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

2019 ◽  
Vol 20 (1) ◽  
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.

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

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 ◽  
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 mm 2 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 mm 2 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.

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

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 ◽  
Saudi Population ◽  
Pronator Quadratus ◽  
Severity Grade ◽  
Significant Difference ◽  
Tunnel Syndrome

Abstract 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 mm 2 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 mm 2 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.

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

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.

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

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 ◽  
Saudi Population ◽  
Pronator Quadratus ◽  
Diagnostic Potential ◽  
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 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 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 the severity neurophysiological CTS (P=0.001). A ∆CSA threshold of 2.5 mm 2 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 mm 2 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.

scholarly journals Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

2014 ◽  
Vol 41 (6) ◽  
pp. 426-433 ◽  
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.

scholarly journals 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

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.

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.

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

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome

2020 ◽  
Vol 22 (5) ◽  
pp. 313-322
Author(s):  
Filip Georgiew ◽  
Andrzej Maciejczak ◽  
Jakub Florek ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Conduction Disturbances ◽  
Tunnel Syndrome ◽  
Sensory Fibers ◽  
American Academy Of Neurology

Background. Nerve compression underlying carpal tunnel syndrome (CTS) results in an increase in the threshold of superficial sensation in the area supplied by the median nerve, which is a mixed nerve dominated by sensory fibres. The distribution of sensory symptoms is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment at wrist level is still unclear. Patho­logical processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients. Material and methods. The study involved 88 patients (104 hands), with 70 women (83 hands) and 18 men (21 hands) aged between 25 and 77 years. 50 age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. The diagnosis of carpal tunnel syndrome was made according to the criteria of the American Academy of Neurology 1993 guidelines. Based on the results of an ENG trace evaluating the degree of conduction disturbances in the median nerve, the patients were classified to one of three severity subgroups. The threshold of sensory excitability to pulsed current was determined in a test with single 100 ms rectangular pulses. Conclusions. 1. The threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly lon­ger in patients with CTS than in controls. 2. Surgical treatment decreases the threshold of sensation in the fingers innervated by the median nerve. 3. Surgical treatment does not decrease the threshold of sensation in the fingers innervated by the ul­nar nerve. 4. The preoperative and postoperative threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly longer in patients with severe carpal tunnel than in mild and moderate cases.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Wei Chang ◽  
Chii-Jen Chen ◽  
You-Wei Wang ◽  
Valeria Chiu ◽  
Shinn-Kuang Lin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carpal Tunnel Syndrome ◽  
Skin Temperature ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Power Doppler ◽  
Power Doppler Ultrasonography ◽  
Local Skin ◽  
Significant Difference ◽  
Tunnel Syndrome

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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