Electrophysiological Severity Research Articles

The multiple roles of nerve biopsy in the diagnosis and prognosis of suspected immune neuropathies

IntroductionThe value of a sural nerve biopsy for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is controversial. Evidence-based recommendations for its implementation are lacking. We investigated factors leading to biopsy and analyzed biopsy outcomes and consequences, assessed the predictability of biopsy outcomes through clinical parameters to avoid unnecessary biopsies, and compared results with electrophysiological and clinical severity to determine their prognostic value.Methods190 sural nerve biopsies were analyzed in two cohorts. One consisted of 163 biopsies and the second of 72 biopsies from the prospective Immune-mediated Neuropathies Biomaterial and Data registry (INHIBIT). Both have an intersection of 45 patients. 75 data sets from patients without biopsy were used. Analysis of nerve conduction studies, treatment, overall disability sum score (ODSS), biopsy outcomes, and diagnosis was performed.Results51% of biopsied patients received the diagnosis CIDP (77% fulfilled EFNS/PNS criteria), 21% were not CIDP typical, and 27% were unspecific. Biopsied patients responded less frequently to immunotherapies at time of biopsy than non-biopsied patients (p = 0.003). Immunotherapy was initiated more frequently after biopsy (p < 0.001) and more often with intravenous immunoglobulins (p < 0.0001). 76% of all biopsied patients met the electrophysiological criteria for CIDP. Sensory nerve action potential amplitudes of 0 µV still provide 73% of histological diagnostic value. Histologic signs of degeneration predicted ODSS worsening after 1 year (p = 0.028) but disease severity did not correlate with histological damage severity.DiscussionThe main indication for nerve biopsy was the treatment of refractory cases of autoimmune neuropathies with the therapeutic consequence of treatment initiation or escalation. Sural biopsy also provided prognostic information. Even with extinguished sural SNAP, the biopsy can still have diagnostic value.

Resting-state functional magnetic resonance imaging indices are related to electrophysiological dysfunction in degenerative cervical myelopathy

The age-related degenerative pathologies of the cervical spinal column that comprise degenerative cervical myelopathy (DCM) cause myelopathy due spinal cord compression. Functional neurological assessment of DCM can potentially reveal the severity and pathological mechanism of DCM. However, functional assessment by conventional MRI remains difficult. This study used resting-state functional MRI (rs-fMRI) to investigate the relationship between functional connectivity (FC) strength and neurophysiological indices and examined the feasibility of functional assessment by FC for DCM. Preoperatively, 34 patients with DCM underwent rs-fMRI scans. Preoperative central motor conduction time (CMCT) reflecting motor functional disability and intraoperative somatosensory evoked potentials (SEP) reflecting sensory functional disability were recorded as electrophysiological indices of severity of the cervical spinal cord impairment. We performed seed-to-voxel FC analysis and correlation analyses between FC strength and the two electrophysiological indices. We found that FC strength between the primary motor cortex and the precuneus correlated significantly positively with CMCT, and that between the lateral part of the sensorimotor cortex and the lateral occipital cortex also showed a significantly positive correlation with SEP amplitudes. These results suggest that we can evaluate neurological and electrophysiological severity in patients with DCM by analyzing FC strengths between certain brain regions.

Electrophysiological grading scale for polyneuropathy severity.

To establish a simple electrophysiological scale for patients with distal symmetric axonal polyneuropathy, in order to promote standardized and informative electrodiagnostic reporting, and understand the complex relationship between electrophysiological and clinical polyneuropathy severity. We included 76 patients with distal symmetric axonal polyneuropathy, from a cohort of 151 patients with polyneuropathy prospectively recruited from November 2016 to May 2017. Patients underwent nerve conduction studies (NCS), were evaluated by the Toronto Clinical Neuropathy Score (TCNS), and additional tests. The number of abnormal NCS parameters was determined, within the range of 0-4, considering low amplitude or conduction velocity in the sural and peroneal nerve. Higher number of NCS abnormalities was associated with higher TCNS, indicating more severe polyneuropathy. Polyneuropathy severity per the TCNS was most frequently (63%-70%) mild in patients with a low (0-1) number of NCS abnormalities, and most frequently (57%-67%) severe in patients with a high number (3-4) of NCS abnormalities, while patients with an intermediate (2) number of NCS abnormalities showed mainly mild and moderate severity with equal distribution (40%). A simple NCS classification system can objectively grade polyneuropathy severity, although significant overlap exists especially at the intermediate range, underscoring the importance of clinical based scoring.

Association of upper extremity anthropometry and subcutaneus adipose tissue with carpal tunnel syndrome

<p>Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders.</p>. <p>Our study included 150 patients who were diagnosed with CTS clinically and electrophysiologically and 165 healthy controls. The biceps and triceps skinfold thickness, the diameters of the wrist and metacarpal joints, and the upper arm circumferences over the belly of the biceps muscle were measured by using skinfold caliper and measuring cylinder. All data were analyzed by using the Statistics Open For All package (SofaStats) programme. To detect the role of anthropometric indexes, we used multivariable multinomial logistic regression models.&nbsp;</p>. <p>We revealed that BMI, biceps and triceps adipose tissue thicknesses were higher in females and also in patients with CTS. There was a positive correlation between electrophysiological grades of CTS and BMI with logistic regression analyzes. The mean Wrist circumference/Metacarpo&shy;ph&shy;arengeal Circumference ratio and biceps circumference were higher in moderate CTS groups. Metacarpofarengeal circumference was smaller in mild and moderate CTS cases compared to healthy ones.</p>. <p>We suggest that the differen&shy;ces between the anatomical bone structure and local adiposity between the genders may play an important role in the occurrence of CTS. Moreover, the structures of proximal muscle groups and distal metacarpal joints may contribute both to the development and severity of CTS.</p>.

Electrophysiologic pattern of carpal tunnel syndrome among patients with and without diabetes mellitus

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb in general population. Female gender, obesity, increase of age, diabetes mellitus (DM), hypothyroidism, pregnancy, rheumatoid arthritis, osteoarthritis and occupational factors like repetitive work are the main risk factors for CTS. The objective of this study was to determine whether the nerve conduction study measurement of the median nerve (MN) at the wrist differ between diabetic and non-diabetic CTS patients. Methods: This cross-sectional study was conducted at Electrodiagnostic Lab of BIRDEM General Hospital and Popular Medical College Hospital, Dhaka during the period of October 2017 to August 2019. Five hundred and seventeen hands from 377 patients were sampled according to inclusion criteria. Participants were assigned to two groups: Group 1 (CTS with DM) and Group 2 (CTS without DM). NCS study were performed using Nihon Kohden electrodiagnostic machine. Measurements at the MN was taken under consideration for study. Severity of CTS was graded according to Canterbury electrophysiologic grading scale and parameters were compared among diabetic and non-diabetic participants. Data were analyzed using Statistical Package for the Social Sciences SPSS version 23 (SPSS Inc., Chicago, IL, USA). Results: The 377 participants comprised 144 and 233 in Group 1 and Group 2, respectively. Out of 377 patients, 334 (88.59%) were females and there was no statistically significant difference between two groups. The average age was 50.66±10.2 years in diabetic participants and 43.34±10.7 years in non- diabetic participants. In the study population moderate CTS (Grade 3) was the most frequent (46.4%) followed by very severe (Grade 5) CTS. There was no statistically significant difference in incidence between diabetic and non-diabetic patients. Analysis of electrophysologic parameters of MN showed statistically significant difference in mean MN sensory nerve action potential (SNAP) amplitude (P 0.003), compound muscle action potential (CMAP) amplitude (p 0.05, right) and CMAP latency (p 0.02, right and 0.05, left) between diabetic and non –diabetic patients. Inter-group comparison revealed that impaired glycaemic status and duration of diabetes in diabetic population had a minimal influence in the electrophysiological severity of CTS in either hands. Conclusion: Some nerve conduction study parameters of the MN differ significantly between diabetic and non-diabetic patients with CTS and may provide both diagnostic and predictive results across the entire spectrum of CTS. BIRDEM Med J 2023; 13(3): 136-142

Temporal Changes in Electrophysiological Parameters in Untreated Patients With Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy worldwide.This study aimed to investigate the temporal changes in electrophysiological parameters in untreated patients with CTS. Patients were recruited among those with the symptoms of CTS who were referred to the electrophysiology laboratory of Niğde Ömer Halisdemir University Bor Physical Therapy and Rehabilitation Hospital in Niğde, Turkey. Forty-nine patients (78 hands) who had not received any sort of treatment for CTS and had prior electrophysiological examination postive for CTS were included.Laboratory records were reviewed retrospectively. Recent electrophysiological parameters of the patients were compared to their prior examinationsusing Wilcoxon signed-rank test and sign test was used to compare the change in the electrophysiological severity of the study hands between two examinations. One-way analysis of variance(ANOVA) was used to compare individual parameters of the median NCS amongelectrophysiological change groups (improved, deteriorated, and same). The mean age was 50 ± 11 years, and 43 (88%) patients were female. The mean duration of time between the two electrophysiological examinations was 37 ± 20 months. Median sensory peak latency and median motor distal latency increased significantly in the second evaluation (p=0.005 and p=0.004, respectively). Median sensory conduction velocity decreased in the second examination (p=0.002). However, CTS severity determined electrophysiologically did not differ significantly in the two examinations (p=0.286). Although there was a deterioration in electrophysiological parameters during a mean follow-up period of 37 months, the electrophysiological severity of the patients did not worsen.

Do nerve conduction studies or ultrasound imaging correlate more closely with subjective symptom severity in carpal tunnel syndrome?

Previous studies have reported weak correlations between neurophysiological measurements and subjective severity of symptoms in carpal tunnel syndrome, with Pearson r ≤ 0.26. We hypothesize that this resulted in part from patient-to-patient variability in the assessment of subjective severity using tools such as the Boston Carpal Tunnel Questionnaire. To compensate for this, we aimed to assess within-patient differences in symptom and test result severity. In our study we used retrospective data from 13 005 patients with bilateral electrophysiological results and 790 patients with bilateral ultrasound imaging drawn from the Canterbury CTS database. Measures of neurophysiological (nerve conduction studies [NCS] grade) and anatomical (cross-sectional area on ultrasound) severity within individual patients were compared between the right and left hands, eliminating individual variation in the way in which patients interpret the questionnaire. There was a correlation found between right-hand NCS grade and symptom severity score (Pearson r = -0.302, P < .001, n = 13,005), but not between right-hand cross-sectional area and symptom severity (Pearson r = 0.058, P = .10, n = 790). In the within-subject analyses, there were significant correlations between symptoms and NCS grade (Pearson r = 0.6, P < .001, n = 6521) and between symptoms and cross-sectional area (Pearson r = 0.3. P < .001, n = 433). The simple correlation between symptomatic and electrophysiological severity was comparable with previous studies, but within-patient analysis revealed that the relationship was stronger than previously reported and strong enough to be clinically useful. The relationship between symptoms and cross-sectional area measurement on ultrasound imaging was weaker.

Predictive value of ultrasonography in polyneuropathy diagnosis: electrophysiological and ultrasonographic analysis.

Peripheral neuropathy may cause serious complications such as foot ulcers and Charcot joint which can prevent by early diagnosis. We aimed to analyze the diagnostic value of ultrasonographic measurements of nerves and muscles in distal symmetric axonal polyneuropathy (DSAP). Study included 51 DSAP patients and 51 controls. Nerve conduction studies were performed. Median, ulnar, tibial, superficial peroneal, and sural nerves and the abductor pollicis brevis (APB), abductor digiti minimi (ADM), first dorsal interosseous (FDI), extensor digitorum brevis (EDB), abductor hallucis (AH) and tibialis anterior (TA) muscles were evaluated with ultrasound. The Toronto clinical scoring system (TCSS) was used to assess the severity of neuropathy. The median, ulnar, and tibial nerve cross-sectional areas (CSA) were higher in the DSAP group (p = 0.025, p = 0.011, p < 0.001 respectively) while superficial peroneal and sural nerve CSAs were not differed. Only AH and EDB ultrasonographic findings from the muscles differed between the two groups. Effect of diabetes and DSAP on sonographic findings were assessed with two-way ANOVA. Results indicated that only DSAP had a significant effect on sonographic nerve and muscle examination. The area under the ROC curve was 0.831 ± 0.042 for tibial nerve CSA (p < 0.001) with a cut-off value of 15.5 mm2 (sensitivity 74% and specificity 83%). Median, ulnar and tibial nerve CSAs were found to be larger in polyneuropathy patients and they were associated with the clinical and electrophysiological severity of polyneuropathy. ROC analysis showed that tibial nerve CSA may have a predictive value in the diagnosis of DSAP.

Electrophysiological severity of carpal tunnel syndrome and body composition measurement

Electrophysiological severity of carpal tunnel syndrome and body composition measurement

Effects of weight loss after bariatric surgery on the median and ulnar nerves conduction studies

BackgroundThe aim of the present study was to compare the nerve conduction study (NCS) of median and ulnar nerves before and after bariatric surgery. MethodsThis prospective cross-sectional study included 32 patients with BMI≥35 who were candidate for Sleeve gastrectomy. NCS of median and ulnar nerves were evaluated before and 3 months after surgery. In CTS cases, Boston Carpal Tunnel Questionnaire (BCTQ) was completed. ResultsEligible participants were 32 patients aged between 19 and 64 years. 20 patients including 34 hands had CTS. Severity of CTS and BCTQ scores were significantly different after surgery. Moreover, sensory amplitude, and motor NCV for both median and ulnar nerves in hands without CTS as well as sensory amplitude of ulnar nerve in hands with CTS were significantly different after bariatric surgery (P value < 0.05). ConclusionsThe results of this study suggest that three months after the bariatric surgery, the clinical and electrophysiological severity of CTS shows a significant improvement. Ethical code of studyIR.IUMS.FMD.REC.1396.15008.

A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR).

There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio ("Nerve Tendon Ratio", NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1-5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. In controls, the mean MN-CSA was 5.81 mm2, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm2, NTR 117%. In severe CTS (PS &gt; 3), the mean MN-CSA was 15.9 mm2, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (p &lt; 0.001), distal motor latency (DML) (p &lt; 0.001) and PS (p &lt; 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (p = 0.023), DML (p = 0.016) and PS (p = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm2 (9 mm2 with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS &gt; 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm2 (15.3 mm2 with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). NTR can be simply and quickly calculated, and it can be used in anthropometric extremes.

Diagnostic Utility of Superb Microvascular Imaging and Power Doppler Ultrasonography for Visualizing Enriched Microvascular Flow in Patients With Carpal Tunnel Syndrome.

Recent studies suggest that blood flow changes in the median nerve may help confirm a diagnosis of carpal tunnel syndrome (CTS). Herein, we examined the utility of superb microvascular imaging (SMI), a new ultrasonographic (US) technique for visualizing microvascular flow, for detecting blood flow differences between CTS patients and healthy controls. We performed a retrospective analysis of 28 hands with suspected CTS. Patients received both nerve conduction and US examinations. Ten healthy volunteers were enrolled as the control group. The nerve compression ratio and the blood flow signal area were quantified using color Doppler US (CDUS), power Doppler US (PDUS), and SMI. Correlation analyses between the blood flow signal area, the compound muscle action potential of the thenar muscle, and the nerve compression ratio were performed. As a result, the mean nerve compression ratio was found to be significantly higher in the CTS group. There were no differences in the blood flow signal area between the groups using CDUS, while PDUS and SMI showed higher blood flow signals in the CTS group. The blood flow signal area measured by SMI had stronger correlations with the compound muscle action potential amplitude and the nerve compression ratio than those for PDUS. The diagnostic utility of SMI was equivalent to PDUS, but superior to conventional CDUS. Nevertheless, the blood flow signal by SMI was more strongly correlated with the electrophysiological severity and compression ratio than for PDUS. Use of SMI in future studies may help clarify the underlying mechanisms of blood flow changes in CTS.

Evaluation of the Existing Electrophysiological Severity Classifications in Carpal Tunnel Syndrome

Electrophysiological examination is important for the diagnosis and evaluation of nerve function in carpal tunnel syndrome (CTS). Electrophysiological severity classifications of CTS using a nerve conduction study (NCS) have been reported, and there are many reports on the relationship between severity classifications and clinical symptoms. The existing electrophysiological severity classifications have several problems, such as cases that do not fit into a classification and unclear reasons for the boundary value. The purpose of this study was to clarify the relationship between sensory nerve conduction velocity (SCV) and distal motor latency (DML) and to evaluate whether the existing severity classification method is appropriate. We created a scatter diagram between SCV and DML for our NCSs and found a negative correlation between SCV and DML (correlation coefficient, −0.786). When we applied our NCSs to the existing classifications (Padua and Bland classifications), there were many unclassifiable cases (15.2%; Padua classification), and the number of Grade 3 cases was significantly higher than that of Grade 2 or 4 cases (Bland classification). Our large dataset revealed a strong negative correlation between SCV and DML, indicating that the existing severity classifications do not always accurately reflect the severity of the disease.

Preoperative Evaluation of Thenar Muscles in Carpal Tunnel Syndrome by Ultrasonography.

This article aims to evaluate the usefulness of ultrasonography for the measurement of thenar muscles in carpal tunnel syndrome (CTS). A total of 85 patients with CTS who had a carpal tunnel release procedure were included in this study. The transducer was applied onto the palmar surface of the hand perpendicularly to the longitudinal axis of the first metacarpal bone. Thenar atrophy was evaluated visually and classified using the visual grading scale. A nerve conduction test was performed and classified according to the electrophysiological severity scale. This technique is more precise than visual evaluation because it is a quantitative assessment.

Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome.

Background:Previous researchers have used a 30-min eutectic mixture of local anesthetic (EMLA) test, which assesses the sympathetically mediated vasomotor function, in diagnosing carpal tunnel syndrome (CTS). However, its specificity was low, limiting its clinical diagnostic utility. In this study, we assessed the efficiency of 90-min extended EMLA-induced stimulated skin-wrinkling (SSW) test in CTS diagnosis.Methods:A cross-sectional study was designed among patients clinically diagnosed with CTS. Hands of healthy volunteers and the asymptomatic hands of selected patients served as control. The Boston symptom severity scale (SSS) and the neuropathic pain severity inventory (NPSI) were used to assess symptom severity, and nerve conduction study (NCS) was used to assess electrophysiological severity. EMLA-induced SSW was visually graded after 90 min of application and correlated with symptom and NCS severities.Results:Forty-two symptomatic hands and 30 asymptomatic hands were enrolled as cases and controls, respectively. The diagnostic efficiency of the extended EMLA test was found to be 83.4% for digit 2 and 87.3% for the lateral 4 digits (mean), whereas the diagnostic efficiency of standard NCS was 88.1%. Boston SSS and NPSI were better correlated with EMLA positivity than NCS positivity. A linear regression analysis showed negative correlation of wrinkling grade with NCS grade.Conclusion:With its improved diagnostic efficiency, the 90-min extended EMLA test can feasibly be used as an alternative to NCS, especially in general practice settings. Its potential clinical utility should be explored in a large population of CTS patients showing varying clinical and electrophysiological severities.

Questionnaires can reflect the severity of electrophysiological findings In diabetic patients

Objective: The aim of this study was to determine whether a relationship exists between pain questionnaires, diabetic peripheral neuropathy, and the severity of electrophysiological findings. Methods: Patients with diabetes mellitus (DM) whose clinical signs and symptoms were found to be consistent with diabetic neuropathy were included in the present study in Ankara City Hospital Neurology Department between June 2020-January 2021. It was designed as a prospective cross-sectional study. Demographic characteristics, type and duration of DM, the onset of neuropathic complaints, systemic diseases, and DM treatments were noted. Blood tests were performed on all patients. Participants were administered the Douleur Neuropathique 4 Questions (DN4), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and Numerical Rating Scale (NRS) questionnaires and an electrophysiological examination. Results: The study included 108 patients. A statistically significant correlation was found between the severity of electrophysiological findings and the age of patients, duration of diabetes, and treatment modality. Additionally, a statistically significant correlation was found between the severity of electrophysiological findings and blood urea nitrogen (BUN) levels and monocyte and platelet counts. According to the NRS, a significant relation was found between BUN values and the severity of pain experienced. The LANSS predicted the severity of electrophysiological findings at a significantly higher accuracy than other questionnaires. Conclusion: Questionnaires can detect diabetic neuropathy, which is mostly asymptomatic, before the onset of DM complications. The LANSS questionnaire reflects the electrophysiological findings severity.

Correlation Nerve Conduction Studies with Findings of the Ultrasound of the Median Nerve in Patients with Carpal Tunnel Syndrome

Background: Ultrasonography is a diagnostic resource that serves as a complement in the evaluation of patients with carpal tunnel syndrome. The correlation of ultrasonography findings with nerve conduction studies can serve to classify new phenotypes and to evaluate therapeutic responses. Objectives: To determine the diagnostic sensitivity of ultrasound, the correlation between the diameter of the nerve (CSA) against the motor and sensitive latencies, and the capacity to differentiate the mild, moderate and severe degrees of the electrophysiological classification of carpal tunnel syndrome. Methods: A cross-sectional study with prospective data collection was carried out. An ultrasonography system with a 15 MHz transducer was used. Nerve conduction studies of the median nerve were performed with conventional techniques. Data from the most symptomatic hand were used. Determination of the correlations of nerve diameter with motor and sensitive latencies of the median nerve was performed in four age groups: &lt;40(n=11), 40-54 (n=47), 55-70 (n=42) y &gt;70(n=27). Results : A total of 127 patients were evaluated (average age = 58.2 years: minimum = 26; maximum = 85; SD = 13.4); 109 (85.8%) were female patients. According to the electrophysiological classification, 40 (31.5%) were mild ; 60 (47.2%) were moderate ; and 27 (21.3%) were severe . Significant differences in the area of the median nerve were found between the electrophysiological types (mild, moderate and severe; p = 0.000). The diagnostic sensitivity of ultrasonography differed for each age group. In general, the diagnostic sensitivity was high in patients with severe cases and low for mild cases. The capacity for ultrasonography to classify the degrees of electrophysiological severity was different for each age group. For patients above 70 years and in the age group of 40 to 54 years, the CSA did not differentiate the electrophysiologically moderate cases from the severe ones. Conclusions: There is a well-defined and significant correlation between nerve conduction studies and median nerve diameter in patients with Carpal Tunnel Syndrome. However, it shows that the exclusive use of the ultrasonographic measurement of the cross-sectional area through the inlet of the carpal tunnel would not be enough to confirm or rule out an entrapment of the median nerve through the carpal tunnel, nor to predict in every case their electrophysiological severity.

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.

Carpal tunnel syndrome treatment and the subsequent alterations in tendon and connective tissue dynamics

BackgroundCarpal tunnel syndrome patients demonstrate diminished motion of the median nerve and fibrotic changes in the subsynovial connective tissue within the carpal tunnel. Currently, there are few prognostic factors to help predict the outcome of commonly performed treatments including surgical carpal tunnel release and corticosteroid injections. This study aimed to non-invasively assess the changes in the dynamic response of the subsynovial tissue relative to tendon motion after the intervention and to correlate this with disease severity. MethodsA total of 145 patients with carpal tunnel syndrome were recruited into this study. Clinical and demographic data, electrophysiological severity and dynamic ultrasound images were collected before and after treatment, either by injection or surgery. The relative motion of the subsynovial tissue with the underlying middle finger flexor digitorum superficialis tendon was measured using a speckle tracking algorithm and was expressed as a shear index (SI). Baseline and follow-up data, the association between change in SI and severity, and the role of treatment modality were analyzed and statistically compared. FindingsOverall, there was a significant increase (more relative motion) after treatment in the mean shear index from 79.9% (±15.4% SD) to 82.9% (±14.8% SD) (p = 0.03). Secondary analyses showed that this change was mostly present in those with mild disease severity undergoing surgery (p = 0.01). InterpretationThis study shows that the relative subsynovial tissue movement increases in patients after intervention. The present study lays a foundation for future studies to non-invasively assess the role of carpal tunnel dynamics in response to treatment.

A Clinical and Neurophysiological Analysis of Idiopathic Carpal Tunnel Syndrome with Respect to Gender and Occupation.

Background:Carpal tunnel syndrome (CTS) predominantly affects women. Previous studies observed more intense symptoms among women without a corresponding increase in disease severity and attributed it to reporting bias. In this study, we examined whether women are inherently more vulnerable to work related median nerve dysfunction at wrist and whether reported CTS symptoms among women correspond to the degree of median neuropathy at wrist.Methods:A cross-sectional study was designed for outpatients (aged 25-59 years) diagnosed with CTS. Occupational categorisation was done based on the analysis of their individual job tasks. Symptom severity (Boston Symptom Severity Scale – SSS), functional disability (Boston Functional Status Scale - FSS), and clinical (Hi – Ob scale) and neurophysiological severity (NCS grade) were determined, compared among occupational groups and were statistically analysed.Results:A total of 454 patients (348 women and 106 men; F: M ratio 3.28:1) were included. Among them, 191 were housewives. Female manual workers and housewives reported significantly more intense symptoms with a corresponding increase in clinical and electrophysiological severity (p < 0.001) when compared to female non-manual workers. However, no significant difference in symptoms, clinical or neurophysiological severity was found between male non-manual and manual workers. Among manual workers, women were more symptomatic than men, but clinical and neurophysiological severities were significantly higher only in the older age groups.Conclusion:The differential vulnerability of the female population to hand-intensive work predisposes them to severe median nerve dysfunction at wrist with proportionately higher CTS symptoms. Therefore, working women need focussed attention for remedial measures.