Abstract
BackgroundUltrasonography is a convenient non-invasive diagnostic tool with wide availability and cost effectiveness. Musculoskeletal ultrasonography is a growing field used for diagnosis of many musculoskeletal disorders; carpal tunnel syndrome (CTS) could be one of these disorders. The purpose of this study was to assess the impact of median nerve ultrasonography in carpal tunnel syndrome on surgical management, and its added value in operative techniques selection, and in tailoring the surgical steps. Thirty patients with CTS and thirty normal subjects underwent superficial ultrasonography. The cross-sectional area at different levels and flattening ratios were measured on both groups. The patients who had failed conservative treatment had surgical carpal tunnel release.ResultsThere was significant positive correlation between the need for external neurolysis with increased flattening ratio with cutoff values > 4, and between the need for approach extension with increased cross-sectional area difference between pisiform level and pronator quadratus level with cutoff values of cross-sectional area difference > 7.ConclusionsUltrasonographic measurements of median nerve in CTS could be helpful in selection and modification of operative procedure including the surgical approach and need for neurolysis.
Highlights
Ultrasonography is a convenient non-invasive diagnostic tool with wide availability and cost effectiveness
Different imaging tools have been utilized for assessment of Median nerve (MN) in carpal tunnel syndrome (CTS); they vary from the simple cost-effective tool as ultrasonography to more complex one as MRI, which
The entrapment of the MN occurs between the transverse carpal ligament and carpal bones, with subsequent cross-sectional area (CSA) enlargement which occurs at the level of proximal carpal tunnel, the MN size appears to be not affected at more proximal level above the carpal tunnel [12]
Summary
Ultrasonography is a convenient non-invasive diagnostic tool with wide availability and cost effectiveness. Carpal tunnel syndrome (CTS) is the most frequently encountered upper limb compression neuropathy; it mostly occurs in patients subjected to repetitive wrist motion [1]. Median nerve compression in CTS results in neural enlargement which could be expressed radiologically by the increase in cross-sectional area (CSA) [2, 3]. It was found that median nerve CSA enlargement is a specific criterion for the radiological diagnosis of CTS [4,5,6]. Different imaging tools have been utilized for assessment of MN in CTS; they vary from the simple cost-effective tool as ultrasonography to more complex one as MRI, which. Ultrasonography is a non-invasive, widely available and cost effective imaging tool could be used in diagnosis of CTS. There is no consensus on which value of median nerve CSA used for CTS diagnosis; most studies found a cutoff value ranging from 9 to 12 mm2 [10,11,12,13,14]
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