Median Nerve In Patients Research Articles

Effectiveness of the scapula mobilization technique on the neural mechanosensitivity of the upper limb neural test 1 in individuals with mechanical cervicalgia. A randomized controlled trial

Objectiveto observe whether the mobilization of the scapula improves the mechanosensitivity of the median nerve in patients with cervicalgia. Localized cervical pain caused by compression of a nerve root without presenting irradiated features along the nerve path is diagnosed as cervicalgia. Muscles around the scapula can be directly responsible of this compression. Methods60 adults diagnosed with cervicalgia and with a positive upper limb neural test 1(ULNT1) were recruited. Participants in the experimental group received a scapula mobilization technique. Participants in the control group, with electrodes on both sides of the neck and connected to turned off analgesic current device, received an abduction-adduction mobilization of the calcaneus in the lower limb contralateral to the painful area. The variables measured were pain, goniometry of elbow extension in movement for the median neurodynamic test (ULNT1) and hand grip strength. ResultsResults showed that the increase in strength (p = 0.01) and elbow extension movement (p = 0.01) and the decrease in pain (p < 0.01) from the intervention group showed significant changes compared to the changes from control group. ConclusionScapula mobilization technique in subjects presenting with cervicalgia and a positive ULNT1 significantly appears to help improve the neural mechanosensitivity of the median nerve and pain.

Comparison of median nerve area measurement between MRI and electromyography in patients diagnosed with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that occurs when the median nerve is compressed within the carpal tunnel. Electromyography (EMG) is accepted as the most frequently used and important diagnostic method for CTS. Recently, magnetic resonance imaging (MRI) has begun to be used in CTS patients to directly visualize the median nerve and examine the changes occurring in the nerve structure. In this study, the area of the median nerve was measured at various levels in the wrist in patients with CTS using MRI, examining its relationship with signal increase, and comparing this to results obtained with EMG. Overall, 35 patients diagnosed with CTS were included in the study. Patients with normal-mild and moderate-severe EMG tests were included in the study; wrist MRI was taken to investigate the area/mm2 of the median nerve at various levels and whether there was an increase in signal. Thenar muscles included in the imaging were also evaluated. Of the 35 patients included in the study, 24 were women (68.6%) and 11 were men (31.4%). Measurements of the average median nerve area measured in mm2 at the distal radioulnar junction (DRUJ) and the median nerve area measured in mm2 at the hamate bone level were obtained, showing that DRUJ and hamate bone distance measurements were higher in patients with positive EMG. Electromyography findings were also significantly positive in patients with increased signal. In some cases, the diagnosis of CTS can be easily made with history and physical examination or employing confirmatory tests such as EMG, which is considered the gold standard. Magnetic resonsnace imaging can be used as an alternative method for imaging the median nerve in patients with CTS. In our study, EMG findings were also significantly positive in patients with increased signal on MRI, making it a preferable method, especially in soft tissue-related pathological cases.

MRI Neurography Using DTI and Tractography as a Quantitative Tool in the Assessment of Median Nerve in Patients with Carpal Tunnel Syndrome

MRI Neurography Using DTI and Tractography as a Quantitative Tool in the Assessment of Median Nerve in Patients with Carpal Tunnel Syndrome

Automated segmentation of the median nerve in patients with carpal tunnel syndrome

Machine learning and deep learning are novel methods which are revolutionizing medical imaging. In our study we trained an algorithm with a U-Net shaped network to recognize ultrasound images of the median nerve in the complete distal half of the forearm and to measure the cross-sectional area at the inlet of the carpal tunnel. Images of 25 patient hands with carpal tunnel syndrome (CTS) and 26 healthy controls were recorded on a video loop covering 15 cm of the distal forearm and 2355 images were manually segmented. We found an average Dice score of 0.76 between manual and automated segmentation of the median nerve in its complete course, while the measurement of the cross-sectional area at the carpal tunnel inlet resulted in a 10.9% difference between manually and automated measurements. We regard this technology as a suitable device for verifying the diagnosis of CTS.

Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy

BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.

Changes in Ultrasound Parameters of the Median Nerve at Different Positions of the Radiocarpal Joint in Patients with Carpal Tunnel Syndrome.

Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position.

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.

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.

Manipulative treatment of carpal tunnel syndrome: Biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament.

To quantify the amount of transverse carpal ligament (TCL) elongation in response to osteopathic manipulation or sustained load bearing (or both), a study involving seven cadaver limbs was conducted. Distances from the trapezium to the hamate (distance A) and from the scaphoid to the pisiform (distance B) were measured in five mounted cadaver limbs during and after the limbs bore the weight (2 newtons [N] to 4 N) for 2 several-hour periods. A several-hour period occurred between the weight bearing to assess recoil. Distances A and B were measured before and after the limbs were manipulated, according to previously described techniques, as well as with a new maneuver, termed the "guy-wire" technique. Two dissected limbs also were subjected to further weight bearing, this time increased to 8 N. Greater weight loads produced greater lengthening of the TCL, and recoil after removal of weight loads was slower than recoil after manipulation. Manipulation was more effective than weight loading for increasing distance A (distal canal), but weight loading generally was more effective than manipulation for increasing distance B (proximal canal). The guy-wire manipulation combined with direct transverse extension appeared to have the greatest impact on lengthening the TCL distally. These results show promise for the effective use of manipulation and load bearing for TCL elongation and nonsurgical relief of pressure on the median nerve in patients with carpal tunnel syndrome.

Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release.

Background: This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). Methods: We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Results: Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, p < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, p < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, p < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, p < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, p < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm2, p < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm2, p = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, p < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, p < 0.01). Conclusions: Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level of Evidence: Level III (Therapeutic).

MRI of wrist and diffusion tensor imaging of the median nerve in patients with carpal tunnel syndrome.

Diagnosis of carpal tunnel syndrome (CTS) is based on the clinical symptoms and nerve conduction study. Magnetic resonance imaging (MRI) is non-invasive objective tool for assessing the median nerve and carpal tunnel. The purpose of this study was to evaluate MRI changes in patients with CTS, and compare them with healthy subjects. Forty-three CTS patients and 43 age matched control were included and scanned in a 3T MRI scanner. Cross-sectional areas (CSA) of median nerve were measured at the level of distal radio-ulnar joint level (CSA1), proximal row of carpal bone (CSA2), and hook of hamate (CSA3). Flattening ratio (FR) of median nerve, thickness of flexor retinaculum, median nerve signal intensity, and thenar muscles were assessed. Fractional anisotropy (FA), average diffusion coefficient (ADC), and radial diffusivity (RD) of median nerve of CTS patients were obtained from diffusion tensor imaging (DTI) and compared with those of controls. Thirty-three patients (76.7%) were female. Mean duration of the pain was 7.4 ± 2.6 months. The mean CSA1 (13.2 ± 4.2 mm2), CSA2 (12.5 ± 3.5 mm2), and CSA3 (9.2 ± 1.5 mm2) in CTS patients were significantly higher compared to control group: CSA1 (10.15 ± 1.64 mm2), CSA2 (9.38 ± 1.37 mm2), and CSA3 (8.4 ± 0.9 mm2), (P = 0.001 in all). The mean FR of median nerve and thickness of flexor retinaculum were increased in CTS patients. The mean FA was reduced in CTS patients compared to control proximal to carpal tunnel and within the tunnel. Mean ADC and RD values were higher in CTS patients as compared to control for both levels. MRI can detect subtle changes in the median nerve and thenar muscles in CTS and may be useful in equivocal cases and to exclude secondary causes of CTS. DTI shows reduced FA and increased ADC and RD in CTS patients.

Diabetes Increases Median Nerve Cross-Sectional Area but Not Disease Severity in Patients with Carpal Tunnel Syndrome

BackgroundUltrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS. MethodsPatients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy. ResultsNinety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA. ConclusionDiabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes. Level of EvidenceLevel 3 Diagnostic.

Diagnostic value of diffusion-weighted MRI using apparent diffusion coefficient (ADC) in evaluation of median nerve in carpal tunnel syndrome

BackgroundThe diagnosis of carpal tunnel syndrome is based on a combination of clinical history, clinical examination and frequent use of electrodiagnostics as nerve conduction study and electromyography which often do not provide the spatial and anatomical localizing information, especially with small nerves of the extremities. Conventional magnetic resonance imaging can reveal morphological changes in carpal tunnel syndrome patients.AimThe purpose of our study was to assess the efficacy of diffusion magnetic resonance imaging as a functional imaging in evaluation of median nerve in carpal tunnel syndrome.Patients and methodsThis prospective study included a group of 33 patients with carpal tunnel syndrome diagnosed by both clinical examination and electromyography; 40 writs were examined. A control group of 20 subjects of matched age group were also included. All the participants were subjected to conventional and diffusion magnetic resonance imaging studies.ResultsMedian nerve apparent diffusion coefficient values of patients are lower than those of controls. The sensitivity and diagnostic accuracy of diffusion conventional magnetic resonance imaging were 95% and 97.5%, respectively, versus 25% and 62.5% of conventional magnetic resonance imaging. A cut-off apparent diffusion coefficient value ≤ 0.99 obtained at distal radio-ulnar joint level and > 1.07 at pisiform level as well as apparent diffusion coefficient ratio at a cut-off ≤ 0.2 was significantly valid for diagnosing carpal tunnel syndrome.ConclusionsDiffusion magnetic resonance imaging provides functional evaluation of median nerve in patients with carpal tunnel syndrome.

Role of High-resolution Ultrasonography in the Evaluation of the Tibial and Median Nerves in Diabetic Peripheral Neuropathy.

To evaluate and measure the mean cross-sectional area of the tibial and median nerves in patients with diabetic peripheral neuropathy, and to study the association between high-resolution ultrasonographic findings in diabetic peripheral neuropathy with the duration of illness, glycosylated haemoglobin values, random blood sugar levels, and aesthesiometry (using monofilament examination). A prospective observational study was conducted among 63 patients who were diagnosed with type 2 diabetes mellitus and underwent ultrasound and monofilament examinations. The cross-sectional area of the median nerve of the dominant hand and the tibial nerves was calculated on ultrasound examination. The mean cross-sectional area of the median and tibial nerves was higher in patients with poor glycaemic control, with the mean cross-sectional area of the median nerve being 10.9, 12.8, 13.0, and 12.9 mm2 at various points in the leg in cases where the monofilament examination was negative, as compared to 7.30, 7.78, 7.91, 7.87 mm2 in patients with positive monofilament examination results. There was a significant positive correlation between the cross-sectional area of the tibial and median nerves and HbA1c, duration of diabetes, aesthesiometry, and random blood sugar levels. With an increase in HbA1c, duration of diabetes, and random blood sugar levels, there was a corresponding increase in the cross-sectional area of the nerves. These findings helped us to identify diabetic peripheral neuropathy. High-resolution ultrasonography along with aesthesiometry and HbA1c values can be an effective and easily available tool for detecting changes secondary to diabetic peripheral neuropathy. The method has a potential to replace or substitute nerve conduction tests in the near future.

Use of diffusion tensor imaging as a prognostic biomarker after decompression surgery for carpal tunnel syndrome.

Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction. To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery. Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters. Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; P = 0.0172) and 1.01 points (-0.13 to 1.88; P = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation (P = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; P = 0.0312]) and postoperative (motor latencies [rho = -0.7488; P = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; P = 0.0280) ​​and lower postoperative proximal ADC values (rho = -0.9047; P = 0.0020). Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.

Association Between A-Waves and Outcome in Pediatric Guillain-Barré Syndrome.

IntroductionTo examine the importance of abundant A-waves in electrophysiological classification and prognosis of pediatric Guillain-Barré Syndrome (GBS).MethodsA single-center and retrospective study enrolling 65 children-patients, aged 16 years and younger, with clinically diagnosed GBS between 2013 to 2020. Hughes grade was used to assess functional disability at nadir, 1 month, and 6 months after symptom onset. Patients were divided into 2 groups according to the presence of abundant A-waves. Clinical features and prognosis between the 2 groups were compared.ResultsThe distal motor latency of the median nerve in patients with GBS with A-waves (9.18 ms) was more prolonged than that of patients with GBS without A-waves (4.1 ms). An electrophysiological variant of these two groups was also statistically different (p = 0.006). The short-term prognosis of patients with AIDP with A-waves was worse than patients with AIDP without A-waves (χ2 = 5.022, p = 0.025), and univariable logistic regression analysis showed statistically significant (OR: 5.844, 95% CI 1.118–30.553; p = 0.036).ConclusionA-waves were strongly associated with demyelination and poor short-term prognosis of AIDP in children. We proposed an electrophysiological marker for early prediction of outcome in the AIDP subtype of GBS, applicable for clinical practice and future treatment administration.

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1.

Background The upper limb neurodynamic test 1 (ULNT1) consists of a series of movements that are thought to detect an increase in neuromechanical sensitivity. In vivo, no trail was made to quantify the association between the nerve elasticity and different limb postures during ULNT1. Objectives (1) To investigate the relationship between nerve elasticity and limb postures during ULNT1 and (2) to investigate the intra- and interoperator reliabilities of shear wave elastography (SWE) in quantifying the elasticity of median nerve. Methods Twenty healthy subjects (mean age: 19.9 ± 1.4 years old) participated in this study. The median nerve was imaged during elbow extension in the following postures: (1) with neutral posture, (2) with wrist extension (WE), (3) with contralateral cervical flexion (CCF), and (4) with both WE and CCF. The intra- and interoperator reliabilities measured by two operators at NP and CCF+WE and intraclass correlation coefficients (ICCs) were calculated. Results The intraoperator (ICC = 0.72–0.75) and interoperator (ICC = 0.89–0.94) reliabilities for measuring the elasticity of the median nerve ranged from good to excellent. The mean shear modulus of the median nerve increased by 53.68% from NP to WE+CCF. Conclusion SWE is a reliable tool to quantify the elasticity of the median nerve. There was acute modulation in the elasticity of the median nerve during the ULNT1 when healthy participants reported substantial discomfort. Further studies need to focus on the elasticity properties of the median nerve in patients with peripheral neuropathic pain.

The additional diagnostic value of motor nerve excitability testing in chronic axonal neuropathy

ObjectiveTo explore potential differences in motor nerve excitability testing (NET) variables at group levels between patients with a clinical diagnosis of polyneuropathy (PNP), which did not fulfil diagnostic criteria of conventional nerve conduction studies (NCS) and patients without polyneuropathy. Such differences could support a role for NET in increasing the diagnostic sensitivity of NCS in chronic axonal PNP. MethodsMotor NET was performed using the median nerve in patients with a clinical suspicion of PNP in addition to conventional NCS, skin biopsies, corneal confocal microscopy and structured clinical evaluation including scoring of neuropathy symptoms and signs. ResultsOf the 57 patients included, 32 had PNP, half of which had NCS, which fulfilled criteria for PNP (NCS+ PNP). There were no significant differences for any of the NET variables between PNP patients with non-diagnostic conventional NCS (NCS− PNP) and patients without PNP. Rheobase was increased, and Ted (undershoot) and subexcitability were decreased in NCS+ PNP. Sural amplitude, peroneal nerve F-wave latency and tibial nerve F-wave-latency were correlated with subexcitability, and tibial nerve motor amplitude was correlated with rheobase. ConclusionsNET was correlated with conventional NCS and no differences were found between NCS− PNP patients and patients without PNP. SignificanceNET does not seem to offer any additional diagnostic value in chronic mixed etiology neuropathy.

Excursion of the median nerve in patients with and without cervical radiculopathy during a contra-lateral cervical lateral glide movement

Purpose: A segmental contra-lateral cervical lateral glide (CCLG) mobilization technique is effective for patients with cervical radiculopathy (CR). The CCLG technique induces median nerve sliding in healthy individuals, but this has not been assessed in patients with CR. This study aimed: 1)to assess longitudinal excursion of the median nerve (using ultrasound imaging) in patients with CR and asymptomatic subjects during a CCLG movement, 2)to reassess nerve excursions at 3-month follow-up in patients with CR following an intervention and 3)to correlate change in nerve excursion with changes in clinical signs and symptoms.

Evaluation of Restricted Motion Area of the Median Nerve in Patients with Carpal Tunnel Syndrome: A New Measurement Method Using an Ultrasonographic Video Image.

Background: The precise etiology of carpal tunnel syndrome (CTS) remains unclear. One of the accepted factors for CTS is the restriction of the median nerve. Previous reports using ultrasound had only observed and measured the movement of parts of the median nerve. In this study, we aimed to elucidate the difference in the movement of the entire median nerve in patients with CTS (before and after surgery) and healthy volunteers using a new measurement method. Methods: We expressed the amount of movement of the entire nerve by a new method creating the motion area of the median nerve (MAMn) from an ultrasonographic video image on the computer. We compared the MAMn, the real MAMn (RMMn) (the value obtained by subtracting the nerve cross-sectional area from the MAMn), and mobile ratio (MR) (the value obtained from dividing the MAMn by the nerve cross-sectional area) between six wrists of six cases of CTS (before and at an average of 3.5 months after surgery) and six wrists of six healthy volunteers. Results: During passive wrist flexion, the average MAMn, RMMn, and MR of healthy cases were 23.1 mm2, 16.4 mm2, and 3.52, respectively. The average MAMn, RMMn, and MR of cases of CTS were respectively 11.8 mm2, 5.4 mm2, and 1.86 preoperatively; and 16.2 mm2, 7.3 mm2, and 1.87, postoperatively. The MAMn, RMMn, and MR decreased more significantly in patients with CTS than in healthy volunteers (p < 0.01). The MAMn and RMMn increased postoperatively (p < 0.05), but the MR remained low. Conclusions: The new measurement method revealed that the mobility of the entire median nerve was significantly restricted in cases of CTS compared to healthy participants. However, after surgery, nerve restriction was not restored despite improvements in symptoms, suggesting that decreases in nerve mobility contribute to CTS but are not a direct cause of symptoms.