Sono-Elastography in evaluation of the median nerve in carpal tunnel syndrome patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Maha Mohamed Abdelraouf ◽  
Amal Ibrahim Ahmed ◽  
Nouran Abdelrahman Elghitany
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Area Under Curve ◽  
University Hospitals ◽  
Electrodiagnostic Testing ◽  
Study Population ◽  
Tunnel Syndrome ◽  
Study Setting

Abstract Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The diagnosis of CTS is based on a combination of characteristic symptoms and electrophysiologic abnormalities. Electrodiagnostic testing (EDT) is uncomfortable for patients, time consuming and expensive. Objective To evaluate the role of greyscale and strain elastography ultrasound imaging in diagnosing patients with CTS and controls in comparison with nerve conductive studies. Patients and Methods Type of Study: Descriptive, prospective study. Study Setting: The study will be conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months. Study Population: Patients with carpal tunnel syndrome diagnosed clinically and underwent nerve conduction velocity study. Results In this study 7 wrists were diagnosed with mild CTS, 5 wrists demonstrated moderate CT, whereas only 3 wrists revealed severe CTS. The mean CSA would have increased if the number of cases with severe CTS had been higher. CSA of the median nerve has been reported to increase with the severity of entrapment. The cut off point of the average CSA to differentiate between cases and controls was found > 8 with sensitivity of 93.33%, specificity of 80% and area under curve (AUC) of 91.3% while the best cut off point for Elasto score was found > 1 with sensitivity of 86.6%, specificity of 80% and area under curve (AUC) of 93.3%. Conclusion We concluded that sonoelastography is a sensitive tool for prediction of CTS and it’s severity in correlation to NCV.

scholarly journals Role of High Resolution Ultrasound in Assessment of Abnormalities of Median Nerve in Carpal Tunnel Syndrome

2020 ◽  
Vol 10 (02) ◽  
pp. 73-88
Author(s):  
Mohamed Farouk Agag ◽  
Moutaz M. Kamal Elsharkawy ◽  
Ahmed Khedewy Ahmed
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Tunnel Syndrome

scholarly journals The Effect Of Tenosynovectomy On Patient Outcome In Carpal Tunnel Syndrome Surgery

2021 ◽  
Author(s):  
Ahmet Levent Aydın ◽  
Melih Üçer
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Large Scale ◽  
Long Term Results ◽  
Vascular Elements ◽  
Tunnel Syndrome ◽  
Subsynovial Connective Tissue

INTRODUCTION: Carpal tunnel syndrome (CTS) is estimated to be the most frequently seen mononeuropathy, needing surgical intervention. Its prevalence is known to range between 1, and 3 percent. The components contained in this tunnel are the median nerve, four deep digital flexor tendons, as well as four superficial flexors and the tendon of flexor pollicis longus. Between the tendons and bursae an anatomical structure is present called subsynovial connective tissue (SSCT). SSCT absorbs and transmits stress between tendons and the median nerve and it functions as a scaffold for vascular elements. To find out the role of compression or pathologic proliferation of SSCT in the pathogenesis of CTS, we aimed to conduct a study about the surgical technique of this pathology and compared the long- term results of patients operated with or without SSCT excision in our neurosurgery clinic. METHODS: Between 2003 and 2019 we operated 1279 patients at our neurosurgery clinic. Among them 250 patients who had SSCT excision (syn+) were chosen and they were compared with other 250 patients operated without SSCT excision (Syn-). RESULTS: All patients were evaluated preoperatively and 12 months postoperatively based on the results of Boston Carpal Tunnel Syndrome Questionnaire. When pre-, and post-operative results were compared, we didn’t observe a statistically significant intergroup difference. DISCUSSION AND CONCLUSION: Although our primary goal in patients in whom we performed excision of tenosynovium is to relieve the median nerve by increasing decompression, we observed that there was no difference between the two groups in this large-scale study. We think that only liberation of the transverse carpal ligament during surgery will be sufficient.

scholarly journals Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome—A Systematic Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2691
Author(s):  
Katarzyna Osiak ◽  
Agata Mazurek ◽  
Przemysław Pękala ◽  
Mateusz Koziej ◽  
Jerzy A. Walocha ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Quantitative Measure ◽  
Electrodiagnostic Testing ◽  
Partial Resolution ◽  
Number Of Patients ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.

scholarly journals Understanding central sensitization for advances in management of carpal tunnel syndrome

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 605
Author(s):  
César Fernández-de-las-peñas ◽  
José L Arias-Buría ◽  
Ricardo Ortega-Santiago ◽  
Ana I De-la-Llave-Rincón
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Central Sensitization ◽  
Current Data ◽  
Carpal Tunnel Surgery ◽  
The Central Nervous System ◽  
Tunnel Syndrome ◽  
Pain Symptoms

Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).

scholarly journals The Role of Multifactorial Contribution in Carpal Tunnel Syndrome Occurrence

2021 ◽  
Vol 6 (2) ◽  
pp. 266-272
Author(s):  
Putu Feryawan Meregawa ◽  
John Nolan
Keyword(s):  
Risk Factor ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Strength Loss ◽  
Peripheral Neuropathies ◽  
Functional Disturbance ◽  
Tunnel Syndrome ◽  
The Common

As one of the common peripheral neuropathies, carpal tunnel syndrome (CTS) is accountable for the majority of typical hand pain and functional disturbance in median nerve innervation. The median nerve compression may cause some uncomfortable sensations including pain, numbness, tingling, and strength loss which also depends on the severity of the condition. Many factors could contribute to CTS occurrence. Several risk factors are thought to be in charge in CTS progressions, such as body mass index (BMI), gender, pregnancy, and biomechanical exposures combination is significantly explained as the major component in suffering CTS. Clinicians need to know the contributing risk factor to benefit the information within the implication for the treatment and reducing symptoms severity. Keywords: carpal tunnel syndrome, risk factor, multifactor.

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study

2020 ◽  
Vol 236 (4) ◽  
pp. 660-667 ◽  
Author(s):  
Carla Stecco ◽  
Federico Giordani ◽  
Chenglei Fan ◽  
Carlo Biz ◽  
Carmelo Pirri ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Ultrasound Study ◽  
Tunnel Syndrome

scholarly journals CARPAL TUNNEL SYNDROME

2012 ◽  
Vol 19 (01) ◽  
pp. 023-027
Author(s):  
MOHAMMAD SUBHAN ◽  
FARIDULLAH SHAH ◽  
Mohammad TARIQ ◽  
Iftekhar Ali Shah ◽  
Najeeb Ul Haq ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Clinical Examination ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Clinical Presentation ◽  
Standard Of Care ◽  
Tunnel Syndrome ◽  
Age Range

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The symptoms of CTS include pain,paraesthesia and hypoesthesia in the hand, in the area innervated by the median nerve, and often occurs or worsens during the night or earlymorning, waking the patient up. Physical examination and nerve conduction studies are used to diagnose this condition. Early diagnosis andtreatment of CTS are important because any delay can cause irreversible median nerve damage. Objective: To highlight the role of physicalexamination and nerve conduction study in the diagnosis of CTS. Setting: Kuwait teaching Hospital Peshawar. Period: June 2008 to June2010. Methods: Fifty patients of carpal tunnel syndrome were studied. All patients who reported numbness and/or tingling in the median nervedistribution in the hands at least twice weekly during the preceding four weeks were enrolled to undergo clinical examination and nerveconduction tests. Following the clinical examination the symptomatic persons underwent bilateral nerve conduction tests. Results: Out of thesetwelve patients were males and thirty eight were females with a ratio of 1:3.1. The age range was between 20 to 60 years. CTS was bilateral in 22patients (44%), right-sided in 23(46%) patients and left-sided in 5(10%) patients. Conclusions: In addition to the clinical presentation,electrophysiology has been proposed as the standard of care for diagnosing CTS with a recommendation that it should be performed in allcases.

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study

2018 ◽  
Vol 22 (4) ◽  
pp. 846-847
Author(s):  
Chenglei Fan ◽  
Caterina Fede ◽  
Federico Giordani ◽  
Nathaly Gaudreault ◽  
Carlo Biz ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Ultrasound Study ◽  
Tunnel Syndrome

Role of Panchakarma in the management of Carpal Tunnel Syndrome - A Review

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Suresh N. Hakkandi ◽  
Dr. Manjunath Akki ◽  
Dr. Snigdha Rani Patra
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Early Diagnosis ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Common Condition ◽  
Long Time ◽  
Tunnel Syndrome ◽  
Brachial Neuralgia ◽  
Over Time

Carpal tunnel syndrome is a common condition that causes pain, numbness and tingling in the hand and arm. The condition occurs when one of the major nerves of the hand, the median nerve is squeezed or compressed as it travels through the wrist. In most patients, carpal tunnel syndrome gets worsen over time, so early diagnosis and treatment are important.[1] If CTS (carpal tunnel syndrome) left untreated, symptoms can last a long time and get worsen. Carpal tunnel syndrome cannot be compared directly to any of the disease in Ayurveda. But to some extend we can compare CTS to Jhinjhini Vata described in Chakradatta.[2] And in later stage when CTS is left untreated the pain and numbness radiates from hand to forearm and arm, at that stage we can compared it with Vishwachi (Brachial neuralgia).[3]

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