Median Nerve Cross-sectional Area Research Articles

Ultrasound-Guided Modified Thread Carpal Tunnel Release for Carpal Tunnel Syndrome: A Pilot Study.

This study aimed to investigate the effectiveness and safety of modified thread carpal tunnel release (mTCTR) using Smartwire-01 in patients with carpal tunnel syndrome (CTS). Patients with CTS who required CTR were enrolled. Symptom severity and functional status were assessed using the Boston Carpal Tunnel Syndrome Questionnaire-Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and pain was assessed using a numerical rating scale (NRS) at 4, 8, and 12 weeks after mTCTR. The scores were compared with the pre-procedural scores. The electrophysiologic study and median nerve cross-sectional area (CSA) measurements at the wrist before and 12 weeks after mTCTR were compared. A total of 11 patients were included. No adverse effects were reported throughout the study period. The NRS, BCTQ-SSS, and BCTQ-FSS scores significantly improved at 4 weeks after mTCTR, and this improvement persisted throughout the follow-up period (NRS and BCTQ-SSS, P < 0.001; BCTQ-FSS, P = 0.012). After 12 weeks, the latency and velocity of the median sensory nerve action potential significantly improved, compared with those before mTCTR (latency, 5.4 ± 1.3 to 4.7 ± 1.1 ms, P = 0.01; velocity 27.8 ± 6.8 to 31.8 ± 7.4 m/s, P = 0.019). No significant change was observed in the median nerve CSA before and after mTCTR. mTCTR using Smartwire-01 is a safe and effective procedure and a possible alternative to surgery.

Assessment of sonographic measurement of the median nerve cross-sectional area in pregnant women with hypertensive disorders

Assessment of sonographic measurement of the median nerve cross-sectional area in pregnant women with hypertensive disorders

Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of severity of carpal tunnel syndrome.

Neuromuscular ultrasound plays an increasing role in diagnosing carpal tunnel syndrome (CTS). There are limited data supporting the correlation between the electrodiagnostic studies and ultrasound measurements in CTS. To assess the association between different electrodiagnostic severities and ultrasound measurements of the median nerve in CTS. A retrospective cohort study. An academic tertiary care center. Patients 18 years or older evaluated with upper limb electrodiagnostic studies and neuromuscular ultrasound. Ultrasound measurements of the median nerve cross-sectional area (CSA) at the wrist and the calculated wrist-to-forearm ratio (WFR) were compared with the electrodiagnostic severity (normal, mild, moderate, and severe). Mean analysis and analysis of variance test (α = 0.05) were performed to assess the association. A total of 1359 limbs were identified. There was a statistically significant association between electrodiagnostic severity of CTS and median nerve CSA at the wrist (p < .001), as well as the WFR (p < .001). The mean median nerve CSA at the wrist and WFR were 7.01 ± 2.06 mm2 (95% CI: 6.80-7.20) and 1.24 ± 0.36 (95% CI: 1.16-1.24) in electrodiagnostically normal median nerves, 10.47 ± 2.82 mm2 (95% CI: 10.25-10.75) and 2.06 ± 0.67 (95% CI: 2.04-2.16) in electrodiagnostically mild CTS, 12.95 ± 4.74 mm2 (95% CI: 12.41-13.59) and 2.49 ± 1.04 (95% CI: 2.37, 2.63) in electrodiagnostically moderate CTS, and 14.69 ± 5.38 mm2 (95% CI: 13.95-15.44) and 2.71 ± 1.02 (95% CI: 2.56-2.84) in electrodiagnostically severe CTS, respectively. This study suggests a direct association between electrodiagnostic severity and ultrasound measurements of the median nerve in patients with suspected CTS.

Diagnostic efficacy of high-frequency Grey-scale ultrasonography and Sono-elastography in grading the severity of carpal tunnel syndrome in comparison to nerve conduction studies.

To correlate the cross-sectional area (CSA) and elasticity of the median nerve (MN) measured at carpal tunnel inlet between healthy controls and various degrees of carpal tunnel syndrome (CTS) graded as per nerve conduction studies (NCS). A total of 53 patients (with 81 wrists) presenting with clinical symptoms characteristic of CTS, having their diagnosis confirmed and severity graded by NCS, and 48 healthy controls (with 96 wrists) were included in the study. All the study participants underwent wrist ultrasound which included initial Grey-scale USG followed by strain and shear wave elastography. The CSA and elasticity (in terms of strain ratio and shear modulus) of MN were measured at the carpal tunnel inlet. Statistical analysis was performed using the Mann-Whitney U test to compare between the two groups and for subgroup analysis of cases. The diagnostic performance of each variable was evaluated using the receiver operating characteristic curves. The mean CSA was 9.20 ± 1.64, 11.48 ± 1.05, 14.83 ± 1.19 and 19.87 ± 2.68 mm2, the mean shear modulus was 17.93 ± 2.81, 23.59 ± 2.63, 32.99 ± 4.14 and 54.26 ± 9.24kPa and the mean strain ratio was 5.26 ± 0.68, 5.56 ± 0.70, 7.03 ± 0.47 and 8.81 ± 0.94 in control, mild, moderate and severe grades of CTS, respectively (p < 0.001). The combined utility of Grey-scale USG and Elastography may serve as a painless and cost-effective alternative to NCS in grading the severity of CTS.

Median Nerve Shear Wave Elastography is Associated With the Neurophysiological Severity of Carpal Tunnel Syndrome.

This study examines the associations between the median nerve (MN) shear wave elastography (SWE), the MN cross-sectional area (CSA), patient's symptoms, and the neurophysiological severity of carpal tunnel syndrome (CTS). The most appropriate site to perform SWE was also tested. This prospective study comprised 86 wrists of 47 consecutive patients who volunteered for MN ultrasound after an electrodiagnostic study. The neurophysiological severity of CTS was assessed according to the results of a nerve conduction study (NCS). The MN CSA was measured at the carpal tunnel inlet (wCSA) and the forearm (fCSA). SWE was performed on the MN in a longitudinal orientation at the wrist crease (wSWE), at the forearm (fSWE), and within the carpal tunnel (tSWE). The wCSA and wSWE correlated positively with the neurophysiological severity of CTS (r = .619, P < .001; r = .582, P < .001, respectively). The optimal cut-off values to discriminate the groups with normal NCS and with findings indicating CTS were 10.5 mm2 for the wCSA and 4.12 m/s for the wSWE. With these cut-off values, wCSA had a sensitivity of 80% and specificity of 87% and wSWE a sensitivity of 88% and specificity of 76%. Neither tSWE nor fSWE correlated with the neurophysiological severity of CTS or differed between NCS negative and positive groups (P = .429, P = .736, respectively). Shear wave velocity in the MN at the carpal tunnel inlet increases in CTS and correlates to the neurophysiological CTS severity equivalently to CSA measured at the same site.

Application of radiomics model based on ultrasound image features in the prediction of carpal tunnel syndrome severity.

The aim of our study is to develop and validate a radiomics model based on ultrasound image features for predicting carpal tunnel syndrome (CTS) severity. This retrospective study included 237 CTS hands (106 for mild symptom, 68 for moderate symptom and 63 for severe symptom). There were no statistically significant differences among the three groups in terms of age, gender, race, etc. The data set was randomly divided into a training set and a test set in a ratio of 7:3. Firstly, a senior musculoskeletal ultrasound expert measures the cross-sectional area of median nerve (MN) at the scaphoid-pisiform level. Subsequently, a recursive feature elimination (RFE) method was used to identify the most discriminative radiomic features of each MN at the entrance of the carpal tunnel. Eventually, a random forest model was employed to classify the selected features for prediction. To evaluate the performance of the model, the confusion matrix, receiver operating characteristic (ROC) curves, and F1 values were calculated and plotted correspondingly. The prediction capability of the radiomics model was significantly better than that of ultrasound measurements when 10 robust features were selected. The training set performed perfect classification with 100% accuracy for all participants, while the testing set performed accurate classification of severity for 76.39% of participants with F1 values of 80.00, 63.40, and 84.80 for predicting mild, moderate, and severe CTS, respectively. Comparably, the F1 values for mild, moderate, and severe CTS predicted based on the MN cross-sectional area were 76.46, 57.78, and 64.00, respectively.. This radiomics model based on ultrasound images has certain value in distinguishing the severity of CTS, and was slightly superior to using only MN cross-sectional area for judgment. Although its diagnostic efficacy was still inferior to that of neuroelectrophysiology. However, this method was non-invasive and did not require additional costs, and could provide additional information for clinical physicians to develop diagnosis and treatment plans.

Association Between Thenar Musculature and Carpal Tunnel Syndrome.

Background: Dynamic forces acting on the transverse carpal ligament (TCL) may influence the mechanics of the carpal tunnel (CT), thus affecting the occurrence of CT syndrome (CTS). Previous studies demonstrated an association between muscle overlying the CT and the diagnosis of CTS. Understanding the location of insertion/origin of the thenar musculature will allow mechanical analysis of the forces applied to the TCL during performance of individual tasks. Our purpose was to determine the location of muscle overlying the CT on magnetic resonance imaging (MRI) in CTS and controls. Methods: Case-control study of 21 normal adult wrist MRI scans. MRI measurements were performed on an axial cut at the level of the hook-of-hamate. Median nerve cross-sectional area (CSA), median nerve shape and increased signal intensity within the CT were associated with CTS. The amount and length of muscle crossing the midline and the CT on the same cut was measured and the association with the occurrence of CTS was analysed. Results: We found an inverse relationship between the amount of muscle crossing the midline and the size of the CT, and a direct relationship with occurrence of CTS p less than 0.01, but no differences regarding length of muscle crossing the midline. Conclusions: This study supports an association between the thenar musculature location relative to the CT and the predictors of CTS on MRI. Since the location of muscle origin/insertion is variable, their effect may differ accordingly, therefore, further study is needed to describe the exact location of origin/insertion and its differential dynamic or static effect on the pathogenesis of CTS. Level of Evidence: Level IV (Diagnostic).

Ultrasonographic Assessment of Median Nerve Cross-Sectional Area in Obstetricians

Ultrasonographic Assessment of Median Nerve Cross-Sectional Area in Obstetricians

Diagnostic Ability of Nerve Conduction Study, Ultrasonography and Magnetic Resonance Imaging in Diagnosis of Carpel Tunnel Syndrome

Introduction: Current diagnostic criteria for Carpel Tunnel Syndrome (CTS) include a patient's medical history, physical exam results, and electrophysiological findings. The purpose of the study is to evaluate the diagnostic ability of nerve conduction study, ultrasonography and magnetic resonance imaging for the diagnosis of carpal tunnel syndrome with the use of clinical findings as the gold standard.&#x0D; Methodology: The study was conducted among 30 patients clinically diagnosed having CTS based on the criteria given by American Academy of Neurology and American Academy of Physical Medicine and Rehabilitation. All patients included in the study were underwent USG of affected wrist joint, CT scan as well MRI of the same.&#x0D; Results: Out of total 30 participants, 14 (46.7%) were found moderate severity followed by 11 (36.7%) were found mild severity. Only 5 (16.7%) were found severe carpel tunnel syndrome. Amongst all three investigation methods, nerve conduction study having the lowest sensitivity (83.33%). The sensitivity of the ultrasonography and MRI was 90% each.&#x0D; Conclusion: It is clear from this study that the sensitivity of the parameters utilized in NCS (maximum observed 83.33%) is lower than that of the median nerve cross-sectional area detected on USG (90%) and MRI (90%). The most sensitive, practical, and cost-effective metric of all those seen in the research turned out to be the median nerve cross sectional area evaluated at the wrist crease by USG.

Ultrasonographic changes of the median nerve in patients with end-stage renal failure and comparing it with a control group

Carpal Tunnel Syndrome (CTS) is characterized by median nerve entrapment in the wrist. CTS is diagnosed by clinical symptoms, which are confirmed by electrodiagnostic studies. This study aimed to assess median nerve cross-sectional area and elastography in chronic hemodialysis patients. This case-control study was conducted on end-stage renal failure (ESRD) patients undergoing hemodialysis at Rasool Akram Hospital's Dialysis Unit. The healthy companions of the patients were included as control group. An experienced rheumatologist used a supersonic device with linear array probes and dynamic scanners (5-22 MHz) to perform the sonography. The current study was conducted on both hands. There was no statistically significant difference between 30 patients and 30 healthy individuals regarding age, weight, and body mass index. The cross sectional area of median nerve in both hands was increased in the dialysis group compared to the control group. However, it was significantly higher in the patient group's right hand than in the control group (P = 0.031). Considering the causes of ESRD and parathormone levels, the cross-sectional area and mean right and left median nerve elastography were not different between the two groups. The results showed that the patient group had a larger right and left median nerve cross-sectional area than the control group. However, the median nerve elastographic indices did not differ between dialysis patients and healthy individuals.

Characteristics of diabetic and non-diabetic carpal tunnel syndrome in terms of clinical, electrophysiological, and Sonographic features: a cross-sectional study

BackgroundAlthough diabetes is considered a major risk factor for carpal tunnel syndrome (CTS), the characteristics of diabetic CTS have not been fully understood.ObjectiveThis study is aimed at evaluation of the clinical, electrophysiological, and ultrasonographic findings of non-diabetic and diabetic CTS.MethodsThis retrospective, cross-sectional study included patients diagnosed with CTS. Patient age, sex, involved side, body mass index, clinical and electrophysiological findings, and median nerve cross-sectional area (CSA) were identified. Diabetes was identified through patient or guardian interviews, medical records, and medication history. Linear and binary logistic regression models were established to confirm the associations between the electrophysiological findings, median nerve CSA, and clinical outcomes. Covariates, such as age, sex, body mass index, diabetes, symptom duration, and thenar muscle weakness were adjusted.ResultsOut of the 920 hands, 126 and 794 belonged to the diabetic and non-diabetic CTS groups, respectively. The patients were significantly older in the diabetic CTS group (P < 0.001). The rate of thenar weakness in the diabetic CTS group was also significantly higher than that in the non-diabetic CTS group (P = 0.009). The diabetic CTS group had a more severe electrodiagnostic grade (P = 0.001). The prolonged onset latency of the compound motor nerve action potential (CMAP) and median nerve CSA were well associated with the degree of clinical symptoms. Increased median nerve CSA was significantly associated with prolonged CMAP onset latency (β = 0.64; P = 0.012), prolonged transcarpal latency (β = 0.95; P = 0.044), and decreased CMAP amplitude (β = -0.17; P = 0.002) in the non-diabetic CTS group.ConclusionDiabetic CTS had more profound electrophysiological abnormalities. Distal motor latency and median nerve CSA were not only associated with each other, but also with clinical symptoms. Further studies are needed to investigate the pathophysiological mechanisms underlying diabetic CTS.

Retracted: Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome.

[This retracts the article DOI: 10.1155/2023/3631193.].

Does hot pack application change the morphology of the median and ulnar nerves?

This study aims to investigate the effect of the hot pack application on the morphology of healthy median and ulnar nerves. Between August 2021 and September 2022, a total of 54 healthy volunteers (17 males, 37 females; mean age: 31.9±9.4 years; range, 21 to 63 years) were included in the study. The cross-sectional area (CSA) and depth of the right median and ulnar nerve were measured using ultrasonography before and after 20-min hot pack application. The right median nerve CSA and depth from the level of the scaphoid bone (at the level of the carpal tunnel) and from the mid-forearm were also measured. The right ulnar nerve CSA and depth from the level of the hook of hamate and the mid-forearm were evaluated. The depth measurements between the skin and the outer hyperechoic border of the nerve were performed. After the hot pack application, there was an increase in both the median nerve CSA at the carpal tunnel (from 0.06±0.01 to 0.09±0.02 cm2 ) and forearm (from 0.06±0.02 to 0.09±0.02 cm2 ) levels (p<0.001) and the ulnar nerve CSA at the hook of hamate (from 0.04±0.03 to 0.06±0.01 cm2 ) and forearm (0.05±0.01 to 0.08±0.02 cm2 ) levels (p<0.001). No statistically significant difference was observed between the pre- and post-application depth measurements (p>0.05). Our study results show that the hot pack application leads to acute swelling of the median and ulnar nerves. In future studies, the relationship between morphological changes in healthy and pathological nerves and electrodiagnostic findings should be investigated.

Sonographic evaluation of median nerve cross-sectional area in a normal Iranian population: A cross-sectional study.

Considering disagreements on the normal range of median nerve cross-sectional area (MNCSA) and insufficient data in the Iranian population, this study aimed to measure normal MNCSA. In this cross-sectional study, bilateral upper limbs of 99 subjects were assessed by sonography, and MNCSA was measured at three levels: forearm, carpal tunnel inlet (CTI), and carpal tunnel outlet (CTO). The association between MNCSA and demographic factors was assessed. Mean MNCSA was 6.33 mm2 at the forearm, 9.41 mm2 at CTI, and 10.67 mm2 at CTO. MNCSA was significantly higher in males (6.78 vs. 5.94 mm2 at the forearm, 9.98 vs. 8.92 mm2 at CTI, and 11.24 vs. 10.84 mm2 at CTO in males and females, respectively) and taller (>170 cm) subjects in all three levels (6.69 vs. 6.03 mm2 at the forearm, 9.80 vs. 9.02 mm2 at CTI, and 11.27 vs. 10.12 mm2 at CTO in taller and shorter subjects, respectively). MNCSA was not significantly associated with wrist ratio (WR) or body mass index (BMI). The normal MNCSA range in the Iranian population is 6.31 mm2 (forearm) to 10.74 mm2 (CTO). MNCSA is significantly higher in males and taller subjects but is not associated with BMI and WR.

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.

Application of ultrasound images-based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross-sectional area.

By constructing a prediction model of carpal tunnel syndrome (CTS) based on ultrasound images, it can automatically and accurately diagnose CTS without measuring the median nerve cross-sectional area (CSA). A total of 268 wrists ultrasound images of 101 patients diagnosed with CTS and 76 controls in Ningbo NO.2 Hospital from December 2021 to August 2022 were retrospectively analyzed. The radiomics method was used to construct the Logistic model through the steps of feature extraction, feature screening, reduction, and modeling. The area under the receiver operating characteristic curve was calculated to evaluate the performance of the model, and the diagnostic efficiency of the radiomics model was compared with two radiologists with different experience. The 134 wrists in the CTS group included 65 mild CTS, 42 moderate CTS, and 17 severe CTS. In the CTS group, 28 wrists median nerve CSA were less than the cut-off value, 17 wrists were missed by Dr. A, 26 wrists by Dr. B, and only 6 wrists were missed by radiomics model. A total of 335 radiomics features were extracted from each MN, of which 10 features were significantly different between compressed and normal nerves, and were used to construct the model. The area under curve (AUC) value, sensitivity, specificity, and accuracy of the radiomics model in the training set and testing set were 0.939, 86.17%, 87.10%, 86.63%, and 0.891, 87.50%, 80.49%, and 83.95%, respectively. The AUC value, sensitivity, specificity, and accuracy of the two doctors in the diagnosis of CTS were 0.746, 75.37%, 73.88%, 74.63% and 0.679, 68.66%, 67.16%, and 67.91%, respectively. The radiomics model was superior to the two-radiologist diagnosis, especially when there was no significant change in CSA. Radiomics based on ultrasound images can quantitatively analyze the subtle changes in the median nerve, and can automatically and accurately diagnose CTS without measuring CSA, especially when there was no significant change in CSA, which was better than radiologists.

Recurrent motor branch neuropathy in carpal tunnel syndrome: An ultrasound study.

The reason for the variable rate of progression of patients with carpal tunnel syndrome (CTS) to thenar muscles impairment is not fully understood. The aim of this study was to evaluate the occurrence of ultrasound signs of recurrent motor branch (RMB) neuropathy in patients with CTS and to correlate imaging findings with clinical and electrophysiological data. Two cohorts were recruited, one consisting of CTS patients with electrodiagnostic evidence of prolonged median distal motor latency from wrist to thenar eminence and another consisting of sex- and age-matched healthy controls. Ultrasound reliability of RMB measurement was assessed by the calculation of the interclass correlation coefficient (ICC). Patients were evaluated with electrodiagnostic tests and asked to complete the Boston Carpal Tunnel Questionnaire. The difference between the RMB diameter in patients and controls was analyzed using a t test. Correlations between RMB diameter and other parameters were assessed using linear mixed models. 46 hands from 32 patients with CTS and 50 hands from 50 controls were evaluated. The intra- and interobserver agreements in RMB measurement were very good (ICC = 0.84; 95% confidence interval [CI], 0.75 to 0.90) and good (ICC = 0.79; 95% CI, 0.69 to 0.87). The RMB diameter was significantly larger in patients than in controls (P < .0001). No significant correlation was found between the RMB diameter and other variables, except for BMI and median nerve cross-sectional area. Ultrasound is reliable in identifying the RMB and characterizing its abnormalities. In this patient cohort, ultrasound allowed for detection of definite signs of RMB compression neuropathy.

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.

Ultrasonography-assisted assessment of the influence of the volar prominence of the plate on the median nerve in distal radius fractures

ObjectiveThe study aimed to explore the effect of differing volar locking plate (VLP) prominence on the median nerve (MN) in distal radius fracture (DRF) with ultrasound assistance to guide clinical treatment. MethodsForty-four patients who received VLP for DRF at our department were admitted and followed-up between January 2019 and May 2021. Different plate positions were graded using Soong classification; 13 were Grade 0, 18 were Grade 1, and 13 were Grade 2. The MN parameters at different wrist positions in patients with different Soong grades were measured with ultrasound assistance, including the median nerve cross-sectional area (MNCSA), diameter in the radial–ulnar direction (D1), and diameter in the dorsal–palmar direction (D2). The sensation in the affected finger and grip strength were collected at follow-up, scored using the Disabilities of the Arm, Shoulder, and Hand (DASH) scale to determine function, and statistically analysed. ResultsThe MNCSA differed significantly across Soong grades. The MNCSA at the flexed, neutral, and extended wrist positions was smallest at Grade 0 and largest at Grade 2 (P < 0.05), and that at the neutral position was not significantly different between Grades 1 and 2 (P > 0.05). There was no significant interaction between the wrist positions and Soong grade (P > 0.05). The differences in D1 and D2 among different Soong grades were not statistically significant (P > 0.05). There were no statistical differences in grip strength, DASH, and sensation among different Soong grades (P > 0.05). ConclusionsDiffering plate protrusions in DRF treatment did not cause clinical symptoms during follow-up; however, excessive plate protrusion (Soong Grade 2) increased the cross-sectional area of the MN. We recommend placing the plate as proximal as possible during VLP treatment of DRFs to avoid excessive bulges affecting the MN.

[Value of High-Frequency Ultrasound in the Diagnosis of Pronator Teres Syndrome].

Objective To investigate the clinical value of high-frequency ultrasound in the diagnosis of pronator teres syndrome (PTS). Methods The high-frequency ultrasound was employed to examine and measure the median nerve of the pronator teres muscle in 30 patients with PTS and 30 healthy volunteers (control group).The long-axis diameter (LA),short-axis diameter (SA) and cross-sectional area (CSA) of the median nerve were measured.The receiver operating characteristic curve of the median nerve ultrasonic measurement results was established,and the area under the curve (AUC) was calculated.The diagnostic efficiency of each index for PTS was compared with the surgical results as a reference. Results The PTS group showed larger LA[(5.02±0.50) mm vs.(3.89±0.41) mm;t=4.38,P=0.013],SA[(2.55±0.46) mm vs.(1.70±0.41) mm;t=5.19,P=0.009],and CSA[(11.13±3.72) mm2 vs.(6.88±2.68) mm2;t=8.42,P=0.008] of the median nerve than the control group.The AUC of CSA,SA,and LA was 94.3% (95%CI=0.912-0.972,Z=3.586,P=0.001),77.7% (95%CI=0.734-0.815,Z=2.855, P=0.006),and 78.8% (95%CI=0.752-0.821,Z=3.091,P=0.004),respectively.With 8.63 mm2 as the cutoff value,the sensitivity and specificity of CSA in diagnosing PTS were 93.3% and 90.0%,respectively. Conclusion High-frequency ultrasound is a practical method for diagnosing PTS,and the CSA of median nerve has a high diagnostic value.