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

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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/v4 ◽

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.

Download Full-text

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/v3 ◽

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.

Download Full-text

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/v1 ◽

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.

Download Full-text

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

Open Journal of Medical Imaging ◽

10.4236/ojmi.2020.102007 ◽

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

Download Full-text

The diagnostic accuracy of high-resolution ultrasound in screening for carpal tunnel syndrome and grading its severity is moderated by age

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.12.005 ◽

2019 ◽

Vol 130 (3) ◽

pp. 321-330 ◽

Cited By ~ 5

Author(s):

Christos Moschovos ◽

Georgios Tsivgoulis ◽

Andreas Kyrozis ◽

Apostolia Ghika ◽

Persefoni Karachalia ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Diagnostic Accuracy ◽

Carpal Tunnel ◽

Tunnel Syndrome

Download Full-text

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.4214 ◽

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.

Download Full-text