQ and DASH scores were improved significantly from the pre-operative scores in both groups (p < 0.001). The mean CSA-I decreased and CSA-M and CSA-O increased similarly in both groups (by 3.3, 3.0, and 3.8 mm2 in the mini-incision group and 2.9, 3.1. and 2.7 mm2 in the endoscopic group. The mean FR-M/FR-O decreased similarly from 3.6/4.2 to 3.2/3.0 in the mini-incision group and 3.8/4.3 to 3.2/2.9 in the endoscopic group. There were no significant differences in the subjective outcome scores or median nerve measures between the two groups. Improvement in the BCTQ-S only was significantly correlated with changes in the CSA at the inlet. CONCLUSIONS Mini-incision and endoscopic release both similarly relieved subjective symptoms and functions along with the pathological changes in the median nerve morphology along the carpal tunnel in patients with idiopathic CTS. Symptom relief after surgical decompression seems to correlate with reduced nerve swelling at carpal inlet and reversed nerve flattening inside carpal tunnel. TRIAL REGISTRATION This study was retrospectively registered in "ClinicalTrials.gov" at Oct 18th, 2013, and the registration number was NCT01972165 .
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Affiliation(s)
- Won-Taek Oh
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Ho-Jung Kang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Il-Hyun Koh
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Jin-Young Jang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Yun-Rak Choi
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea.
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Ikeda M, Okada M, Toyama M, Uemura T, Takamatsu K, Nakamura H. Comparison of Median Nerve Cross-sectional Area on 3-T MRI in Patients With Carpal Tunnel Syndrome. Orthopedics 2017; 40:e77-e81. [PMID: 27648575 DOI: 10.3928/01477447-20160915-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023]
Abstract
This study correlated morphologic abnormalities of idiopathic carpal tunnel syndrome (CTS) with the severity of CTS using 3-T magnetic resonance imaging (MRI). The relationship of the severity of CTS and the cross-sectional area of the median nerve (CSA) was assessed at several levels. Seventy wrists of 35 patients (27 women and 8 men) with unilateral idiopathic CTS underwent nerve conduction study and 3-T MRI of the wrist. The CSA at 4 levels (distal radioulnar joint, body of scaphoid, tubercule of scaphoid, and hook of hamate) and the thickness of the transverse carpal ligament at 3 levels in both affected and unaffected hands were measured using 3-T MRI and correlated with the severity of CTS assessed with distal motor latency. The CSA in the affected hand at the scaphoid body level was significantly higher than in the unaffected hand. The CSA at the scaphoid body level was positively correlated with distal motor latency in the affected hand. The CSA in the affected hand at the scaphoid tubercule level was significantly lower than in the unaffected hand. The CSA had a negative correlation with distal motor latency at the scaphoid tubercule level. The CSA at the distal radioulnar joint and the hamate hook was not significantly different between the affected hand and the unaffected hand. The CSA at the distal radioulnar joint level and hook level were not correlated significantly with distal motor latency in the affected hand. The mean CSA of the affected hand at the scaphoid body level was highest in 4 levels. [Orthopedics. 2017; 40(1):e77-e81.].
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Kim JY, Song S, Park HJ, Rhee WI, Won SJ. Diagnostic Cutoff Value for Ultrasonography of the Common Fibular Neuropathy at the Fibular Head. Ann Rehabil Med 2016; 40:1057-1063. [PMID: 28119836 PMCID: PMC5256328 DOI: 10.5535/arm.2016.40.6.1057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/06/2016] [Indexed: 12/28/2022] Open
Abstract
Objective To establish the diagnostic cutoff value of ultrasonographic measurement for common fibular neuropathy (CFN) at the fibular head (FH). Methods Twenty patients with electrodiagnostically diagnosed CFN at the FH and 30 healthy controls were included in the study. The cross-sectional area (CSA) of sciatic nerve at mid-thigh level, common fibular nerve at popliteal fossa (PF), and common fibular (CF) nerve at FH were measured. Additionally, the difference of CF nerve CSA at the FH between symptomatic side and asymptomatic side (ΔSx–Asx), the ratio of CF nerve CSA at FH to at PF (FH/PF), and the ratio of CF nerve CSA at the FH symptomatic side to asymptomatic side (Ratio Sx–Asx) were calculated. Results CSA at the FH, FH/PF, ΔSx–Asx, and Ratio Sx–Asx showed significant differences between the patient and control groups. The cutoff value for diagnosing CFN at the FH was 11.7 mm2 for the CSA at the FH (sensitivity 85.0%, specificity 90.0%), 1.70 mm2 for the ΔSx–Asx (sensitivity 83.3%, specificity 97.0%), 1.11 for the FH/PF (sensitivity 47.1%, specificity 93.3%), and 1.24 for the Ratio Sx–Asx (sensitivity 72.2%, specificity 96.7%). Conclusion The ultrasonographic measurement and cutoff value could be a valuable reference in diagnosing CFN at the FH and improving diagnostic reliability and efficacy.
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Affiliation(s)
- Ji Yeon Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seojin Song
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jung Park
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Ihl Rhee
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yurdakul OV, Mesci N, Çetinkaya Y, Geler Külcü D. Diagnostic Significance of Ultrasonographic Measurements and Median-Ulnar Ratio in Carpal Tunnel Syndrome: Correlation with Nerve Conduction Studies. J Clin Neurol 2016; 12:289-94. [PMID: 27095524 PMCID: PMC4960212 DOI: 10.3988/jcn.2016.12.3.289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/14/2015] [Accepted: 11/17/2015] [Indexed: 02/01/2023] Open
Abstract
Background and Purpose We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and electrophysiology findings. We determined whether the ratio of the median-to-ulnar cross-sectional areas (CSAs) can support CTS diagnoses. Methods The pisiform CSA (CSApisiform), swelling ratio (SR), palmar bowing, and CSApisiform/ulnar CSA (CSAulnar) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSAulnar was measured in Guyon's canal at the level of most-protuberant portion of the pisiform bone. Results The values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSApisiform could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSApisiform/CSAulnar ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS. Conclusions Only CSApisiform measurements were reliable for diagnosing early stages of CTS, and CSApisiform/CSAulnar had a lower diagnostic value for diagnosing CTS.
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Affiliation(s)
- Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Taksim Education and Research Hospital, Istanbul, Turkey.
| | - Nilgün Mesci
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Yilmaz Çetinkaya
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Duygu Geler Külcü
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Miyamoto H, Morizaki Y, Kashiyama T, Tanaka S. Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome. World J Radiol 2016; 8:281-287. [PMID: 27027498 PMCID: PMC4807337 DOI: 10.4329/wjr.v8.i3.281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/06/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Grey-scale sonography and sonoelastography (SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area (CSA). Several authors have assessed additional parameters. “Delta CSA” is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The “CSA ratio” is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.
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Yamazaki T, Kawahara N, Arai K, Oyoshi K, Oshima M, Koike S, Miyauchi A, Hayasaka T, Saito T, Tsuruoka S. Utility of Ultrasonography of the Median Nerve With a High-Frequency Probe for the Diagnosis of Dialysis-Related Carpal Tunnel Syndrome. Ther Apher Dial 2016; 20:483-491. [PMID: 26991919 DOI: 10.1111/1744-9987.12413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/04/2016] [Indexed: 01/11/2023]
Abstract
This cross-sectional study aimed to determine the utility of ultrasonography with improved resolution using a high-frequency probe for dialysis-related carpal tunnel syndrome (CTS). This study targeted 125 hemodialysis patients at our hospital. A 12 MHz probe was placed on the carpal tunnel area to identify the median nerve. The compression rate of the nerve was calculated by measuring the smallest diameter of the compressed nerve and largest diameter of the unaffected part. To quantify CTS symptoms, we determined the presence of Tinel's sign, measured pinch strength, and used questionnaires to assess numbness and pain. The association of these clinical data with the compression rate was examined. Mean compression rate was 12.1 ± 1.1%. The compression rate cutoff value for those positive with Tinel's sign was 25%, (sensitivity and specificity were 0.80 and 0.91, respectively), and that for those with a history of CTS surgery was 25% (sensitivity and specificity were 0.67 and 0.89, respectively). Multiple regression analysis identified duration of dialysis, β2-microglobulin(β2-Mg) concentration, positivity for Tinel's sign, history of CTS surgery, and pinch strength as independent compression rate determinants. Notably, compression rates were significantly higher in patients with a ≥4-year duration of dialysis and a β2-Mg level of 20 mg/L or more. The compression rate of the median nerve measured by an improved ultrasound device significantly correlated with clinical symptoms, medical history, and serological features associated with dialysis-related CTS. Because ultrasonography is non-invasive, the examination might be a simple method especially for early diagnosis of dialysis-related CTS.
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Affiliation(s)
| | | | | | - Koji Oyoshi
- Hemodialysis Unit, Moka Hospital, Tochigi, Japan
| | | | | | | | | | - Tetsuo Saito
- Hemodialysis Unit, Moka Hospital, Tochigi, Japan
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Electrosonodiagnosis in Carpal Tunnel Syndrome: A Proposed Diagnostic Algorithm Based on an Analytic Literature Review. PM R 2016; 8:463-74. [PMID: 26804668 DOI: 10.1016/j.pmrj.2015.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Suspected carpal tunnel syndrome (CTS) remains the most common clinical scenario prompting referral for electrodiagnostic (EDx) studies to identify objective correlates of reported subjective symptoms and clinical examination findings. Despite much debate and a rapidly expanding literature, identification of an optimal algorithm for diagnosing focal median mononeuropathy at the wrist (FMMW) associated with CTS signs and symptoms remains elusive. The introduction and rapid dissemination of peripheral nerve ultrasound imaging (PN-USI) of the median nerve has raised new questions regarding the relative value of structural information from PN-USI versus physiological information from EDx in the diagnosis of FMMW, as well as the significance of various clinical signs and symptoms suggestive of CTS. The means by which PN-USI and EDx may be optimally deployed and integrated in the process of diagnosing FMMW remains to be clearly delineated. OBJECTIVE To complete an analytical literature review to guide the formulation of a clinical diagnostic algorithm (CDA) integrating the use of PN-USI and EDx for the optimal detection of FMMW in the context of making a clinical diagnosis of CTS. DATA SOURCES A structured literature review was performed on the MEDLINE medical literature database accessed through PubMed. ANALYSIS Papers with particular relevance and connection to the goal of formulating the CDA were selected from the identified studies. Studies specifically examining the correlations between systematically documented clinical symptomatology, EDx findings, and PN-USI findings were reviewed for consistent outcomes that could be incorporated into a CDA to guide the integration of these two complementary technologies in the diagnostic process. LIMITATIONS The formulation of the algorithm was limited to measures with established validity that can be readily obtained by means of widely accepted protocols using standard EDx and ultrasound equipment. The formulated algorithm assumes a consistent association between pathophysiology and anatomical deformation of the median nerve, which may not occur in certain situations. It may also not be as accurately applied to patients with CTS with significant comorbid neuromuscular conditions. CONCLUSIONS An algorithm has been developed and presented, and illustrated as a flow chart, based on findings reported in the relevant reviewed literature in which PN-USI is proposed as a painless and rapidly performed screening test for FMMW to be completed before subjecting a patient to a systematic EDx testing process.
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de Jesus Filho AG, do Nascimento BF, Amorim MDC, Naus RAS, Loures EDA, Moratelli L. Comparative study between physical examination, electroneuromyography and ultrasonography in diagnosing carpal tunnel syndrome. Rev Bras Ortop 2015; 49:446-51. [PMID: 26229843 PMCID: PMC4487453 DOI: 10.1016/j.rboe.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the sensitivity of electromyography and ultrasonography in diagnosing carpal tunnel syndrome (CTS), in comparison with physical examination, which is considered to be the gold standard. METHODS In this cross-sectional study, the medical files of 56 patients with 70 hands affected by CTS who were attended between March 2010 and June 2012 were reviewed. The study included patients with a clinical diagnosis of CTS. The sensitivity of the complementary examinations was analyzed and compared with physical examination. RESULTS Nocturnal symptoms were found in 96.4%, thenar atrophy in 62.5% and abnormal sense of touch in 50%. The sensitivities found were: ultrasonography, 67.1% (95% CI: 55.7%-78.6%); an association of physical examination tests, 95.7% (95% CI: 90.0%-100%); and electromyography, 98.6% (95% CI: 95.7%-100%). The presence of atrophy, abnormalities of the sense of touch and longer-duration symptoms increased the sensitivity of ultrasonography and physical examination. CONCLUSION The sensitivity of ultrasonography for CTS was lower than that of electromyography and physical examination.
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Affiliation(s)
| | | | | | | | | | - Lucas Moratelli
- Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
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Eom YI, Choi MH, Kim YK, Joo IS. Sonographic findings in the ulnar nerve according to the electrophysiologic stage of carpal tunnel syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1027-1034. [PMID: 26014322 DOI: 10.7863/ultra.34.6.1027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Involvement of the ulnar nerve in patients with carpal tunnel syndrome is controversial. The aim of our study was to evaluate sonographic findings in the ulnar nerve in patients with carpal tunnel syndrome. METHODS We performed median and ulnar nerve conduction studies with sonography in 109 hands of 60 patients with clinically suspected carpal tunnel syndrome. Sonographic findings were analyzed with regard to electrophysiologic stages of carpal tunnel syndrome. RESULTS We found that the sensory conduction velocity of the ulnar nerve decreased as the electrophysiologic stage of carpal tunnel syndrome increased (P = .038), but there was no change in the cross-sectional area of the ulnar nerve at the wrist. The median-to-ulnar nerve cross-sectional area ratio at the wrist showed a significant correlation with the electrophysiologic stage of carpal tunnel syndrome (Spearman r = 0.431; P < .0001), in addition to the median nerve cross-sectional area at the wrist and the wrist-to- forearm median nerve cross-sectional area ratio. CONCLUSIONS In our study, ulnar nerve involvement in patients with carpal tunnel syndrome was shown electrophysiologically but not sonographically. These results suggest that morphologic changes in the ulnar nerve do not occur in carpal tunnel syndrome, although functional changes may occur.
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Affiliation(s)
- Young In Eom
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Moon Hee Choi
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Yue Kyung Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - In Soo Joo
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
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Klauser AS, Abd Ellah MMH, Halpern EJ, Siedentopf C, Auer T, Eberle G, Bellmann-Weiler R, Kremser C, Sojer M, Löscher WN, Gabl MF, Feuchtner GM, Jaschke WR. Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies? Eur Radiol 2015; 25:2419-27. [DOI: 10.1007/s00330-015-3649-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/23/2015] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
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A comparison of the ultrasonographic median nerve cross-sectional area at the wrist and the wrist-to-forearm ratio in carpal tunnel syndrome. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:1113-7. [PMID: 25709649 PMCID: PMC4333516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/11/2014] [Accepted: 10/29/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Electrophysiologic (EDX) study is the most valuable method in grading the severity of carpal tunnel syndrome (CTS), but it is invasive and painful. We evaluated the efficacy of ultrasound for this purpose. MATERIALS AND METHODS Eighty-one wrists of 52 consecutive patients with clinical evidences of CTS, confirmed and graded by EDX as mild, moderate, and severe, were examined by ultrasonography. Cross-sectional area (CSA) of the median nerve was measured at the distal wrist (CSA-D), and proximal forearm (CSA-P), and wrist-to-forearm ratio (WFR) was calculated for each hand. RESULTS The mean CSA-D was 0.12 cm(2) ± 0.03, 0.15 cm(2) ± 0.03 and 0.19 cm(2) ± 0.06 and the mean WFR was 2.77 ± 1.14, 3.07 ± 1.07 and 4.07 ± 1.61 in mild, moderate and severe groups respectively. WFR showed significant differences between the severe and none severe CTS groups (P < 0.001), but there was no significant difference between mild and moderate CTS groups (P < 0.381). CSA-D showed a significant difference between all groups (P < 0.0001). In the Receiver Operating Characteristic curve analysis, the optimal cut-off value of the CSA-D and WFR for detecting severe CTS were 0.15 (area under the curve 0.784, 95% confidence interval (CI): 0.662-0.898, P < 0.001, sensitivity of 68.2% and specificity of 70.9%) and 3 (area under the curve 0.714, 95% CI: 0.585-0.84, P = 0.001, sensitivity of 68.2% and specificity of 64.8%) respectively. All values were superior in CSA-D. CONCLUSION Ultrasonography, can be complementary but not conclusive to the classification of CTS severities. CSA-D and WFR both increased in proportion to CTS severity, but neither parameter exhibited excellent performance in grading the severities.
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Yildirim A, Bulut HT, Ekmekci B, Surucu GD, Karabiber M. Use of diffusion tensor imaging for nonsurgical treatments of carpal tunnel syndrome. Muscle Nerve 2014; 50:950-5. [DOI: 10.1002/mus.24236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Adem Yildirim
- Department of Physical Medicine and Rehabilitation; Medical Faculty of Adiyaman University; Adiyaman Turkey
| | - Haci Taner Bulut
- Department of Radiology; Medical Faculty of Adiyaman University; Adiyaman Turkey
| | - Burcu Ekmekci
- Department of Neurology; Medical Faculty of Adiyaman University; Adiyaman Turkey
| | - Gülseren Dost Surucu
- Department of Physical Medicine and Rehabilitation; Medical Faculty of Adiyaman University; Adiyaman Turkey
| | - Mehmet Karabiber
- Department of Physical Medicine and Rehabilitation; Medical Faculty of Adiyaman University; Adiyaman Turkey
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de Jesus Filho AG, do Nascimento BF, Amorim MDC, Naus RAS, Loures EDA, Moratelli L. Estudo comparativo entre o exame físico, a eletroneuromiografia e a ultrassonografia no diagnóstico da síndrome do túnel do carpo. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Bulut HT, Yildirim A, Ekmekci B, Gunbey HP. The diagnostic and grading value of diffusion tensor imaging in patients with carpal tunnel syndrome. Acad Radiol 2014; 21:767-73. [PMID: 24726891 DOI: 10.1016/j.acra.2014.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES In this study, we investigated the diagnostic and grading value of diffusion tensor imaging (DTI) in patients with carpal tunnel syndrome (CTS). MATERIALS AND METHODS Of the 120 subjects included in the present study, 72 were in the CTS group and 48 were in the healthy control group. In addition, the patients with CTS were further divided into three subgroups based on severity (mild, moderate, and severe) according to electrophysiological studies (EPS). DTI-derived parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) were evaluated at four median nerve levels. The mean FA and ADC values of the CTS groups and healthy controls were compared separately. Correlations and possible relationships between DTI parameters and EPS results were analyzed. Receiver operating characteristics analysis was used to calculate the FA and ADC cutoff values for CTS diagnosis and grading. RESULTS Statistically significant differences were observed in mean FA and ADC between the normal and mild, mild and moderate, and moderate and severe subgroups. Significant correlations were found between DTI parameters and EPS measurements based on severity. FA and ADC threshold values, as well as the sensitivity and specificity levels, for diagnosing and grading CTS were determined. CONCLUSIONS DTI parameters can provide helpful information for CTS. The correlations of FA and ADC measurements versus EPS measurements based on severity were significant. Moreover, FA and ADC threshold values were sufficient for the diagnosis and grading of CTS.
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Affiliation(s)
- Haci Taner Bulut
- Department of Radiology, Medical Faculty of Adiyaman University, Adiyaman, 02100 Turkey.
| | - Adem Yildirim
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Adiyaman University, Adiyaman, 02100 Turkey
| | - Burcu Ekmekci
- Department of Neurology, Medical Faculty of Adiyaman University, Adiyaman, 02100 Turkey
| | - Hediye Pinar Gunbey
- Department of Radiology, Samsun Education and Research Hospital, Samsun, Turkey
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Żyluk A, Walaszek I, Szlosser Z. No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome. J Hand Surg Eur Vol 2014; 39:161-6. [PMID: 23677962 DOI: 10.1177/1753193413489046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A prospective study was carried out to investigate any correlation between electrophysiological and sonographic findings in patients with a clinical diagnosis of carpal tunnel syndrome. A total of 113 patients (113 wrists) in 90 women and 23 men, with a mean age of 60 years, underwent sonographic and electrophysiological examination. Fifty-five patients (48%) had mild, 43 (38%) moderate and 12 (11%) had severe conduction disturbances and three patients had normal conduction. Sonographic measurements showed a cross-sectional area of the median nerve of 9.9 mm(2) at the forearm and 17.8 mm(2) at the tunnel inlet. The mean anteroposterior diameter (height) of the nerve at the tunnel inlet was 2.7 mm, and the lowest height inside the tunnel was 1.8 mm. No correlation was found between sonographic and electrophysiological parameters.
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Affiliation(s)
- A Żyluk
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Nerve ultrasound in diabetic polyneuropathy: the new frontier? Clin Neurophysiol 2013; 125:657. [PMID: 24239453 DOI: 10.1016/j.clinph.2013.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/19/2013] [Indexed: 11/20/2022]
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Moon HI, Kwon HK, Kim L, Lee HJ, Lee HJ. Ultrasonography of palm to elbow segment of median nerve in different degrees of diabetic polyneuropathy. Clin Neurophysiol 2013; 125:844-848. [PMID: 24269093 DOI: 10.1016/j.clinph.2013.10.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/12/2013] [Accepted: 10/01/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify the relationship between the ultrasonographic cross-sectional area (CSA) of the median nerve and electrophysiologic findings in diabetic patients. METHODS Sixty diabetic patients, 30 patients with carpal tunnel syndrome (CTS) and 30 healthy volunteers participated. The participants were divided into 4 groups: Control Group; Group I, diabetic patients without diabetic polyneuropathy (DPN); Group II, diabetic patients with DPN; and Group III, patients with CTS. Group II was subdivided into II-1 and II-2 according to DPN severity. The median nerve CSA was measured at 4 levels, and the wrist-to-forearm ratio (WFR) was calculated. RESULTS The median nerve CSAs were larger in Group II than in Group I and the Control Group. There were significant differences in the CSA between Group I and Group II-2 and between Group II-1 and II-2. There was no significant difference in the WFR among these groups. The CSAs at the wrist levels and WFR were significantly greater in Group III. CONCLUSIONS The median nerve CSA was greater in patients with DPN and was related to DPN severity. Diffuse increase in median nerve CSA without change in the WFR might be compatible with DPN. Ultrasonography could be applied for the diagnosis of DPN, especially in advanced cases. SIGNIFICANCE Ultrasonography might have value in the differential diagnosis of DPN and entrapment neuropathy.
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Affiliation(s)
- Hyun Im Moon
- Korea University College of Medicine, South Korea
| | - Hee Kyu Kwon
- Korea University College of Medicine, South Korea.
| | - Lina Kim
- Sahmyook Medical Center, South Korea
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Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol 2013; 24:434-40. [PMID: 24220753 DOI: 10.1007/s00330-013-3023-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS). METHODS The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed. RESULTS The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements. CONCLUSIONS Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique. KEY POINTS • Clinical examination is important for diagnosis of carpal tunnel syndrome • Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound • SWE is highly reproducible in evaluation of median nerve stiffness • Median nerve stiffness is significantly increased in carpal tunnel syndrome • Elastography could become useful in diagnosis of carpal tunnel syndrome.
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Kim JM, Kim MW, Ko YJ. Correlating ultrasound findings of carpal tunnel syndrome with nerve conduction studies. Muscle Nerve 2013; 48:905-10. [DOI: 10.1002/mus.23841] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Jae Min Kim
- Department of Rehabilitation Medicine; Incheon St. Mary Hospital, College of Medicine, The Catholic University of Korea; Incheon Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine; Incheon St. Mary Hospital, College of Medicine, The Catholic University of Korea; Incheon Korea
| | - Young Jin Ko
- Department of Rehabilitation Medicine; Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea; #505 Banpo-Dong, Seocho-Gu Seoul 137-040 Korea
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Yoshii Y, Ishii T, Sakai S. MEDIAN NERVE DEFORMATION DURING FINGER MOTION IN CARPAL TUNNEL SYNDROME: CORRELATION BETWEEN NERVE CONDUCTION AND ULTRASONOGRAPHIC INDICES. ACTA ACUST UNITED AC 2013; 18:203-8. [DOI: 10.1142/s021881041350024x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To compare the median nerve deformation indices between carpal tunnel syndrome (CTS) patients and controls, 60 wrists of asymptomatic volunteers and 40 wrists of idiopathic CTS patients were evaluated by ultrasound. CTS was diagnosed through clinical findings and nerve conduction studies. Deformation indices, which were determined by the ratios of the nerve cross-sectional area, perimeter, aspect ratio, and circularity in finger extension and flexion positions, were measured. The deformation indices were compared between patients and controls. The correlation coefficients between distal motor latency and deformation indices were measured in CTS patients. There were significant differences between patients and controls in the deformation indices of perimeter, aspect ratio, and circularity. There was a mild correlation between distal latency and deformation indices of the perimeter and circularity (correlation coefficient 0.315 and 0.342). The deformation indices of perimeter and circularity might be useful to identify the nerve conduction severity of CTS.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Endowed Department of Human Resources Development for Community Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Endowed Department of Human Resources Development for Community Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
| | - Shinsuke Sakai
- Department of Orthopaedic Surgery, Endowed Department of Human Resources Development for Community Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
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