Carpal Tunnel Syndrome: Diagnosis by Means of Median Nerve Elasticity—Improved Diagnostic Accuracy of US with Sonoelastography

Radiology ◽  
2014 ◽  
Vol 270 (2) ◽  
pp. 481-486 ◽  
Author(s):  
Hideaki Miyamoto ◽  
Ethan J. Halpern ◽  
Martin Kastlunger ◽  
Markus Gabl ◽  
Rohit Arora ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

Assessment of median nerve mobility by ultrasound dynamic imaging in carpal tunnel syndrome diagnosis

2013 ◽  
Author(s):  
Tai-Tzung Kuo ◽  
Ming-Ru Lee ◽  
Yin-Yin Liao ◽  
Wei-Ning Lee ◽  
Yen-Wei Hsu ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Dynamic Imaging ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

scholarly journals The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment

2018 ◽  
Vol Volume 13 ◽  
pp. 1953-1962 ◽  
Author(s):  
Reza Salman Roghani ◽  
Seyed Ebrahim Hashemi ◽  
Mohammad Taghi Holisaz ◽  
Faeze Gohari ◽  
Ahmad Delbari ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Elderly Patients ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Sensitivity And Specificity ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Nerve Ultrasonography

scholarly journals Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Heba Refaat Ibrahim
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Shear Wave ◽  
Carpal Tunnel ◽  
Diagnostic Value ◽  
Ultrasound Elastography ◽  
Control Group ◽  
Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is the commonest type of peripheral nerve entrapment syndromes. The study aimed at evaluation of diagnostic value of median nerve stiffness measured by shear wave ultrasound elastography for diagnosis and differentiation of CTS severity, correlated to electrophysiological studies. This case–control study involved 40 patients (56 wrists) with CTS of different severity and 40 controls (40 wrists). All participants underwent electrophysiological study to assess the CTS severity, high-resolution conventional B-mode ultrasound to assess cross-sectional area “CSA” of median nerve at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm, and shear wave ultrasound elastography with measurement of median nerve mean stiffness and correlation to electrophysiological results as the reference standard. Results Mean median nerve stiffness by shear wave US elastography was increased in patients with CTS compared to controls and across the different CTS severity groups (P value < 0.001 & 0.001, respectively). The cutoff value by ROC curve analysis for median nerve stiffness to differentiate between patients with CTS and control group was 65.4 kPa (P value < 0.001, 94.6% sensitivity, 97.3% specificity). Higher diagnostic accuracy was noted with the combination of shear wave elastography and conventional B-mode US with improved AUC (B-mode + shear wave; 0.962, P value < 0.001). Conclusions Shear wave ultrasound elastography of median nerve was able to discriminate different severity subgroups of CTS with high sensitivity, while conventional US couldn’t. The diagnostic accuracy of CTS was improved when combined high-resolution conventional B-mode US and complementary shear wave ultrasound elastography.

Wrist to forearm ratio as a median nerve shear wave elastography test in carpal tunnel syndrome diagnosis

2018 ◽  
Vol 71 (8) ◽  
pp. 1146-1152 ◽  
Author(s):  
Łukasz Paluch ◽  
Piotr Pietruski ◽  
Jerzy Walecki ◽  
Bartłomiej Henryk Noszczyk
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Shear Wave ◽  
Carpal Tunnel ◽  
Shear Wave Elastography ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

scholarly journals Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

2021 ◽  
Author(s):  
Emanuele Spina ◽  
Pietro Emiliano Doneddu ◽  
Giuseppe Liberatore ◽  
Dario Cocito ◽  
Raffaella Fazio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
Tunnel Syndrome ◽  
Median Neuropathy

AbstractCompression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS demyelinating criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). Accordingly, being carpal tunnel syndrome (CTS) common in the general population, the EFNS/PNS guidelines recommend excluding the DML of the median nerve when DML prolongation may be consistent with median neuropathy at the wrist from CTS. The main aims of this study were to verify whether the inclusion of DML of the median nerve (when consistent with CTS) could improve electrophysiological diagnostic accuracy for CIDP and if the median nerve at the carpal tunnel was more prone to demyelination. We analyzed electrophysiological data from 499 patients included consecutively into the Italian CIDP Database. According to the EFNS/PNS criteria, 352 patients had a definite, 10 a probable, and 57 a possible diagnosis of CIDP, while 80 were not fulfilling the diagnostic criteria. The inclusion of DML prolongation of median nerve did not improve significantly the diagnostic accuracy for CIDP; overall diagnostic class changed in 6 out of 499 patients (1.2%) and electrodiagnostic class of CIDP changed from not fulfilling to possible in only 2 patients (2.5% of not-fulfilling patients). In conclusion, we can infer that excluding DML prolongation of median nerve does not increase the risk of missing a diagnosis of CIDP thus corroborating the current EFNS/PNS criteria.

Assessing the Performance of Morphologic and Echogenic Features in Median Nerve Ultrasound for Carpal Tunnel Syndrome Diagnosis

2019 ◽  
Vol 39 (6) ◽  
pp. 1165-1174
Author(s):  
Michal Byra ◽  
Eric Hentzen ◽  
Jiang Du ◽  
Michael Andre ◽  
Eric Y. Chang ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Ultrasound ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

Ultrasonography of the Median Nerve in the Carpal Tunnel Syndrome Diagnosis

2019 ◽  
Author(s):  
Mihaela Pertea ◽  
S. Ursu ◽  
P. Ciobanu ◽  
Oxana Madalina Grosu ◽  
R. Tudor ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Syndrome Diagnosis ◽  
Tunnel Syndrome

scholarly journals POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 525.1-525
Author(s):  
S. Tsiami ◽  
E. Ntasiou ◽  
C. Krogias ◽  
R. Gold ◽  
J. Braun ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

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