Area Of Median Nerve Research Articles

MRI Assessment of Changes in Swelling of Wrist Structures Following OMT in Patients With Carpal Tunnel Syndrome

Abstract We treated patients with carpal tunnel syndrome using OMT. Treatments were focused on the upper thoracic spine, lower cervical spine, and tenderpoints in the forearm muscles. OMT was not applied to the wrist in an attempt to stretch the transverse carpal ligament. MRI images were used to assess changes in fluid content in both the carpal tunnel and median nerve after OMT treatment. MRI measurements of median nerve area, carpal tunnel area and length of the transverse carpal ligament were also obtained. These measurements were correlated with changes in nerve conduction velocities (NCVs), pain ratings, wrist motion measurements, and somatic dysfunction information. The numeric data were compared and contrasted using Hest statistics. Significance probabilities of P < 0.05 were computed. Statistically significant changes were noted in pain ratings, wrist motions and nerve conduction (sensory amplitude). Five patients responded with improvement in symptoms and one did not. The responder group demonstrated a decrease in the amount of swelling of both the median nerve and carpal tunnel. The nonresponder demonstrated increased swelling in both the median nerve and carpal tunnel. Changes in the swelling of both the median nerve and carpal tunnel appear to more closely parallel changes in hand symptoms than nerve conduction results.1 No statistically significant increases occurred in the length of the transverse carpal ligament or the carpal tunnel area. Minimal changes in both the length of the transverse carpal ligament and carpal tunnel area did occur despite no active attempts to stretch this region. All six patients had a predominance of acute changes in the upper thoracic spine and upper ribs. Most patients had tension in the flexor muscles of the forearm. Treatment of the upper thoracic spine, upper ribs, and forearms are all important in the management of carpal tunnel syndrome.

Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Nerve conduction studies (NCS) is the most valid way of diagnosing CTS in combination of these clinical symptoms together with positive signs by physical examination. Ultrasonography is a useful non-invasive diagnostic method for CTS and there is considerable correlation between the electrophysiological tests and the measurements of cross-sectional area (CSA) by ultrasonography. Many studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycemic control. Although diabetes mellitus is a risk factor for CTS, reports about median nerve CSA measurements between CTS patients with and without DM are scant. This prospective study aimed to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM-CTS patients. To correlate the diagnostic results in both DM and non-DM-CTS patients. Patients and methodsThirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography (US). ResultsHigh mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups. Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients. ConclusionThe CSA of median nerve is larger in CTS hands in both DM and non-DM patients. Mean electro-diagnostic parameters were not significant predictors of CTS in patients with diabetes. The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.

High-resolution ultrasonography of cross-sectional area of median nerve compared with electro-diagnostic study in carpal-tunnel syndrome

Carpal tunnel syndrome is a common chronic entrapment neuropathy. The present study evaluated the diagnostic ability of ultrasound (US) in measuring the cross-sectional area of the median nerve in the entrance of the carpal tunnel area in comparison with electrodiagnostic testing for diagnosing carpal tunnel syndrome. In this cross-sectional study, 253 patients with carpal tunnel syndrome based on American Academy of Neurology clinical symptoms were selected for participation. After screening, 200 patients were enrolled in the study. Wrist US and electrodiagnostic findings for patients were compared. Data were analyzed by SPSS. There was a good agreement between sonographic and electrodiagnostic findings [right hand (kappa= 0.71), left hand (kappa= 0.78)]. For the right and left hands, respectively, ultrasound sensitivity (89% vs 90%), specificity (90% vs 89.2%), positive predictive value (84.7% vs 94.7%), and negative predictive value (75.7% vs 81.6%) were calculated. High-resolution ultrasound of the median nerve cross-sectional area is an accurate test for diagnosing carpal tunnel with an acceptable level of diagnostic ability. In comparison with the electrodiagnostic test, ultrasonography can provide more practical information about anatomical changes in the tunnel, which can be considered in selecting treatment options.

Use of Cross-Sectional Area of Median Nerve in Diagnosis of Carpal Tunnel Syndrome

Use of Cross-Sectional Area of Median Nerve in Diagnosis of Carpal Tunnel Syndrome

Median Nerve Palsies due to Injections: A Review.

Injection nerve palsy (INP) in the median nerve is an iatrogenic peripheral nerve injury that can be inflicted by a faulty intramuscular injection in the median nerve area. The literature reports a 2% incidence of INP among all peripheral nerve injuries. The incidence of INP in developed countries has decreased significantly during the past decade, but the injury appears to remain prevalent in developing countries. A deep understanding of the anatomy of the peripheral nerves, and a precise intramuscular injection technique, have been shown to be vital for preventing INP in the median nerve. Debates continue regarding what, if any, intervention is necessary for injection palsies; and if it is needed, when it should be carried out. In this article, we will review the literature related to median injection nerve palsy and recommended methods of prevention.

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

BackgroundTo date, there have been conflicting suggestions regarding the initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized as either inflammation of the median nerve caused by compression or noninflammatory fibrosis of the subsynovial connective tissue (SSCT). ObjectiveTo investigate the initial pathogenesis of CTS, we compared the deformation and displacement of the median nerve in accordance with the electrophysiological severity between patients with CTS (via the Bland scale) and healthy controls. DesignCross-sectional, case-control study. SettingGeneral teaching hospital, rehabilitation unit. PatientsThirteen hands of 10 healthy participants and 39 hands of 27 patients with CTS were recruited and classified into 4 groups (stage 0−3) according to the severity of the electrodiagnostic test results. MethodsUltrasound images of the median nerve in response to the wrist and finger motions were analyzed. Main Outcome MeasureWe measured the deformation of the median nerve (the maximal change values of the median nerve area, and aspect ratio of the minimum-enclosing rectangle [MER]) and movement of the median nerve (the maximal change value of the median nerve displacement) in response to the motions of wrists and finger. The maximal change value of the median nerve displacement was normalized with respect to the width of the wrist. Moreover, the maximal change values of the median nerve area, and the aspect ratio of the MER, were also normalized to the median nerve area and the aspect ratio of the MER in wrist-neutral position with finger extension. ResultCTS patients in stage 3 showed a significantly lower normalized maximal change of the median nerve movement compared with CTS patients in stages 0, 1, and 2 (P <.001). Regarding the deformation of the median nerve, however, there were statistically significant differences among all groups (area, P < .001; MER, P <.001). According to multivariate logistic regression analysis, the normalized maximal change of the aspect ratio of the MER is a meaningful parameter in diagnosing the initial stage of CTS (P < .01). ConclusionThese results showed that the deformation of the median nerve may be associated with the initial pathogenesis; however, further studies are necessary to validate the findings of this study. Level of EvidenceIII

Electrophysiologic and Ultrasonographic Assessment of Carpal Tunnel Syndrome in Wheelchair Basketball Athletes.

ObjectiveTo investigate the contributing factors of carpal tunnel syndrome (CTS), electrodiagnostic and ultrasonographic findings of median nerve, and median nerve change after exercise in wheelchair basketball (WCB) players.MethodsFifteen WCB players with manual wheelchairs were enrolled in the study. Medical history of the subjects was taken. Electrodiagnosis and ultrasonography of both median nerves were performed to assess CTS in WCB players. Ultrasonographic median nerves evaluation was conducted after wheelchair propulsion for 20 minutes.ResultsAverage body mass index (BMI) and period of wheelchair use of CTS subjects were greater than those of normal subjects. Electrodiagnosis revealed CTS in 14 of 30 hands (47%). Cross-sectional area (CSA) of median nerve was greater in CTS subjects than in normal subjects at 0.5 cm and 1 cm proximal to distal wrist crease (DWC), DWC, 1 cm, 2 cm, 3 cm, and 3.5 cm distal to DWC. After exercising, median nerve CSAs at 0.5 cm and 1 cm proximal to DWC, DWC, and 3 cm and 3.5 cm distal to DWC were greater than baseline CSAs in CTS subjects; and median nerve CSAs at 1 cm proximal to DWC and DWC were greater than baseline CSAs in normal subjects. The changes in median nerve CSA after exercise in CTS subjects were greater than in normal subjects at 0.5 cm proximal to DWC and 3 cm and 3.5 cm distal to DWC.ConclusionBMI and total period of wheelchair use contributed to developing CTS in WCB players. The experimental exercise might be related to the median nerve swelling around the inlet and outlet of carpal tunnel in WCB athletes with CTS.

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

OBJECTIVE:The aim of this study was to investigate the prevalence of anatomic variations of the bifid median nerve, persistent median artery and persistent median vein in Chinese individuals and their relationship with carpal tunnel syndrome.METHODS:One hundred and sixty median nerves were examined using ultrasonography and colour Doppler ultrasonography. The location, shape, and size of the bifid median nerve, persistent median artery and persistent median vein were recorded. The cross-sectional area of the bifid median nerve (two trunks) was measured at the level of the pisiform.RESULTS:Among the 160 wrists examined, a bifid median nerve was observed in 15 (9.4%) wrists, and a persistent median artery was observed in 12 (7.5%) wrists. These two variations either coexisted or were observed independently, and the probability of coexistence (6.3%) was higher than the probability of existing independently (bifid median nerve only 3.1%, persistent median artery only 1.3%). The cross-sectional area of the radial trunk was greater than (13 in 15, 86.7%) the cross-sectional area of the ulnaris trunk. Persistent median vein was observed in 9 wrists (5.6%).CONCLUSIONS:The persistent median artery and bifid median nerve tend to coexist, and the persistent median vein sometimes runs parallel to the persistent median artery. Their positional relationship in carpal tunnel is uncertain, and thus, preoperative ultrasound is necessary. These three variations do not present any additional risk for the development of carpal tunnel syndrome.

Carpal Tunnel Syndrome in Patients with and without Diabetes Mellitus in Upper Egypt: The Impact of Electrophysiological and Ultrasonographical Studies

Introduction: Reports about median nerve CSA measurements between CTS patients with and without DM are actually scant. This study aimed to correlate the diagnostic accuracy of ultrasonography with electrodiagnosis in both DM and non-DM CTS patients. Patients and Methods: Thirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to electrophysiological assessment of wrists and grayscale ultrasonography (US). Results: High mean cross sectional area of median nerve (CSA) on ultrasonography was detected with nonsignificant difference between both groups. A non-significant difference for flattening ratio was found between two groups. There was a highly significant positive correlation between electrodiagnosis and ultrasonography in diabetic patients. Conclusion: The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. The combination of electrophysiology and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients.

Role of ultrasound in diagnosis of Carpal Tunnel Syndrome in diabetic patients

Objective: To detect the musculoskeletal disorders of diabetes affecting the hand by ultrasonography (US) and to study the relationship of these changes with the arterial Doppler blood flow pattern. Materials & Methods: Both hands of 23 diabetic patients (age 53 ± 11.3 years) (10 female, 13 male) were examined by US and compared to age and sex matched control group (age 53 ± 11.1 years). Median nerve diameters, area and circumference measurements, flexor retinaculum thickness and tendinopathic changes as decrease in echogenicity, peritendinous fluid collection were studied. Arterial Doppler echo pattern of radial, ulnar and palmar arch arteries have also been studied. Clinical findings as arthralgia, numbness and limited joint mobility were recorded. Results: Patients group showed a significant increase (P

Neuromuscular ultrasound in patients with carpal tunnel syndrome and normal nerve conduction studies.

Nerve conduction studies (NCS) are sensitive for carpal tunnel syndrome (CTS), but a small proportion of patients with clinical CTS have normal NCS. This retrospective study was designed to assess the neuromuscular ultrasound findings in a group of CTS patients. The electronic medical record was reviewed by a neurologist to identify patients who had a diagnosis of CTS with normal NCS, including either mixed median-ulnar comparison or transcarpal sensory studies, and complete neuromuscular ultrasound evaluation for CTS. Fourteen individuals (22 wrists) met all criteria. A total of 92.3% had median nerve cross-sectional area enlargement at the wrist (mean 16.3 mm2 ), 100% had increased wrist-to-forearm median nerve area ratio (mean 2.4), 82.4% had decreased median nerve echogenicity, 75.0% had decreased median nerve mobility, and 7.1% had increased median nerve vascularity. A large proportion of patients with clinical CTS but normal NCS have abnormal neuromuscular ultrasound findings. Muscle Nerve 55: 913-915, 2017.

The Surgical Strategy for the Treatment of Total Brachial Plexus Avulsion Injury Patient

Objective: The total brachial plexus avulsion injury (BPAI) patients were treated in many organizations in the world, but the results reported differ significantly regarding different surgical strategy. Thus, this study aimed to evaluate the outcomes of different methods of nerve transfer and to determine a relatively optimal surgical strategy for treatment of total BPAI patients. Methods: A retrospective review was conducted on 73 patients with total BPAI who were treated with nerve transfer. The elbow flexion was reconstructed in 73 patients with phrenic nerve (PN) or intercostal nerves (ICNs) or contralateral C7 (cC7) transfer. The shoulder abduction was reconstructed in 73 patients with spinal accessory nerve (SAN) or ICNs transfer or both. Elbow extension was reconstructed in 35 patients with ICNs or cC7 transfer. Wrist and finger flexion were reconstructed in 73 patients with cC7 transfer. Wrist and finger extension were reconstructed in 31 patients with ICNs transfer. The mean follow-up period was 7.3 years. Results: The effective recovery rate were 79.5% in elbow flexion, 76.7% in shoulder abduction, 45.7% in elbow extension, 54.8% in wrist and finger flexion, 57.5% in median nerve area sensation, and 38.7% in wrist and finger extension. No significant difference was found in elbow flexion recovery between the patients with PN, ICN, or cC7 transfer. Shoulder abduction was significantly better in patients with SAN combined with ICNs transfer while no significant difference was found between the patients with anterior or posterior approach SAN transfer. Elbow extension was significantly better in patients with ICNs transfer. Entire cC7 transfer achieved significantly better recovery in wrist and finger flexion than partial cC7 transfer. Conclusion: For the treatment of total BPAI patients, we recommend PN transfer for elbow flexion, SAN combined with ICNs transfer for shoulder abduction, ICNs transfer for elbow extension, entire cC7 transfer for wrist and finger flexion, and ICNs transfer for finger extension, whereas for the elder or PN-injured patients, we recommend SAN combined with ICNs transfer for shoulder abduction, entire cC7 transfer for elbow flexion and wrist and finger flexion, and ICNs transfer for elbow extension and wrist and finger extension.

Outcome of Contralateral C7 Nerve Transfer in the Treatment of Total Brachial Plexus Root Avulsion Injury Patient

Objective: The objective of this study was to evaluate the outcome of patients treated with contralateral C7 (cC7) transfer and to determine the factors that affect the outcome of this procedure. Materials and Methods: A retrospective review of 73 patients with total brachial plexus root avulsion injury (BPAI) who underwent cC7 transfer was conducted. All of the surgeries were performed by 2 stages, and the pedicled ulnar nerve was the bridged nerve. The 73 patients were divided into 2 groups according to different number of the recipient nerves. In group 1 (51 patients), the cC7 nerve was used to transfer to median nerve only. The entire cC7 was used in 11 patients; the posterior division together with the lateral part of the anterior division was used to transfer to median nerve in 15 patients; and the anterior or the posterior division alone was used to transfer to median nerve in 25 patients. In group 2, the cC7 nerve was used to transfer to 2 nerves simultaneously. The entire cC7 was used to transfer to median nerve and biceps branch in 12 patients and to median nerve and triceps branch in 10 patients. The mean follow-up period was 7.3 years. Results: The efficient of these 73 patients was 54.8% in wrist and finger flexor, 57.5% in median nerve area sensation, 66.7% in the elbow flexor, and 20% in the elbow extensor. The patients with entire cC7 root transfer achieved significantly better recovery than the patients with partial cC7 root transfer. The best function recovery could be induced if the interval between 2 stages was 4 to 8 months. Functional recovery of biceps branch was significantly better than that of triceps branch. Conclusion: Contralateral C7 transfer is an effective procedure in treating total BPAI patients. If transferred to single nerve, the entire C7 root transfer can obtain significantly better recovery, and we emphasize using the entire root as the donor. The optimal interval between 2 surgery stages is 4 to 8 months. If transferred to 2 nerves, the 2 recipient nerves should be collaborative in motor function.

Ultrasound-guided Hydrodissection for Severe Carpal Tunnel Treatment

Aims: The main aim of the present study was to assess the clinical outcome after ultrasound-guided hydrodissection and triamcinolone injection into the carpal tunnel in patients with severe carpal tunnel syndrome. Materials and Method: Participants—The prospective study design of the present observational investigation measured the therapeutic effect of ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel in 36 consecutive participants with carpal tunnel syndrome, following American Academy of Neurology (AAN) clinical criteria, and classified as severe in the baseline neurophysiological study. Each participant completed the Boston and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires and underwent median motor and sensory nerve conduction studies (NCS) at baseline and 6 months after injection. Median nerve ultrasonography was assessed at baseline (prior to steroid injection) and at 3 and 6 months after injection. The ultrasound examination included measurement of the median nerve cross-sectional area at the distal wrist crease (DWC) and 12 cm proximal to calculate the wrist-to-forearm median nerve area ratio. Injection—At the initial visit, an ultrasound-guided hydrodissection and steroid injection was performed. In all cases, a baseline electrical and ultrasonography measurements were recorded prior to the injection. Ultrasound imaging of the median nerve was done using an ultrasound device, with a 8.0 a 13 MHz linear-array transducer. We used a linear array transducer with a 8-13 Mhz frecuency range which is the standard for musculoskeletal ultrasound examination. A 21-gauge needle was used for 2 punctures. After proper disinfection of the volar aspect of the wrist, the entry point of the first puncture was located at the ulnar side of the wrist, as described by Smith et al. for the transverse ulnar (short-axis or axial) approach. For the sagittal (long-axis or sagittal) approach, the puncture was performed following the indications by Grassi et al. A combination of lidocaine (1 ml), 40 mg of triamcinolone acetonide (1 ml), and saline serum (9 ml) was injected into the area surrounding the median nerve. Statistical Analysis—Changes in the following variables were assessed at 3 and 6 months after the index procedure: Boston symptom and function scores, DASH score, median nerve motor and sensory latencies (converted to velocity for sensory studies), as well as the median nerve cross-sectional area. Results: The following mean baseline values were recorded: Boston score: 2.99, DASH score: 47.03, motor latency 5.74 ms, sensory velocity 25.52 m/s, DWC area of 13.93 mm2, wrist-to-forearm ratio (WFR) of 6.56 mm2. The following variables showed significant changes within treatment responder patients at 6 months follow-up: 26.8% improvement upon Boston score ( P &lt; .001), 39.9% upon DASH score ( P = .006), 19.6% decrease at DWC area ( P &lt; .001), 19.6% decrease of the WFR ( P = .001). Conclusions: Ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel seems an effective treatment for severe carpal tunnel syndrome in the short-term, with a success rate estimated at 56% of the patients.

Diagnosis of carpal tunnel syndrome assessed using high-frequency ultrasonography: cross-section areas of 8-site median nerve.

This study aimed to determine the most suitable site for diagnosis of carpal tunnel syndrome (CTS) by examining an 8-site measurement of the median nerve's cross-sectional area (CSA). A total of 36 wrists of 26 patients with nerve conduction study (NCS) proven CTS, along with 34 wrists of 23 controls whose age and gender were matched with the patients, were evaluated with ultrasonography. The CSAs of the median nerve at eight predetermined sites including at the sites of 3, 2, and 1cm proximal to the wrist crease, wrist crease, as well as at the sites of 1, 2, 3. and 4cm distal to the wrist crease were obtained. The correlation between CSA and NCS severity, and duration of clinical CTS symptoms was analyzed. Receiver operating characteristic (ROC) curves was applied to determine the optimum cut-off point and to evaluate the diagnostic sensitivity and specificity of sonographic measurements. The CSAs of the median nerves at the eight sites were significantly higher in the CTS subjects, relative to the controls. Moreover, anatomical variation of the median nerve was found in the CTS group. ROC results indicated the areas under curve (AUC) at the site of 4cm distal to the wrist crease were the largest with 0.874cm(2), and an optimal cut-off value of 0.095 yielded a sensitivity of 88.9% and a specificity of 76.5%. The CSAs of "CTS-wrists" positively correlated with NCS severities and the CTS symptoms duration. Using 8-site CSAs measurement of the median nerve from inlet to outlet has positive correlations with NCS severity and duration of CTS symptoms.

The preliminary outcomes of percutaneously looped thread transection in the surgical treatment of carpal tunnel syndrome

Objective To study the preliminary effects of percutaneously looped thread transection on the surgical treatment of carpal tunnel syndrome (CTS). Methods A total of 72 cases (103 sides) were treated from January 2012 to December 2014 (27 males and 45 females, aged 22-94 years, with an average of 51.3 years). Among all the cases, 21 cases (30 sides) were treated with open decompression and 51 cases (73 sides) were treated with percutaneously looped thread transection. We did the incision in the ulnaris hypothenar pattern, revealed and cut off the transverse carpal ligament to decompress the carpal tunnel in the open surgery. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse carpal ligament, respectively, forming loops to cut off and decompressed the carpal tunnel. We observed the median nerve aspect ratio (the ratio of length to width of the uncinatum median nerve on transverse section) and swelling ratio (the ratio of area of median nerve on transverse section of pisiform and distal radius) under ultrasound before, during and 3 months after operation. Telephone follow-up was conducted in postoperative 3 months according to the Boston Carpal Tunnel Questionnaire (BCTQ) to evaluate the symptoms of carpal tunnel syndrome and wrist joint function. Results There were 11 cases lost in the follow-up, and 61 cases were followed up for 3 to 27 months, with an average of 11.6 months. The preoperative BCTQ scores of open decompression group and looped thread transection group were 28.5±4.6 and 29.4±5.3, respectively. There was no statistically significant difference between two groups (t=1.34, P=0.528). The postoperative 3 months BCTQ scores were 16.3±5.7 and 15.7±4.9. There was no statistically significant difference between two groups (t=1.12, P=0.674). The median nerve aspect ratios measured under ultrasound of open decompression group before and 3 months after operation were 3.8±0.7 and 2.6±0.4, respectively. The swelling ratios were 2.3±0.4 and 1.2±0.3. The difference of preoperative and postoperative changes was statistically significant (P< 0.05). The median nerve aspect ratios measured under ultrasound of looped thread transection group before and 3 months after operation were 3.9±0.6 and 2.7±0.5, respectively. The swelling ratios were 2.1±0.3 and 1.4±0.4. The difference of preoperative and postoperative changes was statistically significant (P<0.05). There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treatment of CTS has less trauma and rapid recovery. It can improve the symptoms of median nerve stimulation, restore the morphology and function of the median nerve and reach the same effects as the open decompression surgery. Key words: Carpal tunnel syndrome; Surgical procedures, minimally invasive; Ultrasonography; Decompression, surgical

Correlations of Median Nerve Area, Strain, and Nerve Conduction in Carpal Tunnel Syndrome Patients.

The objective of this study was to see if ultrasound-interpreted median nerve strain and cross-sectional area correlate with abnormal nerve conduction studies and thumb opposition strength in patients with carpal tunnel syndrome (CTS). Sixty wrists of 30 idiopathic CTS patients were assessed by ultrasound and nerve conduction study. Distal motor latency, cross-sectional area, and strain ratio of the median nerve were measured. In addition, thumb opposition strength was classified using the manual muscle testing grade from 0 to 5, clinically. The strain ratio was defined as the strain of the reference coupler divided by the strain of the median nerve. The correlations between clinical examinations of distal motor latency, cross-sectional area, strain ratio, and thumb opposition strength were estimated with the Spearman rank correlation coefficients. The correlation coefficients between distal motor latency and strain ratio, distal motor latency and cross-sectional area, and strain ratio and cross-sectional area were .597, .352, and .324, respectively. The correlation coefficients between thumb opposition strength and distal motor latency, thumb opposition and cross-sectional area, and thumb opposition and strain ratio were -.523, -.307, and -.358, respectively. All of the correlations showed statistical significance. The correlation coefficients between distal motor latency and strain ratio, and thumb opposition and distal motor latency, were relatively high. The results of this study suggest that the nerve conduction delay is related to changes in the material properties of the median nerve. In addition, nerve conduction study was the principal indicator of the thumb opposition strength.

Relationship Between Electrodiagnosis and Various Ultrasonographic Findings for Diagnosis of Carpal Tunnel Syndrome.

ObjectiveTo investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard that has closest consistency with the electrodiagnosis.MethodsUltrasonography was performed on 50 female patients (65 cases) previously diagnosed with CTS and 20 normal female volunteers (40 cases). Ultrasonography parameters were as follows: cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the levels of hamate bone, pisiform bone, and lunate bone; anteroposterior diameter (AP diameter) of the median nerve in the carpal tunnel; wrist to forearm ratio (WFR) of median nerve area at the distal wrist crease and 12 cm proximal to distal wrist crease; and compression ratio (CR) of the median nerve. Independent t-test was performed to compare the ultrasonographic findings between patient and control groups. Significant ultrasonographic findings were compared with the electrodiagnosis results and a kappa coefficient was used to determine the correlation.ResultsCSA and FR of median nerve at the hamate bone level, CSA of median nerve at pisiform bone level, AP diameter of median nerve within the carpal tunnel, CSA of median nerve at the distal wrist crease and WFR showed significant differences between patient and control groups. WFR showed highest concordance with electrodiagnosis (κ=0.71, p<0.001).ConclusionThese findings suggested the applicability of ultrasonography, especially WFR, as a useful adjunctive tool for diagnosis of CTS.

The Utility of Semmes-Weinstein Monofilament Test in Detecting Carpal Tunnel Syndrome with Clinical Stage, Nerve Conduction Study, and Sonography Correlations

Background and purpose: Nerve conduction study (NCS) and ultrasonography (US) are used to support the diagnosis of carpal tunnel syndrome (CTS). The ability of the Semmes-Weinstein monofilament test (SWMT), a sensibility threshold test, to detect CTS, and its relationship to clinical severity, NCS, and US, remain controversial. We conducted this study to address this controversy. Method: Thirty-three patients presenting with typical symptoms and signs of CTS and 20 normal subjects were enrolled. SWMT on the index finger, NCS, and US of the cross-sectional area of the median nerve at the pisiform level (PCSA) were performed. Receiver operating characteristic (ROC) curves of SWMT, variables of NCS, and PCSA were plotted to analyze their discriminative utilities. The diagnostic agreement for CTS among SWMT, NCS, and PCSA were analyzed by kappa statistics. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies, as well as the correlation coefficients among SWMT, NCS measures, and PCSA, were calculated. Results: The areas under the ROC curve (AUC) for SWMT and PCSA were 0.852 and 0.71, respectively. AUCs for three NCS variables ranged from 0.822 to 0.902. All these variables were discriminative for CTS and were not significantly different in their discriminative power. SWMT yielded sensitivity, specificity, PPV, NPV, and accuracy of 82%, 70%, 82%, 70%, and 77%, respectively. There is significant agreement in detection of CTS using SWMT and NCS (kappa=0.575, p＜0.001). The kappas between SWMT and PCSA, as well as NCS and PCSA, were 0.305 and 0.427, respectively (p=0.025 and 0.002). SWMT significantly correlates with not only clinical stage, but also NCS measures and PCSA (r ranged from 0.381 to 0.581, p＜0.01). Conclusion: SWMT shows discriminative power similar to NCS and US for detection of CTS. SWMT also has a moderate correlation with clinical stage, NCS measures, and PCSA on US. As a painless, convenient, and inexpensive modality, SWMT may have the ability to diagnose CTS, but further research is needed.

Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers.

ObjectiveTo describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations.Materials and MethodsTwo hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome.ResultsCarpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel’s test (p < 0.0001), Phalen’s test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24).ConclusionThe prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.