Measurement Of Median Nerve Cross-sectional Area Research Articles

The Impact of Rheumatoid Arthritis (RA) in Median Nerve Area in the Wrist Joint: A Case-Control Study.

Background Rheumatoid arthritis (RA) is one cause of carpal tunnel syndromes (CTS); due to increased intracarpal pressure in the rheumatoid wrist, synovial enlargement, joint erosions, and ligamentous laxity cause the compression of the median nerve (MN). Materials and methods A case-control study was conducted to assess the measurement of median nerve areas in RA using high-frequency ultrasound (US) and to correlate the measurement with the disease duration. Forty patients with rheumatoid arthritis (RA)and 40 with non-rheumatoid arthritis (RA) as a control group were referred to the radiology department of Yastabshiron Hospital, Khartoum, Sudan, from June to August 2022. After assessing the wrist joint by ultrasound scans, median nerve (MN) cross-sectional area (CSA)measurements were performed using a Fukuda Denshi ultrasound machine (Tokyo, Japan) with a linear-array high-frequency transducer (10 MHz), after receiving ethical approval from the research committee of the faculty of radiological science at University of Medical Sciences and Technology (UMST) and the study participants. Results The study demonstrated that the mean measurement of MN cross-sectional area (CSA) in RA patients was 13.60 mm2for the right and 13.25 mm2 forthe left MN. The study found that the MN CSA decreased by increasing the disease duration, with significant differences in the median nerve cross-sectional areas in RA and healthy control (p-value of <0.01). Conclusion The study concluded that rheumatoid arthritis (RA) had a greater influence on the median nerve cross-sectional areas. MN areas significantly decreased with increasing duration of diseases; the MN cross-sectional areas were more in RA than in the healthy control group.

Changes in Cross-sectional Area of the Median Nerve and Boston Carpal Tunnel Questionnaire Scores After Carpal Tunnel Release.

We hypothesized that postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores and ultrasound (US) measurements of the median nerve cross-sectional area (CSA) at the distal wrist crease are significantly decreased at 2-week, 6-week, and ≥ 6 months follow-up appointments, compared with baseline values. This study was a retrospective chart review of patients who presented to a single hand clinic with evidence of carpal tunnel syndrome over a 6-year period (2014-2020). Patients received baseline US measurements of the median nerve CSA as well as completion of the BCTQ, and for the patients who underwent carpal tunnel release (CTR), postoperative US measurements and questionnaire scores were obtained at 2 weeks, 6 weeks, or ≥ 6 months postoperatively. This study included 224 separate wrists. Median Nerve CSA measurements were 13.2 ± 4.5 mm2 at baseline, 11.9 ± 3.6 mm2 at 2 weeks postoperatively, 11.6 ± 4.5 mm2 at 6 weeks postoperatively, and 11.7 ± 4.3 mm2 at 6 months or more (P = .002). The BCTQ Symptom Severity Scale scores were 3.14 ± 0.76 at baseline, 1.76 ± 0.63 at 2 weeks, 1.68 ± 0.70 at 6 weeks, and 1.41 ± 0.64 at 6 months or longer (P < .001). The BCTQ Functional Status Scale scores were 2.56 ± 0.89 at baseline, 2.03 ± .1.0 at 2 weeks, 1.65 ± 0.77 at 6 weeks, and 1.36 ± 0.61 at 6 months or longer (P < .001). These findings demonstrated a sustained decrease in median nerve CSA and patient-reported outcomes following CTR at 2 weeks, 6 weeks, and between 6 and 12 months.

Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography.

Prospective, cross-sectional observational study. We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography. Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to "double-crush syndrome" hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression. Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point. CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points. The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR. 2.

A Comparison of Ultrasound and MRI Measurements of the Cross-Sectional Area of the Median Nerve at the Wrist

Background: Ultrasound (US) measurement of cross-sectional area (CSA) of the median nerve has emerged as a viable alternative to electromyography/nerve conduction studies (EMG/NCS) for diagnosis of carpal tunnel syndrome (CTS). The purpose of this study is to compare CSA of the median nerve between US and MRI using current MRI and US technology. The null hypothesis is there is no difference between US and MRI CSA measurements. Methods: The study design was an observational cohort, enrolling patients presenting to clinic with MRI of the wrist. Participants with clinical signs and symptoms of CTS were excluded. The CSA measurements of the median nerve on MRI T1-weighted axial images were performed by a hand fellow blinded to results of US measurements, and US measurement of median nerve CSA was performed by a hand fellowship trained surgeon blinded to results of the MRI measurements. Results were analyzed via percent error, Pearson correlation, and t tests. Results: Twenty participants were enrolled with mean age of 29.4 years. Four left wrists and 16 right wrists were measured. The US mean CSA of the median nerve was 6.8 mm2 (±2.330 mm2). The MRI mean CSA of the median nerve was 6.8 mm2 (±2.153 mm2), P = .442. Pearson correlation between modalities was 0.93, suggesting near-perfect correlation. Mean percent error was 8.8%. Conclusions: Results of this study suggest that US is an accurate method to measure CSA of the median nerve at the carpal tunnel inlet. The mean difference between US and MRI was unlikely to be clinically significant.

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.

Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation

The aim of this study was to investigate factors affecting median nerve cross-sectional area (CSA) and determine a dependable swelling ratio (SR) calculation method. Using ultrasonography, median nerve CSAs were measured at the tunnel inlet, midtunnel, and outlet, and at 4 cm and 12 cm proximal to the wrist. We used CSAmax as the largest of the tunnel measurements and calculated swelling ratios (SRs) by using the CSAmax. Sonographic measurements were correlated with electrophysiologic findings. We evaluated the effects of gender, weight, and height on median nerve thickness. We studied 95 wrists of 55 CTS patients and 48 wrists of 27 volunteers. Gender, weight, and height had effects on certain median nerve CSA measurements. CSAmax, SRmax4, and SRmax12 had superior correlations with electrophysiologic findings. The correlation between 4-cm and 12-cm median nerve CSAs was statistically significant (r = 0.879 and P < 0,001). We have developed a reliable SR method considering factors affecting median nerve CSA.

Sonographic measurement of cross‐sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies

To assess the usefulness of sonographic measurement of the median nerve cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) and grading of its severity using nerve conduction (NC) studies as the standard. The CSA of the median nerve was measured at the tunnel inlet and outlet using the ellipse formula and automatic tracing in 72 hands with suspicion of CTS. The lack of inter-reader reliability led to excluding CSA measurements obtained at the tunnel outlet. Based on the receiver operating characteristic curves, the following cut-off points for the CSA of the median nerve at the tunnel inlet was selected: 9.8 mm and 12.3 mm(2) for the ellipse formula and 11 and 13 mm(2) for automatic tracing. For the ellipse formula, a CSA less than or equal to 9.8 mm(2) excluded CTS whereas a CSA greater than or equal to 12.3 mm(2) was diagnostic of CTS with measurements between 9.8 and 12.3 mm(2) being indeterminate and requiring NC studies. For automatic tracing, the cutoff value of 11 mm(2) was excluded because of the high percentage of false negatives, whereas CSAs greater than or equal to 13 mm(2) were diagnostic of CTS. There were no statistically significant differences in CSA measurements between the various degrees of CTS severity determined by NC studies. Sonographic measurement of median nerve CSA at the tunnel inlet is a good alternative to NC studies as the initial diagnostic test for CTS, but it cannot grade the severity of CTS as well as NC studies.

Reproducibility of Sonographic Measurements of the Median Nerve

The purpose of this study was to evaluate the reproducibility of median nerve cross-sectional area (CSA) measurements using the indirect method (ellipsoid formula) and the direct or tracing method. The median nerve CSA was measured in 22 wrists of patients with carpal tunnel syndrome by means of high-frequency sonography. Measurements were made at the level of the pisiform bone by a standardized sonographic examination protocol. Two observers with different levels of experience performed the measurements, independently and blinded. An analysis of reliability was carried out, and the concordance between the methods was determined with parametric statistical tests. The results point to good reproducibility of the median nerve CSA measurements obtained by both methods, whether performed by an experienced observer or by an inexperienced observer after a short learning period. The results suggest sonography for median nerve CSA measurements is reproducible by either the direct or indirect method when a standardized sonographic examination protocol is used.