Carpal Tunnel Syndrome Group Research Articles

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

BackgroundCarpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done.ResultsRegarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%).ConclusionsThe concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

Prediction of carpal tunnel syndrome using the thenar muscle cross-sectional area by magnetic resonance imaging.

Carpal tunnel syndrome (CTS) is a common neuropathy. Although CTS progression is known to be associated with thenar muscle (TM) atrophy, the diagnostic value of TM atrophy for CTS has not been established. In this research, the thenar muscle cross-sectional area (TMCSA) was evaluated to analyze the relationship between the TMCSA and CTS. We assumed that TMCSA is a major diagnostic parameter in the CTS.Both TMCSA and thenar muscle thickness (TMT) samples were acquired from 18 CTS patients, and from 18 control subjects who underwent wrist magnetic resonance imaging with no evidence of CTS. T2-weighted transverse magnetic resonance imaging images were obtained. We measured the TMCSA and TMT at the level of first carpometacarpal joint.The average TMCSA was 296.98 ± 49.39 mm2 in the normal group and 203.36 ± 72.13 mm2 in the CTS group. The average TMT was 8.54 ± 1.45 mm in the normal group and 7.38 ± 1.14 mm in the CTS group. CTS group had significantly lower TMCSA and TMT. Receiver operator characteristics curve analysis showed that the best cutoff point for the TMCSA was 260.18 mm2, with 77.8% sensitivity, 77.8% specificity. The best cutoff point of the TMT was 7.70 mm, with 61.1% sensitivity, 66.7% specificity.Although the TMCSA and TMT were both significantly associated with CTS, the TMCSA was a much more sensitive measurement parameter. Thus, to evaluate CTS patients, the physician should more carefully inspect the TMCSA than TMT.

Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?

Objective To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound.MethodsFourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA.ResultsThe maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups.ConclusionThe PCBMN could be concomitantly affected in patients with severe CTS.

Comparison of Diagnostic Accuracy of Electrodiagnostic Testing and Ultrasonography for Carpal Tunnel Syndrome.

Confirmatory methods such as electrodiagnostic testing (EDX) and ultrasonography (US) are currently used to support a clinical diagnosis of carpal tunnel syndrome (CTS). Scientific consensus long has preferred nerve conduction studies (NCS); however, recent studies have advocated for a diagnostic niche for ultrasound examination. This study seeks to compare diagnostic accuracies, sensitivity, and specificity between these 2 diagnostic tools. An institutional database was retrospectively analyzed to reveal 402 upper extremity cases (265 patients) with potential for CTS diagnosis. Demographics, NCS results, and US findings were determined for each patient case. Sensitivity and specificity values were determined for each diagnostic modality using Carpal Tunnel Syndrome 6 (CTS-6), a validated clinical CTS scoring system, as the reference standard. Demographic and diagnostic values were compared between positive and negative CTS groups using the 2-tailed t test and χ2 test. Electrodiagnostic testing resulted in a sensitivity of 87% and a specificity of 27%, whereas US produced a sensitivity of 76% and a specificity of 51%. No statistical difference was found in CTS-6 scores between NCS-positive and NCS-negative patient hands, whereas CTS-6 scores were significantly greater in US-positive CTS cases than US-negative cases (15.2 and 13.1, respectively, P < .001). Electrodiagnostic testing yields a greater sensitivity for CTS than US examination. However, US testing aligns more closely with CTS-6 scores and results in a greater specificity and positive predictive value. These findings suggest that US holds a non-trivial niche in CTS diagnosis and that EDX is not clearly preferable for all CTS diagnoses and cases.

Association of body mass index with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) is a chronic disabling condition of hands, occurring due to occupational and non-occupational risk factors, including high body mass index (BMI). This study was intended to find out the association of BMI with CTS. Methods: This was a cross-sectional analytical study was conducted in four teaching hospitals in Dhaka, Bangladesh from June 2017 to May 2018. Patients with electrophysiologically documented CTS were taken as cases and age matched healthy individuals without CTS were taken as controls. Following clinical and electrodiagnostic confirmation, data were collected from total 63 patients and 63 controls. Results: Mean BMI was 29.3±4.8 Kg/m2 in CTS group, which was higher than the control (24.1±3.3 Kg/m2). In CTS group, 56 (88.9%) had high BMI and 7 (11.1%) had normal BMI. On the other hand. 23 (36.9%) subjects in control group had high BMI and 40 (63.1%) had normal BMI. High BMI was significantly associated with carpal tunnel syndrome (p &lt;0.01) but ncreasing BMI was not associated with severity of CTS (p 0.654). Conclusion: High BMI has a significant association with CTS but not with CTS severity. BIRDEM Med J 2021; 11(3): 179-185

The impact of cell phone texting on superficial blood flow, touch threshold, and symptoms for individuals with carpal tunnel syndrome.

It is unclear how individuals with carpal tunnel syndrome (CTS) are affected by texting, or how the texting performance of those with CTS might be impaired or different from individuals without CTS. The primary purpose of this case-control study was to determine the immediate effects of texting on superficial blood flow, sensory threshold, and symptoms of fatigue, numbness, and pain for individuals with CTS compared to asymptomatic age-matched controls. Another objective was to detect differences in texting performance between the two groups. Superficial blood flow, pain, fatigue, numbness, and touch threshold were measured before, and at three time points following a standardized 15-minute texting task. Overall texting speed was compared between groups. Changes in red blood cell concentration after the texting task was not significantly different for either the CTS group or controls for any of the measurement time points. Mean touch thresholds at baseline were 4.0 g/mm2 for the CTS group versus 2.6 g/mm2 for healthy controls; a 53%greater touch threshold. Following the texting task, touch threshold did not change for normal controls, but increased to 6.7 g/mm2 for the CTS group, representing a significant increase in touch threshold from baseline. Texting performance was compromised in people with CTS, and symptoms worsened with a short-term controlled texting task. Our results suggest that texting performance is limited in individuals with CTS and that texting results in a short term increase in touch threshold values for individuals with CTS. Further study is needed to determine the effect of long term texting on carpal tunnel pressures.

Neuromuscular ultrasound (NMUS) O-NU001. Feasibility of shear wave elastography and high definition color in evaluation of carpal tunnel syndrome

Introduction . Diagnosis of carpal tunnel syndrome (CTS) is based on clinical findings and electrodiagnostic tests (EDT). However, EDT has high false negative rates, and the results often do not reflect the severity of symptoms. The aim of this study is to investigate the value of shear wave elastography (SWE) and high definition (HD) color in diagnosis and evaluation of symptom severity in CTS. Methods . The study prospectively enrolled 39 wrists from 23 patients with EDT-confirmed CTS, 15 wrists from 12 patients who have CTS symptoms without EDT abnormality and 28 wrists from 14 healthy volunteers. Cross-sectional area (CSA) and longitudinal diameter of median nerve were measured. SWE of median nerve at the wrist and midforearm were performed, and the ratio between them was calculated. SWE of abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were also measured and the ratio was obtained. HD color was conducted in the longitudinal plane at carpal tunnel. Results . The CSA of the median nerve at the carpal inlet and longitudinal diameter were significantly larger for the EDT-confirmed CTS group compared to control group (13.21[11.28,17.23] vs 7.98[6.53,8.94]; p < 0.001, 2.77[2.41,3.08] vs 2.07[1.79,2.24]; p < 0.001). It also had significantly higher median nerve elasticity ratio (2.59[1.77,4.09] vs 1.61[1.32,1.94]; p = 0.007). HD color showed significantly higher grades in the former group (p = 0.004). In ROC analysis, a 1.97 cut-off value on SWE ratio revealed sensitivity, specificity, PPV, NPV of 74.4%, 78.6%, 82.9%, 68.8%, respectively (AUC: 0.796[0.687,0.905]). Inter-rater reliability was excellent for SWE measurements (ICC: 0.908(0.761,0.967)). There was no significant correlation of CSA, elasticity and HD color grade with clinical symptom scores. In comparison between the group of CTS patients without EDT abnormality and control group, the former had significantly larger CSA in carpal inlet and elasticity ratio (9.61[7.21,11.55] vs 7.98[6.53,8.94]; p = 0.011, 2.59[0.94,4.65] vs 1.61[1.32,1.94]; p = 0.009). Conclusion . SWE and HD color are helpful supportive tools in diagnosing CTS, especially in patients who have typical CTS symptoms but normal results in EDT.

The Relation Between Mean Platelet Volume and Carpal Tunnel Syndrome

Objectives:The aim of this study was to evaluate the relationship between Carpal tunnel syndrome (CTS) and mean platelet volume (MPV) in which is raleted with angiogenesis, thrombosis, immunity and inflammation.&#x0D; Material and Methods:Between 2013 and 2019, 1660 patients underwent mini-open decompression and 1056 healthy individuals were included in the study as study and control grup respectively. After the exclusion criteria are provide, patients were determined 166 CTS patients and 156 control patients in two groups. In the CTS and control groups, MPV, platelet count (PLT), platelet distribution width (PDW), white blood cell(WBC) count, haemoglobin (Hb), ESR and CRP levels were obtained from venous blood samples drawn after 12-h fasting and were recorded retrospectively from the hospital database.In addition, blood samples were taken from the patients in the CTS group at the postoperative 6th and 12th month controls and the values studied before the operation were re-recorded from the file.&#x0D; Results:Among the CTS patients, only there was a significant difference in the mean MPV at 6 months postoperatively compared to baseline (p=0.027). No significant difference was detected inthe mean MPV at 1 year compared to baseline (p=0.70). In addition, no significant differences were found in MPV values or in other blood parameters (platelet count, white blood count, platelet distribution widthand, haemoglobin) between patients with CTS and controls. &#x0D; Conclusion:We found that no significant relationship was detected between CTS and MPV in our study. We believe that further prospective studies with larger sample size are needed to elucidate this topic.

Sleep disorders and relationship with comorbid anxiety and depression in carpal tunnel syndrome

Objectives: In this study, it was aimed to assess relationship of disease severity with sleep quality, depression and anxiety in patients with carpal tunnel syndrome (CTS) and to compare findings with healthy controls. Methods: The study included 35 patients diagnosed as CTS and 20 healthy individuals. In CTS patients, symptom severity and functional disorders were assessed using Boston Carpal Tunnel Questionnaire (BTCQ). The sleep quality was assessed using Pittsburg Sleep Quality Index (PSQI) in CTS patients and healthy controls. The Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used to evaluate depression and anxiety accompanying to CTS and sleep disorder. Results: In the assessment of general sleep quality, it was found that PSQI scores were significantly higher in CTS group when compared to healthy controls (p &amp;lt; 0.0001). Again, the BDI and BAI scores were also significantly higher in CTS group than control group (p &amp;lt; 0.0001 and p &amp;lt; 0.003, respectively). There was a strong, positive correlation between BTCQ symptom severity scale (SSS) and PSQI (r = 0.774; p &amp;lt; 0.0001). A significant, positive correlation was observed between Boston SSS and BDI scores (r = 0.666; p &amp;lt; 0.001). When assessed correlation between anxiety scores and Boston SSS and functional state scale (FSS), it was found that anxiety was increased by increasing severity of CTS, indicating a positive, moderate correlation (r=0.469, p &amp;lt; 0.0001 and r=0.464, p &amp;lt; 0.0001). Conclusions: The pain in patients with CTS can impair sleep quality, which, in turn, may increase risk for depression and anxiety. Thus, comorbid psychiatric symptoms and signs should be considered in the treatment of patients with CTS.

Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome.

Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF (P = .002), PI (P = .0002), and UE (P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF (P = .001), PI (P = .02), and UE (P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level IV.

Efficacy of Diagnosing Carpal Tunnel Syndrome Using the Median Nerve Stenosis Rate Measured on Ultrasonographic Sagittal Imagery: Clinical Case-Control Study.

The purpose of the present study was to evaluate the usefulness of the median nerve stenosis rate (MNSR) measured on sagittal sonographic images of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). The study population consisted of 45 hands from 37 patients with idiopathic CTS (CTS group), and 60 hands from 35 asymptomatic healthy subjects (control group). Carpal tunnel syndrome was diagnosed by clinical findings and positive electrophysiological study results. All patients and control subjects underwent ultrasonographic examination. At the carpal tunnel level, the transducer was placed longitudinally to the median nerve, and an image of the longitudinal median nerve was obtained. The minimum median nerve diameter (MND) was measured at the middle part of the capitate level, while the maximum MND was measured at the distal radioulnar joint level. The MNSR was calculated as (1 - minimum MND/maximum MND) × 100 (%). The cross-sectional area of the median nerve was also measured at the level of the pisiform. On longitudinal sonographic images, the MNSR was significantly larger in the CTS group than the control group. When the cut-off value of the MNSR was 26.73%, the sensitivity and specificity were 91.1% and 80%, respectively. The area under the receiver operating characteristic curve was larger for the MNSR than for the cross-sectional area. The results suggest that the MNSR proposed in the present study may be useful as an auxiliary method for CTS diagnosis on ultrasonographic examination.

Effects of wrist extension on median nerve and flexor tendon excursions in patients with carpal tunnel syndrome: a case control study

BackgroundReduced gliding ability of the median nerve in the carpal tunnel has been observed in patients with carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the gliding abilities of the median nerve and flexor tendon in patients with CTS and healthy participants in the neutral and 30° extended positions of the wrist and to compare the gliding between the finger flexion and extension phases.MethodsPatients with CTS and healthy participants were consecutively recruited in a community hospital. All the subjects received the Boston CTS questionnaire, physical examinations, nerve conduction study (NCS), and ultrasonography of the upper extremities. Duplex Doppler ultrasonography was performed to evaluate the gliding abilities of the median nerve and flexor tendon when the subjects continuously moved their index finger in the neutral and 30° extension positions of the wrist.ResultsForty-nine patients with CTS and 48 healthy volunteers were consecutively recruited. Significant differences in the Boston CTS questionnaire, physical examination and NCS results and the cross-sectional area of the median nerve were found between the patients and the healthy controls. The degree of median nerve gliding and the ratio of median nerve excursion to flexor tendon excursion in the CTS group were significantly lower than those in the healthy control group in both the neutral and 30° wrist extension positions. Significantly increased excursion of both the median nerve and flexor tendon from the neutral to the extended positions were found in the CTS group. The ratio of median nerve excursion to flexor tendon excursion was significantly higher in the finger flexion phase than in the extended phase in both groups, and this ratio had mild to moderate correlations with answers on the Boston CTS Questionnaire and with the NCS results.ConclusionsReduced excursion of the median nerve was found in the patients with CTS. The ratio of median nerve excursion to flexor tendon excursion was significantly lower in the patients with CTS than in the healthy volunteers. The median nerve excursion was increased while the wrist joint was extended to 30° in the patients with CTS. Wrist extension may be applied as part of the gliding exercise regimen for patients with CTS to improve median nerve mobilization.

English

BACKGROUND Human motor performance (MP) and motor skills are essential aspects of the various daily activities. Skilled laboratory workers involved in prolonged duration of skillful, repetitive work by hands are susceptible to carpal tunnel syndrome (CTS). This study was conducted to assess MP of the hands and determine the relation between MP and workplace factors. METHODS Present cross-sectional study was conducted among 94 laboratory workers (technicians and attenders). Participants were categorised into two groups namely, attenders and technicians, each of which was further divided into two sub-groups of normal participants and those diagnosed with CTS. MP was assessed by median motor nerve conduction velocity (MNCV), work done and fatiguability, hand grip strength and bimanual coordination. Unpaired ‘t’ test / analysis of variance (ANOVA) was used to compare the mean values of selected parameters at a P &lt; 0.05 threshold of significance. RESULTS Mean values of median MNCV, work done and time for onset of fatigue were similar across both groups. In the CTS group, hand grip strength (19.00 ± 5.94 Kg) and efficiency index (89.54 ± 8.47) were slightly diminished, while the duration of error in task execution (29.20 ± 21.67 sec) was slightly more than the normal group; however, these differences were statistically insignificant (P &gt; 0.05). Work done, hand grip strength, error and efficiency index significantly differed between technicians and attenders (P &lt; 0.05). CONCLUSIONS Most of MP measures being normal in those with CTS suggest that they are at early stages of development of CTS, hence requiring suitable preventive measures. Moreover, workplace factors may adversely affect their work performance. KEYWORDS Motor Performance (MP), Median Motor Nerve Conduction Velocity (MNCV), Mosso’s Ergography, Hand Grip Strength, Bimanual Coordination

Diagnostic value of high-frequency ultrasound in carpal tunnel syndrome during pregnancy: A case-control study

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment syndrome in the upper limbs, for which pregnancy is a known risk factor. CTS diagnosis is confirmed via nerve conduction studies (NCSs), which sometimes is expensive, and the electrical stimulation makes it an unpleasant diagnostic modality, especially for pregnant subjects. Recently, high-frequency ultrasonography (HF-USG) is known as a diagnostic method. This study is concerned with determining the diagnostic value of this modality for CTS among pregnant women. Methods: This cross-sectional case-control study was conducted with 40 CTS cases and 40 matched controls. The HF-USG of wrists was performed bilaterally on all participants with a focus on the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) inlet. Results: Mean MNCSA was statistically different between the CTS group (11.71 ± 1.86 mm2, range: 8 to 18 mm2) and the control group (6.75 ± 1.38 mm2, range: 4 to 11 mm2) (P < 0.001). The receiver operating characteristic (ROC) curve was drawn, and the cross-sectional area (CSA) cut-off point of 8.5 mm2 showed sensitivity and specificity of 98% and 93%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 95% and 98%, respectively, with the mentioned point as the diagnostic threshold. Conclusion: HF-USG of the median nerve can be utilized as a preferable alternative to NCS (the current gold standard diagnostic method) in pregnant women, due to its convenience and lower cost, or at least, it can be used as a screening tool among pregnant women with suspicious symptoms.

Abnormal Brain Connectivity in Carpal Tunnel Syndrome Assessed by Graph Theory.

IntroductionNumerous resting-state functional magnetic resonance imaging (fMRI) researches have indicated that large-scale functional and structural remodeling occurs in the whole brain despite an intact sensorimotor network after carpal tunnel syndrome (CTS). Investigators aimed to explore alterations of the global and nodal properties that occur in the whole brain network of patients with CTS based on topographic theory.MethodsStandard-compliant fMRI data were collected from 27 patients with CTS in bilateral hands and 19 healthy control subjects in this cross-sectional study. The statistics based on brain networks were calculated the differences between the patients and the healthy. Several topological properties were computed, such as the small-worldness, nodal clustering coefficient, characteristic path length, and degree centrality.ResultsCompared to those of the healthy controls, the global properties of the CTS group exhibited a decreased characteristic path length. Changes in the local-level properties included a decreased nodal clustering coefficient in 6 separate brain regions and significantly different degree centrality in several brain regions that were related to sensorimotor function and pain.DiscussionThe study suggested that CTS reinforces global connections and makes their networks more random. The changed nodal properties were affiliated with basal ganglia-thalamo-cortical circuits and the pain matrix. These results provided new insights for improving our understanding of abnormal topological theory in relation to the functional brain networks of CTS patients.PerspectiveThis article presents that the CTS patients’ brain with a higher global efficiency. And the significant alterations in several brain regions which are more related to pain and motor processes. The results provided effective complements to the neural mechanisms underlying CTS.

T2 mapping of the median nerve in patients with carpal tunnel syndrome and healthy volunteers.

We investigated the changes in MRI T2 mapping values in subjects with carpal tunnel syndrome (CTS) compared to healthy controls. We enrolled 71 patients with CTS and 26 healthy controls. Median nerve T2 values were measured at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels. These were compared between patients and controls and correlated with median nerve cross-sectional area (CSA) and nerve conduction measurements. The mean T2 values at the proximal carpal tunnel levels were higher in the CTS group (56.7 ms) than in the control group (51.2 ms, P = .02) and also were higher than at the distal carpal tunnel (51.0 ms, P < .001) and forearm levels (47.6 ms, P < .001). T2 values were not significantly associated with CSA or nerve conduction measurements. T2 mapping of the carpal tunnel provides qualitative information on median nerve pathology but does not reflect CTS severity.

Prolonged median distal sensory nerve action potential duration in carpal tunnel syndrome.

Routine nerve conduction study (NCS) parameters are less sensitive in the early stage of carpal tunnel syndrome (CTS). Recently, some studies have shown that prolonged distal sensory nerve action potential (DSNAP) duration may be a more sensitive technique for the diagnosis of demyelinating peripheral neuropathies. We aimed to evaluate the sensitivity of median DSNAP duration in patients with CTS. DSNAP duration and routine NCS data of the median nerve were retrospectively collected in 173 CTS patients, 73 controls, and 78 cervical radiculopathy patients. Prolonged median DSNAP durations were found in 22 patients (22/35, 63%) and 36 patients (36/54, 67%) in the minimal and mild CTS groups respectively, which was more sensitive than routine NCS parameters. The percentage of patients demonstrating abnormalities in median NCS was significantly increased from 80% to 92% with the addition of DSNAP duration. Our results demonstrate the electrodiagnostic value of median DSNAP duration for the diagnosis of CTS, especially in early cases.

Ultrasonographic Measurement of the Median Nerve Transverse Diameter at the Wrist for Diagnosing Carpal Tunnel Syndrome.

Background: Ultrasonographically measuring the median nerve cross-sectional area (MN-CSA) is a useful and complementary method for diagnosing carpal tunnel syndrome (CTS). This study investigated the usefulness of the median nerve transverse diameter (MN-TD) as a simpler and easier technique than MN-CSA for diagnosing CTS severity. Methods: We examined 145 hands from 101 patients with CTS and 114 age- and gender-matched control hands. Based on the electrodiagnostic findings, the severity of CTS was divided into minimal, mild, moderate, severe and extreme. An ultrasonographic assessment of MN-TD and MN-CSA was performed to measure the maximal values around the carpal tunnel inlet level. The values were assessed for comparisons between the CTS and control groups and for the evaluation of differences by CTS severity. Results: The ultrasonographic measurements of MN-TD and MN-CSA were significantly increased in the CTS group compared to the normal group. Furthermore, both measurements significantly increased with increasing CTS severity. A receiver operating characteristic curve (ROC) analysis showed that participants with MN-TD > 7.2 mm had CTS with 88% specificity and 74% sensitivity, and those with MN-CSA > 12.0 mm2 had CTS with 86% specificity and 84% sensitivity. Conclusions: Ultrasonographic measurement for MN-TD may be useful for diagnosing CTS patients and predicting the severity.

SENSITIVITY AND SPECIFICITY OF MEDIAN NERVE ULTRASONOGRAPHY IN DIAGNOSIS OF CARPAL TUNNEL SYNDROME

Background: Although controversial, recent studies have demonstrated advantages of sonographic techniques in the diagnosis of carpal tunnel syndrome (CTS). The purpose of this study was to assess the utility of median nerve ultrasonography in the diagnosis of CTS in Indian patients. Methods: Ninety patents with clinically suspected CTS were studied. Based on gold standard electromyography/nerve conduction ve-locity studies, wrists with CTS were divided into three groups on the basis of severity of CTS, ie, mild, moderate, and severe. In addition, both sides of the wrist were examined using sonography. Transverse images of the median nerve were obtained and median nerve cross-section areas were measured at three levels, ie, immediately proximal to the carpal tunnel inlet, at the carpal tunnel inlet, and at the carpal tunnel outlet. Furthermore, flexor retinaculum thickness was evaluated. Results: The mean age of the studied patients was 48.52  12.17 years. Median values of the median nerve cross-section at the carpal tunnel in-let, carpal tunnel outlet, and proximal carpal tunnel significantly differed between the wrists with and without CTS (P &lt; 0.05). Comparisons be-tween the CTS groups (mild, moderate, and severe) and non-CTS wrists demonstrated that the median cross-sections of median nerve at the carpal tunnel inlet, carpal tunnel outlet, and inlet proximal carpal tunnel were significantly greater in the severe CTS group than in the other three groups (P &lt; 0.05). The results showed that the median nerve cross-section at the three levels of carpal tunnel could only fairly differentiate se-vere CTS from other cases. Conclusion: The present study demonstrated that median nerve ultrasonography cannot replace the gold standard test (nerve conduction velocity) for the diagnosis of CTS because of low overall sensitivity and specificity, although it might provide useful information in some patients.

Asymptomatic Median Neuropathy in Patients with Diabetic Polyneuropathy

Aim: This study aims to investigate whether asymptomatic median neuropathy (AMN) in patients with diabetic peripheral polyneuropathy (DPNP) is a result of polyneuropathic involvement of median nerve (MN) or its true entrapment. Subjects and Methods: We determined the grades of the Michigan severity scale and the rates of peripheral nerve conduction abnormalities in study subgroups, including patients with carpal tunnel syndrome (CTS), AMN, and normal MN conductions to highlight if the severity of polyneuropathic involvement was different between them. In addition, the results of conventional and comparative nerve conduction studies (NCSs) were compared between these study subgroups. Results: Distributions of Michigan grades and rates of abnormalities in peroneal and sural NCSs were similar between the subgroups (P &gt; 0.05 for all analyses). Abnormality rates of ulnar NCSs were higher in the AMN group than in the other groups, whereas those of comparative transcarpal NCSs were higher in the CTS group. The mean distal sensory latency (DSL) and motor latency (DML) of MN were longer, sensory conduction velocity (SCV) was slower in the CTS group than AMN group, whereas MN motor conduction velocity (MCV) was slower, UN DSL was longer, SCV was slower, SNAP amplitude was smaller, DML was longer, and MCV were slower in the AMN group (P &lt; 0.05 for all analyses). Discussion: Our findings reveal that grade of polyneuropathic involvement is more prominent in AMN, whereas transcarpal MN conduction delay is greater in CTS. The results of the study suggest that the prominence of polyneuropathic impairment in addition to a lesser degree of MN sheet compression obscures the clinical signs in patients with diabetes with AMN.