Abstract
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS). Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion–extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC) curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating median nerve dysfunction in CTS patients.
Highlights
Carpal tunnel syndrome (CTS), was first described in 1854 by Paget [1], and is the most frequently encountered peripheral compression mononeuropathy, with a prevalence of 5% in the general population [2, 3]
A smaller amount of median nerve motion was correlated with more-severe nerve conduction studies (NCS), which implied that the decreasing median nerve mobility was correlated with the reduced median nerve conduction velocity
Motion of the median nerve exhibits a non uniform pattern dependent on the local anatomical and biomechanical properties and the specific finger or wrist movements involved, we have demonstrated in this study that the transverse sliding of the median nerve within the carpal tunnel during standardized active finger movements can be substantially converted into analyzable estimates for differentiating between normal subjects and CTS patients
Summary
Carpal tunnel syndrome (CTS), was first described in 1854 by Paget [1], and is the most frequently encountered peripheral compression mononeuropathy, with a prevalence of 5% in the general population [2, 3]. Nine flexor tendons of the fingers and the median nerve pass through the carpal tunnel at the wrist level. The carpal tunnel can be grossly divided into a proximal part, approximately at the level of the pisiform bone, and a distal part, approximately at the level of the hook of the hamate bone. These bony structures could serve as anatomical landmarks for the quantitative analysis of the median nerve in imaging studies
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