Influence of temperature on sonographic images of the median nerve for the diagnosis of carpal tunnel syndrome: a case control study

Abstract Background In addition to nerve conduction studies (NCSs), ultrasonography has been widely used as an alternative tool for diagnosing carpal tunnel syndrome (CTS). Although the results of NCSs are influenced by local skin temperature, few studies have explored the effects of skin temperature on ultrasonography of the median nerve. Since swelling and intraneural blood flow of the median nerve might be influenced by local temperature changes, the aim of this study was to evaluate the cross-sectional area (CSA) and intraneural blood flow of the median nerve under three skin temperatures (30 °C, 32 °C, 34 °C). Methods Fifty patients with CTS and 50 healthy volunteers were consecutively recruited from a community hospital. Each participant received physical examinations and NCSs and underwent ultrasonography, including power Doppler, to evaluate intraneural vascularity. Results The CSA of the median nerve in the CTS patients was significantly larger than that in the healthy controls at all three temperatures. However, significant differences in the power Doppler signals of the median nerve between the two studied groups were observed only at 30 and 32 °C, not at 34 °C. Conclusion The significant difference in the intraneural vascularity of the median nerve between the patients with CTS and the healthy subjects was lost at higher temperatures (34 °C). Therefore, the results of power Doppler ultrasonography in diagnosing CTS should be cautiously interpreted in patients with a high skin temperature or those who reside in warm environments.

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Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912014006008 ◽

2014 ◽

Vol 41 (6) ◽

pp. 426-433 ◽

Cited By ~ 2

Author(s):

Adham do Amaral e Castro ◽

Thelma Larocca Skare ◽

Paulo Afonso Nunes Nassif ◽

Alexandre Kaue Sakuma ◽

Bruno Luiz Ariede ◽

...

Keyword(s):

Bariatric Surgery ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Control Group ◽

Clinical Tests ◽

Ultrasound Evaluation ◽

Significant Difference ◽

Before And After ◽

Tunnel Syndrome

Objective:To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods:We studiedthree groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results:We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work.Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

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Carpal tunnel syndrome: assessment of the need for rehabilitation and recovery treatment after endoscopic decompression of the median nerve in the late and long-term postoperative periods

Neuromuscular Diseases ◽

10.17650/2222-8721-2019-9-4-34-43 ◽

2020 ◽

Vol 9 (4) ◽

pp. 34-43

Author(s):

D. G. Yusupova ◽

A. A. Zimin ◽

D. A. Grishina ◽

N. V. Belova ◽

A. V. Vershinin ◽

...

Keyword(s):

Surgical Treatment ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Controlled Study ◽

Control Group ◽

Clear Understanding ◽

Significant Difference ◽

Tunnel Syndrome

Background. Carpal tunnel syndrome is the most common tunnel neuropathy in which the median nerve is compressed at the level of the wrist in the carpal canal. Treatment of carpal tunnel syndrome can be conservative and surgical. Surgical treatment is indicated in case of ineffective conservative treatment. However, the strategy of managing patients with carpal tunnel syndrome in the postoperative period has not yet been determined; there is no clear understanding of the effectiveness and necessity of rehabilitation in the early and long-term postoperative periods.Aim. Follow-up the patients after decompression of the median nerve in the late (up to 3 weeks after surgery) and long-term (3 weeks after surgery) postoperative periods to assess the effectiveness of different methods of rehabilitation.Materials and methods. A randomized controlled study included 108 cases of idiopathic carpal tunnel syndrome (unilateral and bilateral). After surgery, the patients were divided into three groups: the restorative treatment group using magnetic therapy, the kinesiotherapy group, and the control group. Clinical, neurophysiological and ultrasound monitoring was carried out for six months.Results. Patients of all the groups showed similar improvement in the most of the analyzed parameters, without any significant difference.Conclusion. Thus, according to the results of a comprehensive study, it is evident that early diagnosis of carpal tunnel syndrome and a high-quality surgical decompression of the median nerve with a complete dissection of the flexor retinaculum of the hand guarantee improvement within six months or later after surgical treatment without additional rehabilitation measures.

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Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3010-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Basant Elnady ◽

Elsayed M. Rageh ◽

Tohamy Ekhouly ◽

Sabry M. Fathy ◽

Mohamed Alshaar ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Control Group ◽

Saudi Population ◽

Pronator Quadratus ◽

Severity Grade ◽

Significant Difference ◽

Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population. Methods Sixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitus or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group. High resolution ultrasound (US) was performed to assess median nerve cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd). Results There was a significant difference between both groups regarding mean ± SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with neurophysiologic severity grade of CTS (P = 0.001). A ∆CSA threshold of 2.5 mm2 showed the highest sensitivity and specificity to diagnose CTS in Saudis. Conclusion High resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.

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Effect of exercise on nerve conduction study of Carpal tunnel syndrome patients

Research Journal of Pharmacy and Technology ◽

10.52711/0974-360x.2021.00719 ◽

2021 ◽

pp. 4157-4160

Author(s):

J. K Sahoo ◽

A. G Joshi ◽

K. N Sahoo

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Research Work ◽

Clinical Signs ◽

Common Disease ◽

Exercise Treatment ◽

Significant Difference ◽

Tunnel Syndrome

Background: Carpal tunnel syndrome is the most common entrapment neuropathy of the median nerve at the wrist. In general population CTS is known to be a very common disease and the prevalence of CTS is estimated to be 2.7% as confirmed by clinical and electrophysiological findings. Typical symptoms of CTS are tingling, numbness and parasthesia in thumb, index, middle finger and radial half of ring finger which is often exaggerated at night. Previously research studies have been done on pain control, grip strength, wrist function. Very little research work has been done on effect of exercise on NCS of CTS patients. So the aim of the study is to find the short term (6weeks) effects of exercise on NCS of CTS patients. Methodology: Bilateral sensory and motor nerve conduction studies were carried out in 50 CTS patients before and after 6weeks of exercise. Exercise treatment was given to patients under the guidance of trained physiotherapist. Clinical examination was also done after 6 weeks. RMS machine from Chandigarh was used. Statistical analysis was done by INSTAT- 3.6 software. Result: DML, DML (diff.) DSL, DSL (diff.) showed significant decrease after 6 weeks of exercise in symptomatic (Rt.) hand, but no significant difference was found in SCV, CMAP, SNAP of median nerve. Whereas in Lt. hand only DML (diff.) between median and ulnar nerve showed significant change. There was also improvement in clinical signs and symptoms and pain scale. Conclusion: It was concluded that exercise treatment for 6 weeks under the proper guidance of trained physiotherapist showed significant improvements in clinical as well as electrophysiological parameters in symptomatic hands. So, exercise treatment can be suggested as choice of treatment for CTS patients.

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PENGARUH PENAMBAHAN MOBILISASI SARAF MEDIANUS SETELAH DIBERIKAN ULTRASOUND THERAPY PADA PENURUNAN NILAI NYERI CARPAL TUNNEL SYNDROME

JURNAL MEDICAL P-ISSN : 2685-7960 e-ISSN : 2685-7979 ◽

10.36089/jm.v1i2.12 ◽

2019 ◽

Vol 1 (2) ◽

pp. 7-12

Author(s):

Ruhana F Mujahad

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Wilcoxon Test ◽

Ultrasound Therapy ◽

Test Results ◽

Significant Difference ◽

Post Test ◽

Tunnel Syndrome ◽

Test Result

Carpal tunnel syndrome can result fromexcessive movement in the joints can lead tocarpal synovial joints increases and tapping themedian nerve in the carpal tunnel so that itappears one of the various complaints of pain. Toreduce the pain of carpal tunnel syndrome can begiven additional mobilization of the median nerveafter ultrasound therapy which have beencommonly used in physiotherapy services in manyhospitals. To determine the effect of the mediannerve mobilization after ultrasound therapy todecrease the value of the pain of carpal tunnelsyndrome. This research uses quasi experimentalapproach, research design pre and post test twogroups design. The first group of elderly givenultrasound therapy and the second group wasgiven the mobilization of the median nerve. Thenumber of samples in this study of 12 samples,sample taker technique by purposive samplingtechnique that uses existing population criteria ofinclusion and exclusion. In the study the effect oftest used Wilcoxon test and Mann Whitney testdifferent influences. Wilcoxon test results on themedian nerve mobilization group after the additionof ultrasound therapy asymp values obtained. Sig(2-tailed) = 0.026 indicates the value of p <0.05there is the influence of pain using the VAS valuereduction in carpal tunnel syndrome. From theresults of Mann Whitney test result Sig (2-tailed) =0.183 (Asymp. Sig (2-tailed)> 0.05), which meansthere is no significant difference in both groups, inthe sense that both have effects in lowering painCarpal Tunnel Syndrome. No effect of the mediannerve mobilization after ultrasound therapy todecrease the value of the pain of carpal tunnelsyndrome.

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Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity.

10.21203/rs.2.16396/v2 ◽

2019 ◽

Author(s):

Basant Elnady ◽

Elsayed M Rageh ◽

Tohamy H. Ekhouly ◽

Sabry M. Fathy ◽

Mohamed Alshaar ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Control Group ◽

Pronator Quadratus ◽

Severity Grade ◽

Diagnostic Potential ◽

Significant Difference ◽

Tunnel Syndrome

Abstract BackgroundCarpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population.MethodsSixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitis or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group. High resolution ultrasound (US) was performed to assess median nerve cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd).ResultsThere was a significant difference between both groups regarding mean±SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with neurophysiologic severity grade of CTS (P=0.001). A ∆CSA threshold of 2.5 mm2 showed the highest sensitivity and specificity to diagnose CTS in Saudis. Conclusion High resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.

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Application of digital infrared thermography for carpal tunnel syndrome evaluation

Scientific Reports ◽

10.1038/s41598-021-01381-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dougho Park ◽

Byung Hee Kim ◽

Sang-Eok Lee ◽

Dong Young Kim ◽

Yoon Sik Eom ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Skin Temperature ◽

Median Nerve ◽

Infrared Thermography ◽

Ulnar Nerve ◽

Temperature Difference ◽

Carpal Tunnel ◽

Physiological Changes ◽

Thermal Variation ◽

Tunnel Syndrome

AbstractWe investigated the thermographic findings of carpal tunnel syndrome (CTS). We enrolled 304 hands with electrodiagnostically identified CTS and 88 control hands. CTS hands were assigned to duration groups (D1, < 3 months; D2, 3‒6 months; D3, 6‒12 months; D4, ≥ 12 months) and severity groups (S1, very mild; S2, mild; S3, moderate; S4, severe). The temperature difference between the median and ulnar nerve territories (ΔM-U territories) decreased as CTS duration and severity increased. Significant differences in ΔM-U territories between the D1 and D3, D1 and D4, D2 and D4, and S1 and S4 groups (P = 0.003, 0.001, 0.001, and < 0.001, respectively) were observed. Thermal anisometry increased as CTS duration and severity increased. Significant differences in thermal anisometry between the D1 and D4 as well as the D2 and D4 groups (P = 0.005 and 0.04, respectively) were noted. Thermal anisometry was higher in the S4 group than in the S1, S2, and S3 groups (P = 0.009, < 0.001, and 0.003, respectively). As CTS progresses, skin temperature tends to decrease and thermal variation tends to increase in the median nerve-innervated area. Thermographic findings reflect the physiological changes of the entrapped median nerve.

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Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-202328 ◽

2012 ◽

Vol 72 (12) ◽

pp. 1934-1939 ◽

Cited By ~ 35

Author(s):

Christian Dejaco ◽

Martin Stradner ◽

Dorothea Zauner ◽

Werner Seel ◽

Nicole Elisabeth Simmet ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Intraclass Correlation ◽

Power Doppler ◽

Ultrasound Measurement ◽

Anatomical Landmarks ◽

Doppler Signals ◽

Diagnostic Values ◽

Tunnel Syndrome

ObjectiveTo compare ultrasound measurement of median nerve cross-sectional area (CSA) at different anatomical landmarks and to assess the value of power Doppler signals within the median nerve for diagnosis of carpal tunnel syndrome (CTS).MethodsA prospective study of 135 consecutive patients with suspected CTS undergoing two visits within 3 months. A final diagnosis of CTS was established by clinical and electrophysiological findings. CSA was sonographically measured at five different levels at forearm and wrist; and CSA wrist to forearm ratios or differences were calculated. Intraneural power Doppler signals were semiquantitatively graded. Diagnostic values of different ultrasound methods were compared by receiver operating characteristic curves using SPSS.ResultsCTS was diagnosed in 111 (45.5%) wrists; 84 (34.4%) had no CTS and 49 (20.1%) were possible CTS cases. Diagnostic values were comparable for all sonographic methods to determine median nerve swelling, with area under the curves ranging from 0.75 to 0.85. Thresholds of 9.8 and 13.8 mm2 for the largest CSA of the median nerve yielded a sensitivity of 92% and a specificity of 92%. A power Doppler score of 2 or greater had a specificity of 90% for the diagnosis of CTS. Sonographic median nerve volumetry revealed a good reliability with an intraclass correlation coefficient of 0.90 (95% CI 0.79 to 0.95).ConclusionsSonographic assessment of median nerve swelling and vascularity allows for a reliable diagnosis of CTS. Determination of CSA at its maximal shape offers an easily reproducible tool for CTS classification in daily clinical practice.

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Sensory Function after Median Nerve Decompression in Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80356-7 ◽

1997 ◽

Vol 22 (5) ◽

pp. 602-606 ◽

Cited By ~ 18

Author(s):

B. ROSÉN ◽

G. LUNDBORG ◽

S. O. ABRAHAMSSON ◽

L. HAGBERG ◽

I. ROSÉN

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Sensory Function ◽

Significant Difference ◽

Sensory Recovery ◽

Tunnel Syndrome ◽

Median Nerve Decompression ◽

Normal Nerve Conduction

The sensory recovery was monitored for up to 1 year after decompression of the median nerve in 69 patients with carpal tunnel syndrome. Special attention was paid to the rate of recovery, the importance of constant or intermittent numbness or paraesthesiae preoperatively and the influence of gender. Most patients with numbness/paraesthesiae and those with abnormal two-point discrimination recovered within 10 days. Perception of touch and vibration recovered within 3 weeks in most patients but those with abnormal nerve conduction/sensory amplitude recovered slowly during follow-up. After 1 year patients with intermittent preoperative symptoms were significantly more likely to achieve normal nerve conduction and perception of touch. Women were more likely to achieve normal nerve conduction and perception of touch. A comparison of recovery between matched men and women with identical preoperative status showed no significant difference. The results indicate the importance of early treatment of carpal tunnel syndrome.

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Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

Scientific Reports ◽

10.1038/s41598-020-72757-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hyunseok Moon ◽

Byung Joo Lee ◽

Donghwi Park

Keyword(s):

Carpal Tunnel Syndrome ◽

Aspect Ratio ◽

Median Nerve ◽

Carpal Tunnel ◽

Steroid Injection ◽

Nerve Compression ◽

Median Nerve Compression ◽

Significant Difference ◽

Before And After ◽

Tunnel Syndrome

Abstract There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.

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